Lorazepam 2mg/ml Inj, 1ml
Overview
What is this medicine?
How to Use This Medicine
If you need to store this medication at home, consult with your doctor, nurse, or pharmacist to determine the proper storage method.
If you miss a dose, contact your doctor to receive guidance on the appropriate course of action.
Lifestyle & Tips
- Avoid alcohol completely while receiving this medication, as it can dangerously increase drowsiness and breathing problems.
- Avoid driving or operating heavy machinery until you know how this medication affects you and you are no longer feeling drowsy or dizzy.
- Do not take other sedatives, sleeping pills, or pain medications (especially opioids) without discussing with your doctor, as this can lead to dangerous side effects.
- Inform your healthcare provider if you are pregnant, planning to become pregnant, or breastfeeding.
Available Forms & Alternatives
Dosing & Administration
Adult Dosing
Condition-Specific Dosing:
Pediatric Dosing
Dose Adjustments
Renal Impairment:
Hepatic Impairment:
Pharmacology
Mechanism of Action
Pharmacokinetics
Absorption:
Distribution:
Elimination:
Pharmacodynamics
Safety & Warnings
BLACK BOX WARNING
Side Effects
Although rare, this medication can cause severe and potentially life-threatening side effects. If you experience any of the following symptoms, contact your doctor or seek medical attention immediately:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
New or worsening behavioral or mood changes, including:
+ Depression
+ Thoughts of suicide
Hallucinations (seeing or hearing things that are not there)
Changes in balance
Feeling confused
Feeling nervous and excitable
Restlessness
Trouble sleeping
Increased interest in sex
Memory problems or loss
Severe dizziness or fainting
Changes in eyesight
Muscle weakness
Dark urine or yellow skin and eyes
This medication can also cause severe and potentially life-threatening breathing problems. If you experience slow, shallow, or difficult breathing, contact your doctor right away.
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to contact your doctor or seek medical help if you're bothered by any of the following:
Dizziness
Drowsiness
Fatigue
Weakness
Headache
Irritation at the injection site
This is not an exhaustive list of possible side effects. If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Extreme drowsiness or difficulty waking up
- Very slow or shallow breathing
- Bluish lips or skin
- Severe dizziness or lightheadedness
- Unusual confusion or disorientation
- Paradoxical reactions such as agitation, aggression, or hallucinations (rare but possible)
Before Using This Medicine
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the symptoms you experienced.
Certain health conditions, including:
+ Glaucoma
+ Depression or specific mental health issues
+ Sleep apnea or breathing problems
+ Kidney disease or liver disease
This list is not exhaustive, and it is crucial to discuss all your health problems with your doctor.
Additionally, provide your doctor and pharmacist with a comprehensive list of all the medications you are taking, including:
Prescription medications
Over-the-counter (OTC) medications
Natural products
Vitamins
It is vital to verify that it is safe to take this medication with all your existing medications and health conditions. Never start, stop, or adjust the dosage of any medication without first consulting your doctor.
Precautions & Cautions
When taking this medication, it is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are using this drug.
Post-Treatment Precautions
Avoid driving and engaging in activities that require alertness for 1 to 2 full days after receiving this medication, or until its effects have worn off.
For at least 8 hours after using this medication, do not attempt to get out of bed without assistance, as you may be at risk of falling and injuring yourself.
Refrain from consuming alcohol for 1 to 2 full days after receiving this medication.
Special Considerations
Some products containing this medication may include benzyl alcohol. If possible, avoid using these products in newborns or infants, as benzyl alcohol can cause serious side effects in these children, particularly when combined with other medications containing benzyl alcohol. Consult your doctor to determine if this product contains benzyl alcohol.
Before using marijuana, cannabis, or prescription or over-the-counter medications that may slow your reactions, discuss the potential risks with your doctor.
Long-Term Use and Monitoring
If you are taking this medication for an extended period, your doctor may recommend regular blood tests to monitor your condition.
