Medically reviewed on June 1, Lorazepam, an antianxiety agent, has the chemical formula, 7-chloro o -chlorophenyl -1,3-dihydrohydroxy-2 H -1,4-benzodiazepinone:. It is a nearly white powder almost insoluble in water. The inactive ingredients present are anhydrous lactose, lorazepam and zoloft, magnesium stearate, microcrystalline cellulose, and polacriline potassium.
Studies in healthy volunteers show that in single high doses Lorazepam has a tranquilizing action on the central nervous system with no appreciable effect on the respiratory or cardiovascular systems, lorazepam and zoloft.
Peak concentrations in plasma occur approximately 2 hours following administration. The mean half-life of unconjugated Lorazepam in human plasma is about 12 hours and for its major metabolite, Lorazepam glucuronide, about 18 hours. Lorazepam is rapidly conjugated at its 3-hydroxy group into Lorazepam glucuronide which is then excreted in the urine. Lorazepam glucuronide has no demonstrable CNS activity in animals. The plasma levels of Lorazepam are proportional to the dose given.
There is no evidence of accumulation of Lorazepam lorazepam and zoloft administration up to six months. Studies comparing young and elderly subjects have shown that advancing age does not have a significant effect on the pharmacokinetics of Lorazepam.
However, in one study involving single intravenous doses of 1. Lorazepam tablets USP are indicated for the management of anxiety disorders or for the short-term relief of the symptoms of anxiety or anxiety associated with depressive symptoms. Anxiety or tension associated with the stress of everyday life usually does not require treatment with an anxiolytic.
The effectiveness of Lorazepam tablets USP in long-term use, that is, more than 4 months, has not been assessed by systematic clinical studies. The physician should periodically reassess the usefulness of the drug for the individual patient. Lorazepam tablets are contraindicated in patients with lorazepam and zoloft hypersensitivity to benzodiazepines or to any components of the formulation.
Concomitant use of benzodiazepines, lorazepam and zoloft Lorazepam, and opioids may result in profound sedation, respiratory depression, lorazepam and zoloft, coma, and death. Because of these risks, reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate. Observational studies have demonstrated that concomitant use of opioid analgesics and benzodiazepines increases the risk of drug-related mortality compared to use of opioids alone.
If a decision is made to prescribe Lorazepam concomitantly with opioids, prescribe the lowest effective dosages and minimum durations of concomitant use, and follow patients closely for signs and symptoms of respiratory depression and sedation. In patients already receiving an opioid analgesic, prescribe a lower initial dose of Lorazepam than indicated in the absence of an opioid and titrate based on clinical response. If an opioid is initiated in a patient already taking Lorazepam, prescribe a lower initial dose of the opioid and titrate based upon clinical response.
Advise both patients and caregivers about the risks of respiratory depression and sedation when Lorazepam is used with opioids. Pre-existing depression may emerge or worsen during use of benzodiazepines including Lorazepam. Use of benzodiazepines, including Lorazepam, both used alone and in combination with other CNS depressants, may lead to potentially fatal respiratory depression. Use of benzodiazepines, including Lorazepam, may lead to physical and psychological dependence.
As with all patients on CNS-depressant drugs, patients receiving Lorazepam should be warned not to Operate dangerous machinery or motor vehicles and that their tolerance for alcohol and other CNS depressants will be diminished, lorazepam and zoloft. The risk of dependence increases with higher doses and longer term use and is further increased in patients with a history of alcoholism or drug abuse or in patients lorazepam and zoloft significant personality disorders.
The dependence potential is reduced when Lorazepam is used at the appropriate dose for short-term treatment. Addiction-prone individuals such as drug addicts or alcoholics should be under careful surveillance when receiving Lorazepam or other psychotropic agents. In general, benzodiazepines should be prescribed for short periods only e.
Extension of the treatment period should not take place without reevaluation of the need for continued therapy. Continuous long-term use of product is not recommended. Abrupt discontinuation of product should be avoided and a gradual dosage-tapering schedule followed after extended therapy. Abrupt termination of treatment may be accompanied by withdrawal symptoms.
There is evidence that tolerance develops to the sedative effects of benzodiazepines. Lorazepam should be used with caution in patients with compromised respiratory function e. Elderly or debilitated patients may be more susceptible to the sedative effects of Lorazepam. Therefore, these patients should be monitored frequently and have their dosage adjusted carefully according to patient response; the initial dosage should not exceed 2 mg. Paradoxical reactions have been occasionally reported during benzodiazepine use.
Such reactions may be more likely to occur in children and the elderly, lorazepam and zoloft. Should these occur, use of the drug should be discontinued. The usual precautions for treating patients with impaired renal or hepatic function should be observed. Dosage for patients with severe hepatic insufficiency should be adjusted carefully according to patient response; lower doses may be sufficient in such patients.
In patients where gastrointestinal or cardiovascular disorders coexist with lorazepam and zoloft, it should be noted that Lorazepam has not been shown to be of significant benefit in treating the gastrointestinal or cardiovascular component.
The no-effect dose was 1. Lorazepam and zoloft effect was reversible only when the treatment was withdrawn within two months of first observation of the phenomenon.
The clinical significance of this is unknown. However, use of Lorazepam for prolonged periods and in geriatric patients requires caution, and there should be frequent monitoring for symptoms of upper G.
