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LORAZEPAM is a brand name for Lorazepam. The medicine, its uses, side effects and dosage are the same regardless of brand.
Used for: FOR SHORT TERM (2-4 weeks only) USE (adults only) • Symptomatic relief of anxiety that is severe, disabling or subjecting the individual to unacceptable distress occurring alone or in association with insomnia or short-term psychometric, organic or psychotic illness. AS PREMEDICATION (adults and children 5 years and…
Verbatim from this product's MHRA label. Tap a section to expand.
4). Treatment should be given for the shortest possible duration. Treatment to be given: • Under close medical supervision • At the lowest effective dose Doses should be individualised. 4). When treatment is started the patient should be informed that • treatment will be of limited duration • the dosage will be progressively decreased • there is a possibility of rebound phenomena Posology: Adults: Anxiety: 1-4 mg daily in divided doses.
Insomnia: 1-2 mg before retiring Premedication before operative dentistry or general surgery: 2-3 mg the night before operation 2-4 mg one to two hours before the procedure Elderly and debilitated patients: For elderly and debilitated patients reduce the initial dose by approximately 50% and adjust the dosage as needed and tolerated (see section
Adverse reactions, when they occur, are usually observed at the beginning of therapy and generally decrease in severity or disappear with continued use or upon decreasing the dose. Most frequently reported adverse reactions associated with benzodiazepines include daytime drowsiness, dizziness, muscle weakness, and ataxia.
Adverse reactions are listed by frequency:
Very common (≥1/10); Common (≥1/100 to <1/10); Uncommon (≥1/1,000 to <1/100); Rare (≥1/10,000 to <1/1,000); Veryrare (<1/10,000); not known (cannot be estimated from the available data).
Blood and lymphatic system disorders Very rare:
Thrombocytopenia, leucopenia, agranulocytosis, pancytopenia Immune system disorders Very rare: Hypersensitivity including anaphylaxis/anaphylactoid reactions Endocrine disorders Very rare: Inappropriate antidiuretic hormone secretion, hyponatraemia Psychiatric disorders Rare: Confusion, depression and unmasking of depression, numbed emotions, disinhibition, euphoria, appetite changes, sleep disturbance, change in libido, decreased orgasm.
4), Suicidal ideation/attempt Paradoxical reactions such as restlessness, agitation, irritability, aggressiveness, delusion, rage, insomnia, nightmares, hallucinations, psychoses, sexual arousal, and inappropriate behaviour have been occasionally reported during use.
Nervous system disorders Very common:
Daytime drowsiness, sedation Common: Dizziness, ataxia Rare: headache, reduced alertness, dysarthria/slurred speech, transient anterograde amnesia or memory impairment.
Very rare:
Tremor, extrapyramidal reactions, Coma (see
). 5mg according to weight, not less than one hour before operation. 4). Use in patients with severe hepatic insufficiency is contraindicated. 6). Method of administration Lorazepam is for oral use. g. with half to one glass of water). 4 Special warnings and precautions for use Patients should be advised that since their tolerance for alcohol and other CNS depressants will be diminished in the presence of lorazepam, these substances should either be avoided or taken in reduced dosage.
Lorazepam is not intended for the primary treatment of psychotic illness or depressive disorders, and should not be used alone to treat depressed patients. The use of benzodiazepines may have a disinhibiting effect and may release suicidal tendencies in depressed patients.
Therefore, large quantities of lorazepam should not be prescribed to these patients. Pre-existing depression may emerge during benzodiazepine use. Drug dependence, tolerance and potential for abuse Drug addiction comprises behavioural, cognitive and physiological phenomena that may include a strong desire to take the drug, difficulties in controlling drug use and possible tolerance or physical dependence.
Physical dependence is a state that develops as a result of physiological adaptation in response to repeated drug use, which manifests as withdrawal signs and symptoms after abrupt discontinuation or a significant dose reduction of a drug.
Addiction and dependence are related but distinct presentations and in discussing these themes, terminology that apportion blame to the individual should be avoided. For all patients, prolonged use of this product may lead to drug dependence and addiction but can occur with short-term use at recommended therapeutic doses.
, major depression). Additional support and monitoring may be necessary when prescribing for patients at risk of drug misuse. A comprehensive patient history should be taken to document concomitant medications, including over-the-counter medicines and medicines obtained on-line, and past and present medical and psychiatric conditions.
6) • Myasthenia gravis; Benzodiazepines should not be used alone in depression or anxiety with depression (may precipitate suicide)
Not medical advice. Always read the patient information leaflet and follow your prescriber or pharmacist.
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Patients may find that treatment is less effective with chronic use and express a need to increase the dose to obtain the same level of symptom control as initially experienced. Patients may also supplement their treatment with additional medications to achieve the same effect.
These could be signs that the patient is developing tolerance. The risks of developing tolerance should be explained to the patient. Overuse or misuse may result in overdose and/or death. It is important that patients only use medicines that are prescribed for them at the dose they have been prescribed and do not give this medicine to anyone else.
Patients should be closely monitored for signs of misuse, abuse, or addiction. The clinical need for treatment with Lorazepam should be reviewed regularly, with frequent assessments of patients being undertaken during the course of their treatment.
Drug withdrawal syndrome Prior to starting treatment with Lorazepam, a discussion should be held with patients to explain the risk of dependence, addiction, and drug withdrawal syndrome. A withdrawal strategy for ending treatment with Lorazepam should also be put in place with the patient before starting treatment (there may be exceptions to this in specific clinical situations such as symptom management in end of life palliative care).
Drug withdrawal syndrome may occur upon abrupt cessation of therapy or dose reduction. When a patient no longer requires therapy, it is advisable to taper the dose gradually to minimise symptoms of withdrawal. Tapering from a high dose may take in excess of weeks or months.
Patients should be informed of this when the medication is first prescribed. The reduction schedule for a patient should be tailored to the individual and should be modified to allow intolerable withdrawal symptoms to improve before making the next reduction.
If using a published withdrawal schedule, apply it flexibly to accommodate the person’s preferences, changes to their circumstances and the response to dose reductions. Suggest a slow stepwise rate of reduction proportionate to the existing dose, so that decrements become smaller as the dose is lowered, unless clinical risk is such that rapid withdrawal is needed.
If a patient develops withdrawal reactions, consider pausing the taper or increasing the dosage to the previous tapered dosage level. If women take this drug during pregnancy, there is a risk that their newborn infants will experience neonatal withdrawal syndrome.
Abuse of benzodiazepines has been reported. Some loss of efficacy to the hypnotic effects of short-acting benzodiazepines may develop after repeated use for a few weeks. Anxiety or insomnia may be a symptom of several other disorders.
The possibility should be considered that the complaint may be related to an underlying physical or psychiatric disorder for which there is more specific treatment. Caution should be used in the treatment of […]