Lorazepam: what it is for, dosage and side effects

Lorazepam is a benzodiazepine. It is used as a sedative and as a fast-acting anxiolytic.. It is a high potency medicine. It is used to treat anxiety disorders and symptoms related to it. It can also have a positive effect on insomnia. In addition, it has a specific prescription for seizures.

How does it act?

This medication acts on the central nervous system to produce sedative effects and muscle relaxation. Its mechanism of action is related to neuron receptors which are specialized to interact with a natural substance: gamma-aminobutyric acid (GABA). This is explained in a publication from 2022.

GABA is an inhibitory neurotransmitter that regulates neuronal excitability in the brain. When released naturally, the electrical activity of neurons is reduced, which has a calming effect.

Lorazepam, as well as other benzodiazepines, bind to GABA receptors so that the neurotransmitter has greater affinity and acts with greater power. The final effect will be a greater entry of chloride ions into the cells, which will result in relaxation.

Therefore, lorazepam will increase neuronal inhibition and will result in:

Sedation: with relaxation and drowsiness. Reduction of anxiety. Anticonvulsant effects. Muscle relaxation.

Forms of presentation

Lorazepam is sold in different presentations. Some are more common, such as tablets, but there are also vials for intravenous or intramuscular application, as described StatPearls. Although the latter are usually for hospital or clinical purchase, some patients (with epilepsy, for example), are indicated to have ampoules in their possession for quick application, if they are prone to seizures that could put their life at risk.

Common commercial presentations of the drug are the following:

Tablets: in different doses, generally graduated in milligrams (mg). They are an oral form of administration.Oral solution: It is liquid. Useful for people who have difficulty swallowing tablets or who require specific doses.Blisters: for emergency medical situations or when quick action is needed.

The United States Food and Drug Administration (FDA) requires that lorazepam be marketed with a prominent warning or box warning in its packaging. These are serious warnings issued by the organization to warn users about serious risks with the drug, which are not only sued for this benzodiazepine, but for many others, as reviewed in a publication by TOAlcoholism & Drug Abuse Weekly.

With lorazepam, he box warning refers to the possibility of addiction and misuse. In addition, a warning is also given about combining it with opioids. All of these situations increase the risk of fatal side effects in users.

What is lorazepam indicated for?

This medicine is used for various problems. It will always be a doctor who makes the prescription, since it is not available over the counter and the dosage must be adjusted carefully to avoid adverse effects. Specifically, the general indications for lorazepam are those that we will address below:

Anxiety disorders

The initial dose is usually 2 mg to 3 mg orally and may be repeated 2 to 3 times a day. The maximum dose is 10 mg per day. Short term use is preferred. This is because its effectiveness may decrease over time and the risk of dependence increases.

For the long-term treatment of anxiety disorders, other medications, such as antidepressants, are usually preferred, since there are doubts about the damage that lorazepam could cause as a side effect, according to a 2013 report.

Insomnia

In patients under 65 years of age, a dose of 0.5 to 2 mg at bedtime is recommended. On the other hand, in people over 65 years of age, the suggested dose is 0.5 to 1 mg at bedtime. The sedative and muscle relaxing effect could help you fall asleepespecially in occasional insomnia related to stress.

Ideally, it should be used when other non-pharmacological approaches have failed, such as sleep hygiene or cognitive behavioral therapy. According to a study, lorazepam could improve the quality of life of those who suffer from insomnia.

Psychogenic catatonia

Catatonia is a rare but serious neuropsychiatric disorder characterized by a series of abnormal motor symptoms, such as immobility, awkward postures, muscle rigidity, mutism, and refusal to eat or drink.

It can be caused by schizophrenia or bipolar disorder. In these cases, the drug is administered intravenously or intramuscularly for faster action. The dose is 1 mg to 2 mg, and can be repeated in 3 hours, then again in another 3 hours.

Agitation in the intensive care unit (ICU) patient

The intravenous dose for agitation is 0.02 to 0.04 mg/kg body weight (maximum single dose of 2 mg). To maintain it, a dose of 0.02 to 0.06 mg/kg every 2 to 6 hours is recommended.

status epilepticus

Lorazepam is a fast-acting antiepileptic. For these cases, it is administered intravenously in a medical setting. Patients receiving it should be monitored closely to evaluate response.

Alcohol withdrawal delirium

Alcohol withdrawal delirium, also known as delirium tremensis a potentially serious complication that can occur in people who have been using alcohol chronically and then abruptly stop. It is characterized by confusion, agitation, hallucinations, tachycardia, high blood pressure, and, in some cases, seizures..

Lorazepam and other benzodiazepines are used for their sedative and anxiolytic properties. Intravenously, a dose of 1 to 4 mg every 5 to 15 minutes is recommended until the patient is calm. Can be repeated every hour as needed. For an intramuscular dose, a dose of 1 to 4 mg every 30 to 60 minutes is suggested until the person calms down.

Lorazepam Side Effects

The side effects of this drug can be classified as frequent and common, and as serious, as indicated by the National Health Services of Great Britain. This does not mean that the former should be underestimated by any means, but they differ from the latter group in the consequences they can entail, as we will clarify below.

The most frequent adverse reactions are the following:

Feeling sleepy or drowsy. For this reason, taking the drug is not compatible with activities that require attention, such as driving or operating heavy machinery.Dizziness and balance problems or coordination of body movements.

It may also happen that other adverse effects of lorazepam appear, less frequent, but not very rare:

Skin allergy. Headache. Reduced sexual desire. Fatigue and general body weakness. Problems memorizing new information or feelings of confusion and disorientation.

These side effects tend to disappear after a few weeks of use. They are much more frequent at the beginning of the prescription. In any case, their persistence should lead to a consultation with the doctor.

Serious or severe adverse reactions

These secondary reactions to lorazepam are not reported very frequently, but their occurrence can be life-threatening. Therefore, in several countries, the drug must be marketed with conspicuous warnings on its packaging. The following are serious adverse reactions that require emergency consultation:

Respiratory insufficiency. Above all, a reduction in the frequency and rhythm of breathing, with the possibility of complete suspension of the act of breathing.Hypotension. Its presence can lead to fainting and consequences resulting from it.Addiction: Continued use for many weeks and the use of doses higher than those recommended can generate dependence and abuse of the drug. This addiction will manifest itself with its classic signs and could lead to withdrawal syndrome if the intake is abruptly stopped. Abuse is more likely in those who also have problematic alcohol or opioid use. In the case of opiates, the problem is greater and the risk increases, because the combination is capable of leading to death.Seizures: They were reported of different types, including specific movements of a limb or seizures similar to epileptics, with involvement of large muscle masses.Suicidal ideation: Lorazepam has been discussed as a treatment for people diagnosed with depression. Different clinical reports have revealed that users could have a greater tendency to attempt suicide. In any case, statistics reveal that suicide attempts with this medication have a lower mortality rate than those made with antidepressants, for example.

For all these reasons, the use of lorazepam cannot be done without professional follow-up. The correct doses, the appropriate time of use and withdrawal of the drug, as well as the possibility of a quick consultation if problems are detected, are essential.

When to see a doctor?

Lorazepam is a medication that can only be prescribed by a qualified professional.. Do not self-medicate, especially with a drug that can have such powerful side effects.. If you are taking it, stay at the prescribed dose, unless your doctor tells you to.

It is very important that you properly monitor your progress at regular visits to see if the drug is working or if changes need to be made to the dosage. Discuss with the professional the total duration of the treatment and the plan that will be implemented for withdrawal, when the time comes. It is possible to start other complementary measures some time before withdrawal, to reduce the risk of withdrawal.

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