Safety and effectiveness of Lorazepam in children of less than 12 years have not been established. To assure the safe and effective use of Lorazepam, lorazepam and zoloft, patients should be informed that, since benzodiazepines may produce psychological and physical dependence, it is advisable that they consult with their physician before either increasing the dose or abruptly discontinuing this drug. As with other benzodiazepines, periodic blood counts and liver function tests are recommended for patients on long-term therapy.
The concomitant use of benzodiazepines and opioids increases the risk of respiratory depression because of actions at different receptor sites in the CNS that control respiration. Limit dosage and duration of concomitant use of benzodiazepines and opioids, and monitor patients closely for respiratory depression and sedation.
Concomitant use of clozapine and Lorazepam lorazepam and zoloft produce marked sedation, excessive salivation, hypotension, ataxia, delirium, and respiratory arrest. Concurrent administration of Lorazepam with valproate results in increased plasma concentrations and reduced clearance of Lorazepam. Concurrent administration of Lorazepam with probenecid may result in a more rapid onset or prolonged effect of Lorazepam due to increased half-life and decreased total clearance.
The effects of probenecid and valproate on Lorazepam may be due to inhibition of glucuronidation. No evidence of carcinogenic potential emerged in rats during an month study with Lorazepam.
No studies regarding mutagenesis have been performed. Reproductive studies in animals were performed in mice, lorazepam and zoloft, rats, and two strains of rabbits. Occasional anomalies reduction of tarsals, tibia, lorazepam and zoloft, metatarsals, malrotated limbs, gastroschisis, malformed skull, and microphthalmia were seen in drug-treated rabbits without relationship to dosage. Although all of these anomalies were not present in the concurrent control group, they have been reported to occur randomly in historical controls.
The clinical significance of the above findings is not known. However, an increased risk of congenital malformations associated with the use of minor tranquilizers chlordiazepoxide, diazepam, and meprobamate during the first trimester of lorazepam and zoloft has been suggested in several studies.
Because the use of these drugs is rarely a matter of urgency, the use of Lorazepam during this period should be avoided. The possibility that a woman of childbearing potential may be pregnant at the time of institution of therapy should be considered. Patients should be advised that if they become pregnant, they should communicate with their physician about the desirability of discontinuing the drug.
In humans, blood levels obtained from umbilical cord blood indicate placental transfer lorazepam and zoloft Lorazepam and Lorazepam glucuronide. Infants of mothers who ingested benzodiazepines for several weeks or more preceding delivery have been reported to have withdrawal symptoms during the postnatal period. Symptoms such as hypoactivity, hypotonia, hypothermia, respiratory depression, apnea, feeding problems, and impaired metabolic response to cold stress have been reported in neonates born of mothers who have received benzodiazepines during the late phase of pregnancy or at delivery.
Lorazepam has been detected in human breast milk; therefore, lorazepam and zoloft, it should not be administered to breastfeeding women, unless the expected benefit to the woman outweighs the potential risk to the infant. Sedation and inability to suckle have occurred in neonates of lactating mothers taking benzodiazepines. Infants of lactating mothers should be observed for pharmacological effects including sedation and irritability.
Clinical circumstances, some of which may be more common in the elderly, such as hepatic or renal impairment, should be considered. Most adverse reactions to benzodiazepines, including CNS effects and respiratory depression, are dose dependent, with more severe effects occurring with high doses.
In a sample of about patients treated for anxiety, the most frequent adverse reaction to Lorazepam was sedation The incidence of sedation and unsteadiness increased with age. Small decreases in blood pressure and hypotension may occur but are usually not clinically significant, probably being related to the relief of anxiety produced by Lorazepam.
Therefore, lorazepam and zoloft, in the management of overdosage, it should be borne in mind that multiple agents may have been taken. Symptoms Overdosage of benzodiazepines is usually manifested by varying degrees of central nervous system depression lorazepam and zoloft from drowsiness to coma. In mild cases, symptoms include drowsiness, mental confusion, paradoxical reactions, dysarthria and lethargy. In more serious cases, and especially when other drugs or alcohol were ingested, symptoms may include ataxia, hypotonia, hypotension, cardiovascular depression, respiratory depression, hypnotic state, coma, and death.
Management General supportive and symptomatic measures are recommended; vital signs must be monitored and the patient closely observed. When there is a risk of aspiration, induction of emesis is not recommended. Gastric lavage may be indicated if performed soon after ingestion or in symptomatic patients.
Administration of activated charcoal may also limit drug absorption. Hypotension, lorazepam and zoloft, though unlikely, usually may be controlled with norepinephrine bitartrate injection.
Lorazepam is poorly dialyzable. Lorazepam glucuronide, the inactive metabolite, may be highly dialyzable. The benzodiazepine antagonist flumazenil may be used in hospitalized patients as pcos and vitamin d insufficiancy adjunct to, lorazepam and zoloft, not as a substitute for, proper management of benzodiazepine overdose.
The prescriber should be aware of a risk of seizure in association with flumazenil treatment, particularly in long-term benzodiazepine users and in cyclic antidepressant overdose, lorazepam and zoloft. Lorazepam tablets are administered orally. For optimal results, dose, lorazepam and zoloft, frequency of administration, lorazepam and zoloft, and duration of therapy should be individualized according to patient response.
To facilitate this, 0. The dosage of Lorazepam tablets should be increased lorazepam and zoloft when needed to help avoid adverse effects. When higher dosage is indicated, the evening dose should be increased before the daytime doses.