Lorazepam oral
- Drugs List
- Therapeutic Indications
- Dosage
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Oral formulations of lorazepam.
Drugs List
Therapeutic Indications
Uses
Anxiety disorders: short term management
Insomnia (short-term treatment)
Premedication - sedative
Unlicensed Uses
Nausea and vomiting following cancer chemotherapy or irradiation
Dosage
Treatment duration should not exceed four weeks including a tapering off period. Use beyond four weeks should not take place without re-evaluation of the patients need for continued therapy.
Adults
Moderate to severe anxiety
1mg to 4mg daily in divided doses.
For orodispersible tablets the maximum daily dose is 7.5mg.
Insomnia
1mg to 2mg before retiring.
For orodispersible tablets the maximum daily dose is 7.5mg.
Premedication before surgery
2mg to 3mg the night before the operation, and then 2mg to 4mg one to two hours before surgery.
Elderly
Initially use half the normal adult dose and adjust according to individual patient response.
Children
Premedication Before Surgery
Children aged 12 to 18 years
1mg to 4mg at least 1 hour before surgery.
The same dose may be administered the night before in addition to or to replace the dose before surgery.
Children aged 5 to 13 years
Tablets are unlicensed for use in children under 5 years.
50 micrograms/kg to a maximum of 2.5mg at least 1 hour before surgery.
The following dosing schedule may also be suitable:
Children aged 1 month to 12 years
Tablets are unlicensed for use in children under 5 years.
50 micrograms/kg to 100 micrograms/kg at least 1 hour before surgery. The same dose may be administered the night before in addition to or to replace the dose before surgery. Maximum of 4mg per dose.
Lorazepam is not recommended for the treatment of anxiety or insomnia in children.
Contraindications
Acute pulmonary disease
Breastfeeding
History of alcohol abuse
History of drug misuse
Myasthenia gravis
Obsessional states
Pregnancy
Respiratory depression
Severe hepatic impairment
Sleep apnoea
Precautions and Warnings
Children under 18 years
Debilitation
Elderly
Females of childbearing potential
Suicidal ideation
Acute narrow angle glaucoma
Depression
Galactosaemia
Glucose-galactose malabsorption syndrome
Hypotension
Lactose intolerance
Mild hepatic impairment
Personality disorder
Renal impairment
Reduce dose in patients with hepatic impairment
Reduce dose in patients with renal impairment
Advise impaired alertness may affect ability to drive or operate machinery
Advise patient not to drive until they know how the medicine affects them
Advise patient this medicine is subject to driving restrictions
For use only under medical supervision
Not suitable as sole treatment of depression or anxiety with depression
Oral solution contains alcohol
Some formulations contain lactose
Evaluate treatment efficacy regularly
Monitor haematological parameters periodically
Potential for drug abuse
Tolerance and dependence may occur
Amnesia may occur
Psychological adjustment may be impaired in loss or bereavement
Avoid abrupt withdrawal
Discontinue if paradoxical reactions occur
Limit prescribing quantity due to suicide risk
Maintain treatment at the lowest effective dose
Not licensed for all indications in all age groups
Reduce dose in elderly
Avoid repeated or prolonged use
Not recommended for use longer than 4 weeks
Only recommended for short term use
Advise patient to avoid alcohol during treatment
Advise that effects are potentiated by CNS depressants (including alcohol)
Advise patient to avoid grapefruit products
Female: Ensure adequate contraception during treatment
Advise patient of increased risk of falls
Advise patient on possible rebound phenomena on withdrawal
Patients treated for insomnia due to anxiety, should ensure they have a period of uninterrupted sleep (7 to 8 hours).
Pregnancy and Lactation
Pregnancy
Lorazepam is contraindicated during pregnancy.
The manufacturers do not recommend using lorazepam during pregnancy, particularly during the first and last trimester.
Women of childbearing potential should contact their physician regarding the continued use of lorazepam if she is or wishes to become pregnant.
At the time of writing, infants born to mothers taking lorazepam during the later stages of pregnancy may develop physical dependence or withdrawal symptoms during the postnatal period. Symptoms like hypoactivity, hypotonia, hypothermia, respiratory depression, apnea, feeding problems and impaired metabolic response to cold stress have been reported.
Lactation
Lorazepam is contraindicated during breastfeeding.
The manufacturers do not recommend the use of lorazepam during breastfeeding due to the risk of sedation and inability to suckle in neonates of lactating mothers.
Effects on Ability to Drive and Operate Machinery
This class of medicine is in the list of drugs included in regulations under 5a of the Road Traffic Act 1988 (England and Wales). This medicine may be subject to police testing and has specified maximum blood levels for driving.
When prescribing this medicine: Advise patient the medicine can affect cognitive function and is likely to affect ability to drive. Advise patient not to drive until they know how the medicine affects them.
It is an offence to drive while under the influence of this medicine. However, a patient is not committing an offence (called 'statutory defence') if: 1. The medicine has been prescribed to treat a medical or dental problem and 2. The medicine has been taken according to the instructions given by the prescriber and/or in the information provided with the medicine, and 3. The medicine was not affecting the ability to drive safely. For further guidance see https://www.gov.uk
Side Effects
Aggression
Agitation
Agranulocytosis
Allergic dermatitis
Altered liver function tests
Anaphylactoid reaction
Anaphylaxis
Anterograde amnesia
Apnoea
Asthenia
Ataxia
Behavioural disturbances
Blurred vision
Changes in libido
Coma
Confusion
Constipation
Daytime sedation
Delusions
Dependence
Depression
Diplopia
Disinhibition
Disturbances of appetite
Dizziness
Drowsiness
Dysarthria
Euphoria
Exacerbation of obstructive pulmonary disease
Extrapyramidal effects
Fatigue
Hallucinations
Headache
Hypersensitivity reactions
Hyponatraemia
Hypotension
Hypothermia
Impaired memory
Impotence
Inappropriate secretion of antidiuretic hormone
Insomnia
Irritability
Leucopenia
Muscle weakness
Nausea
Nightmares
Numbed emotions
Orgasmic dysfunction
Pancytopenia
Paradoxical reactions
Pre-existing depression may be unmasked
Psychosis
Rages
Rash
Reduced alertness
Respiratory depression
Restlessness
Salivation changes
Sedation
Sleep apnoea
Sleep disturbances
Slurred speech
Suicidal tendencies
Thrombocytopenia
Tremor
Visual disturbances
Withdrawal symptoms
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Further Information
Last Full Review Date: April 2020
Reference Sources
Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.
Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.
Summary of Product Characteristics: Lorazepam 0.5mg tablets. Advanz Pharma. Revised April 2019.
Summary of Product Characteristics: Lorazepam 1mg/ml Oral Solution. Thame Laboratories. Revised November 2016.
Summary of Product Characteristics: Lorazepam 1mg tablets. Genus Pharmaceuticals. Revised October 2019.
Summary of Product Characteristics: Lorazepam 1mg orodispersible tablets. Aristo Pharma GmbH. Revised March 2019.
Summary of Product Characteristics: Lorazepam 2.5mg orodispersible tablets. Aristo Pharma GmbH. Revised March 2019.
Gov.uk. Government departments. Department for Transport. Publications. Drug driving and medicine: advice for healthcare professionals. Drug driving: Guidance for healthcare professionals on drug driving. Available at: https://www.gov.uk Last accessed: 12 June 2019
NICE Evidence Services Available at: www.nice.org.uk Last accessed: 15 April 2021
Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
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