Lorazepam 2mg/ml Drops 30ml

• Opioids (e.g., fentanyl, oxycodone, hydrocodone): Concomitant use increases the risk of profound sedation, respiratory depression, coma, and death. Reserve for use in patients for whom alternative treatment options are inadequate.
• Other CNS depressants (e.g., alcohol, barbiturates, other benzodiazepines, sedating antihistamines, tricyclic antidepressants, muscle relaxants): Additive CNS depressant effects, increased risk of sedation and respiratory depression.
• Clozapine: Increased risk of severe sedation, respiratory depression, and hypotension.

• Valproate: May increase lorazepam plasma concentrations and enhance its effects by inhibiting glucuronidation. Reduce lorazepam dose by approximately 50% if co-administered.
• Probenecid: May increase lorazepam plasma concentrations and prolong its half-life by inhibiting glucuronidation. Reduce lorazepam dose by approximately 50% if co-administered.
• Scopolamine: Increased incidence of sedation, hallucinations, and irrational behavior.

• Oral contraceptives: May slightly decrease lorazepam clearance, but generally not clinically significant.

• Excessive drowsiness
• Dizziness
• Ataxia (loss of coordination)
• Slurred speech
• Confusion
• Memory impairment
• Respiratory depression (slow, shallow breathing)
• Paradoxical reactions (e.g., agitation, aggression, hallucinations)
• Signs of withdrawal upon discontinuation (e.g., rebound anxiety, insomnia, irritability, tremors, seizures)

Category D. Lorazepam can cause fetal harm when administered to a pregnant woman. There is evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks (e.g., in life-threatening situations or for a serious disease for which safer drugs cannot be used or are ineffective).

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 breastfed infants for sedation, poor feeding, and poor weight gain.

Use with caution. Safety and effectiveness in pediatric patients (<18 years) have not been established for oral solution. Off-label use for anxiety or insomnia should be carefully considered due to potential for paradoxical reactions, respiratory depression, and long-term developmental effects. Dosing must be individualized and closely monitored.

Elderly patients are more sensitive to the effects of benzodiazepines and may be at increased risk for adverse effects, including sedation, dizziness, ataxia, and falls. Start with lower doses (e.g., 0.5-1 mg/day initially) and titrate slowly. Monitor closely for CNS depression and cognitive impairment. Renal and hepatic impairment are more common in the elderly, requiring further dose adjustments.

• Lorazepam has a relatively short-to-intermediate half-life compared to some other benzodiazepines, making it useful for acute anxiety, insomnia, and status epilepticus (IV formulation).
• Unlike many other benzodiazepines, lorazepam is metabolized primarily by glucuronidation, which is less affected by CYP450 enzyme inhibitors/inducers, making it a preferred benzodiazepine in patients with liver disease (though dose adjustment is still needed in severe impairment) or those on medications that significantly interact with CYP450 enzymes.
• High potential for physical and psychological dependence, especially with prolonged use. Tapering is crucial to avoid severe withdrawal symptoms.
• The oral solution (drops) allows for flexible and precise dosing, which is particularly useful for titration or in patients who have difficulty swallowing tablets.
• Paradoxical reactions (e.g., agitation, aggression, hallucinations) can occur, especially in pediatric and geriatric patients, or those with psychiatric disorders.

• Other Benzodiazepines (e.g., Alprazolam, Diazepam, Clonazepam - for anxiety/panic/seizures)
• SSRIs (Selective Serotonin Reuptake Inhibitors - e.g., Sertraline, Escitalopram - for anxiety/panic/depression, first-line for long-term management)
• SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors - e.g., Venlafaxine, Duloxetine - for anxiety/depression)
• Buspirone (for generalized anxiety disorder, non-sedating, non-addictive)
• Hydroxyzine (antihistamine with anxiolytic/sedative properties)
• Beta-blockers (e.g., Propranolol - for performance anxiety, physical symptoms of anxiety)
• Non-benzodiazepine hypnotics (e.g., Zolpidem, Zopiclone, Eszopiclone - for insomnia)
• Antidepressants with sedative properties (e.g., Trazodone, Mirtazapine - for insomnia)
• Cognitive Behavioral Therapy (CBT) and other psychotherapies (for anxiety, insomnia, panic disorder)