Lorazepam 1mg Tablets

• Opioids (e.g., fentanyl, oxycodone, hydrocodone): Increased risk of profound sedation, respiratory depression, coma, and death.
• Other CNS depressants (e.g., alcohol, barbiturates, other benzodiazepines, tricyclic antidepressants, antihistamines, muscle relaxants): Additive CNS depression.
• Sodium oxybate: Increased CNS depression.

• Valproate: May increase lorazepam plasma concentrations and enhance its effects; consider dose reduction of lorazepam.
• Probenecid: May increase lorazepam plasma concentrations and prolong its effects; consider dose reduction of lorazepam.
• Scopolamine: Increased incidence of sedation, hallucinations, and irrational behavior.
• Clozapine: Increased risk of sedation, hypotension, respiratory depression, and rarely, respiratory arrest.

• Oral contraceptives: May slightly decrease lorazepam clearance, but generally not clinically significant.
• Theophylline/Aminophylline: May antagonize the sedative effects of lorazepam.

• Excessive sedation
• Dizziness
• Ataxia
• Confusion
• Memory impairment
• Respiratory depression
• Paradoxical excitation (agitation, aggression)
• Signs of withdrawal (rebound anxiety, insomnia, tremors, seizures, hallucinations) upon discontinuation

Lorazepam is classified as Pregnancy Category D, indicating positive evidence of human fetal risk. Use during pregnancy should only be considered if the potential benefit justifies the potential risk to the fetus.

Lorazepam is excreted into breast milk. The American Academy of Pediatrics considers it to be a drug for which the effect on the nursing infant is unknown but may be of concern. Monitor infants for sedation, poor feeding, and weight gain.

Use with caution, especially in younger children, due to potential for paradoxical excitation and increased sensitivity to CNS depressant effects. Dosing for anxiety/insomnia is not well-established; primarily used for acute seizure management. Closely monitor for respiratory depression and sedation.

Elderly patients are more sensitive to the effects of benzodiazepines and may experience increased sedation, dizziness, ataxia, and cognitive impairment, increasing the risk of falls. Initiate with lower doses (e.g., 0.5-1 mg/day) and titrate slowly. Monitor closely for adverse effects.

• Lorazepam has a relatively short half-life compared to some other benzodiazepines, making it suitable for acute anxiety or insomnia, but also increasing the risk of rebound anxiety or withdrawal symptoms if discontinued abruptly.
• Unlike many other benzodiazepines, lorazepam is metabolized primarily by glucuronidation, which is less affected by liver disease or concomitant medications that inhibit CYP450 enzymes, making it a preferred benzodiazepine in patients with liver impairment.
• IV lorazepam is a first-line agent for status epilepticus due to its rapid onset of action.
• Due to the risk of dependence and withdrawal, lorazepam should generally be prescribed for short-term use (2-4 weeks) for anxiety or insomnia.
• Patients should be educated on the risks of concomitant use with opioids and alcohol, and the importance of gradual tapering when discontinuing.

• Other benzodiazepines (e.g., alprazolam, diazepam, clonazepam) for anxiety/insomnia/seizures.
• SSRIs/SNRIs (e.g., escitalopram, sertraline, venlafaxine) for long-term anxiety/panic disorder.
• Buspirone for generalized anxiety disorder (non-sedating).
• Z-drugs (e.g., zolpidem, eszopiclone) for insomnia.
• Antidepressants (e.g., mirtazapine, trazodone) for insomnia.
• Anticonvulsants (e.g., levetiracetam, phenytoin) for seizure management.
• Beta-blockers (e.g., propranolol) for situational anxiety (e.g., performance anxiety).
• Cognitive Behavioral Therapy (CBT) for anxiety and insomnia.