Lorazepam

 

Class
Benzodiazepine, sedative-hypnotic, anticonvulsant

Description
Lorazepam is frequently used to treat anxiety and stress. In emergency care, it is used to treat alcohol withdrawal and grand mal seizure activity. Benzodiazepines act on the limbic, thalamic, and hypothalamic regions of the CNS to potentiate the effects of inhibitory neurotransmitters, raising the seizure threshold in the motor cortex. It may also be used in conscious patients during cardioversion to induce amnesia and sedation. Though the drug is still widely used as an anticonvulsant, it is relatively weak and of shorter duration than diazepam. Rapid IV administration may be followed by respiratory depression and excessive sedation.

Onset & Duration
Onset: (IV) 1-5 min. (IM) 1-5 min.
Duration: (IV) 15 min-1 hr (IM) 15 min-1 hr

Indications
1. Status epilepticus
2. Acute anxiety states
3. Acute alcohol withdrawal
4. Preoperative sedation

Contraindications
1. Hypersensitivity to the drug
2. Acute narrow angle glaucoma
3. Open angle glaucoma
4. Hypotension
5. Head injury
6. CNS depression
7. Respiratory depression

Adverse Reactions
1. Hypotension
2. Reflex tachycardia
3. Respiratory depression
4. Ataxia
5. Psychomotor impairment
6. Confusion
7. Nausea
8. Vomiting

Drug Interactions
1. Lorazepam may precipitate CNS depression and psychomotor impairment when the patient is taking CNS depressant medications.
2. Should not be administered with other drugs because of possible precipitation (incompatible with most fluids; should be administered into an IV of normal saline solution).

Special Considerations
1. Pregnancy safety: Category D
2. Must be diluted 1:1 with normal saline prior to IV administration, and given not more than 2 mg/minute
3. Has short duration of anticonvulsant effect
4. Reduce dose by 50% in elderly patients
5. Resuscitation equipment should be readily available, monitor respirations carefully
6. Antidote: Flumazenil (Ramazicon)
7. Refrigerate at 36-46°F

 

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