Lorazepam is a benzodiazepine sedative and tranquilizer primarily acting on the central nervous system. This medication enhances the neurotransmitter gamma-aminobutyric acid (GABA), producing anxiolytic, sedative, and muscle-relaxant effects. Clinically, it is mainly used to treat acute anxiety disorders, control epileptic seizures, preoperative sedation, and manage alcohol withdrawal symptoms.
Its onset of action is rapid, and it has a relatively long duration of effect. Compared to other benzodiazepines, it undergoes less first-pass metabolism in the liver, resulting in an oral bioavailability of up to 90%, allowing for more stable therapeutic effects. This characteristic makes it particularly common in emergency medicine and situations requiring rapid symptom relief.
Lorazepam’s generic name is lorazepam. Major brand names include:
Available formulations include oral liquids, tablets, and intravenous injections, each suitable for different treatment scenarios. Patients should verify the active ingredient on the medication label to avoid confusion with drugs of similar names.
Lorazepam is classified as a benzodiazepine sedative-hypnotic. This class of drugs has multiple mechanisms of action, including anxiolytic, sleep-inducing, muscle-relaxing, and anticonvulsant effects. Its chemical structure contains a 7-nitro substituent, which confers a longer half-life and less susceptibility to hepatic enzyme metabolism, making it suitable for treatments requiring stable blood concentrations.
Compared to other benzodiazepines, lorazepam has a higher affinity for GABA receptors. Therefore, it is often the first choice in emergencies such as status epilepticus or alcohol withdrawal tremors. Its pharmacological properties also make it a common preoperative sedative option.
1. Relief of acute anxiety symptoms, especially in reactions triggered by psychological or physiological stress
2. Control of epileptic seizures, including emergency treatment of status epilepticus
3. Sedative premedication before surgery or diagnostic procedures
4. Management of alcohol withdrawal symptoms, particularly severe symptoms such as tremors and delirium
Additionally, it may be used in clinical settings to treat certain types of insomnia, but long-term use may lead to tolerance. When used for epilepsy, it is typically a short-term adjunctive medication, used alongside primary anticonvulsant drugs.
Mild Side Effects include dizziness (occurring in about 30% of patients), drowsiness, decreased coordination, and memory impairment (especially at higher doses). Some patients may experience dry mouth, constipation, or muscle soreness.
Serious Side Effects include respiratory depression (especially when combined with other sedatives), excessive sedation leading to confusion, agitation or aggressive behavior (particularly in elderly patients), urinary retention, and hypotension. Immediate medical attention should be sought if experiencing difficulty breathing, speech disturbances, or inability to stay awake.
Contraindications: Allergic to benzodiazepines, patients with myasthenia gravis, or severe respiratory impairment. Use during pregnancy may cause neonatal respiratory depression or withdrawal symptoms; pregnant and breastfeeding women should strictly follow medical advice.
Special caution should be taken when combined with SSRIs, as they may prolong drug effects. Consult a physician before using herbal supplements such as valerian root or passionflower, as they may enhance sedative effects. During treatment, avoid driving or operating machinery.
Oral doses typically start at 0.5-1 mg, 2-3 times daily, with a maximum daily dose of 6 mg. Intravenous injections should be administered under medical supervision, with adult doses generally 0.05-0.1 mg/kg body weight. Higher doses may be required for status epilepticus but must follow strict medical guidance.
Tablets should be swallowed whole, not chewed or crushed. Oral suspensions should be shaken well before use. Elderly or patients with hepatic impairment should start at half the usual dose. Short-term use (no more than 2-4 weeks) is typical for anxiety treatment; long-term use requires regular assessment of dependency risk.
If a dose is missed, take it as soon as remembered and adjust the next dose timing accordingly. If close to the next scheduled dose, skip the missed dose and continue as planned. Do not double doses to make up for missed ones. If multiple doses are missed and symptoms rebound, contact a physician to adjust the medication plan.
If the patient stops medication on their own for more than 72 hours, a gradual tapering may be necessary to avoid withdrawal symptoms. Patients with chronic anxiety should establish a fixed medication schedule, possibly using alarms or pill organizers for reminders.
1. Maintain airway patency; if the patient stops breathing, perform CPR immediately
2. For conscious patients, induce vomiting if appropriate; do not attempt if unconscious
3. Seek medical attention immediately and bring the medication container for assessment
Experts may use flumazenil as an antidote, but caution is needed as it may trigger seizures or withdrawal reactions. Continuous monitoring of vital signs is essential, and severe cases may require ventilatory support or plasma exchange.
What should I do if I forget to take lorazepam?
If you miss a dose and it is more than 4 hours until the next scheduled dose, take the missed dose immediately. If it is close to the next dose, skip the missed dose and continue with your regular schedule. Do not take double doses to compensate for missed ones. Setting reminders on your pill box or phone can help prevent missed doses.
Can I drink alcohol while taking lorazepam?
Absolutely not. Combining alcohol with lorazepam can enhance sedation, leading to severe drowsiness, respiratory depression, or impaired consciousness. Even small amounts of alcohol can increase the risk of falls or accidents. Strictly avoid alcohol during treatment.
Does long-term use of lorazepam lead to tolerance?
Long-term use may lead to drug tolerance, reducing the effectiveness of the original dose. Physicians will adjust doses or treatment strategies based on response; do not alter doses yourself. Regular follow-up every 3-6 months is recommended to monitor efficacy and adaptation.
What irreversible physiological changes can lorazepam cause?
Short-term use usually does not cause permanent damage, but long-term use may impair cognitive function or muscle coordination, especially in the elderly. If memory problems or slowed movements occur, seek medical evaluation promptly.
Can I fly or operate machinery while taking lorazepam?
Due to side effects like drowsiness and impaired concentration, avoid operating vehicles or machinery during medication. It is recommended to take the medication before sleep and avoid high-focus activities during peak effect (2-4 hours after dosing).
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