Do not take this medication for longer than prescribed by your doctor.
Prolonged use or high doses of this medication can lead to tolerance, reducing its effectiveness. If you experience a decrease in the medication's effectiveness, contact your doctor. Do not take more than the prescribed dose.
Age-Related Considerations
If you are 65 or older, use this medication with caution, as you may be more susceptible to side effects.
When using this medication in children, exercise caution, as the risk of certain side effects may be higher in this population.
Pregnancy and Breastfeeding
This medication may harm the unborn baby if taken during pregnancy. If you become pregnant or are pregnant while taking this medication, notify your doctor immediately.
Taking this medication late in pregnancy may increase the risk of breathing or feeding problems, low body temperature, or withdrawal symptoms in the newborn. Discuss the potential risks with your doctor.
If you are breastfeeding or plan to breastfeed, inform your doctor, as this medication can pass into breast milk and potentially harm your baby.
Procedure-Related Risks
Studies have shown that frequent or long-term use of anesthesia or sleep medications in children under 3 years old may lead to long-term brain problems. This risk may also apply to unborn babies if the mother uses this medication during the third trimester of pregnancy. Consult your doctor to discuss the potential risks and benefits.
Overdose Information
Overdose Symptoms:
- Somnolence (extreme drowsiness)
- Confusion
- Lethargy
- Hypotension (low blood pressure)
- Ataxia (loss of coordination)
- Hypoventilation (slow or shallow breathing)
- Coma
- Death
What to Do:
Seek immediate medical attention. Call 911 or Poison Control at 1-800-222-1222. Management is primarily supportive, including maintaining a patent airway, assisting ventilation, and monitoring vital signs. Flumazenil, a benzodiazepine receptor antagonist, may be used to reverse the effects but carries risks, especially in patients with chronic benzodiazepine use or seizure disorders.
Drug Interactions
Major Interactions
- Opioids (e.g., fentanyl, oxycodone, hydrocodone): Increased risk of profound sedation, respiratory depression, coma, and death. Concomitant use should be reserved for patients for whom alternative treatment options are inadequate.
- Alcohol: Potentiation of CNS depressant effects, leading to severe sedation, respiratory depression, and hypotension.
- Other CNS depressants (e.g., barbiturates, other benzodiazepines, tricyclic antidepressants, antipsychotics, antihistamines, general anesthetics): Additive CNS depressant effects.
Moderate Interactions
- Valproic acid: May inhibit lorazepam glucuronidation, leading to increased lorazepam plasma concentrations and enhanced CNS depression. Consider a 50% reduction in lorazepam dose.
- Probenecid: May inhibit lorazepam glucuronidation, leading to increased lorazepam plasma concentrations and enhanced CNS depression. Consider a 50% reduction in lorazepam dose.
- Scopolamine: Increased incidence of sedation, hallucinations, and disoriented behavior.
Minor Interactions
- Theophylline/Aminophylline: May antagonize the sedative effects of lorazepam.
Monitoring
Baseline Monitoring
Rationale: To assess baseline respiratory function and identify risk for respiratory depression, especially with IV administration.
Timing: Prior to administration
Rationale: To assess baseline cardiovascular status and monitor for hypotension or bradycardia.
Timing: Prior to administration
Rationale: To establish baseline mental status and guide dosing.
Timing: Prior to administration
Rationale: To assess baseline oxygenation, especially in patients with respiratory compromise.
Timing: Prior to administration
Routine Monitoring
Frequency: Every 5-15 minutes during IV administration and for 1-2 hours post-administration, then as clinically indicated.
Target: Maintain within patient's normal range, avoid significant depression.
Action Threshold: Respiratory rate <10 breaths/min, shallow breathing, or signs of respiratory distress; administer oxygen, consider flumazenil if severe.
Frequency: Every 5-15 minutes during IV administration and for 1-2 hours post-administration, then as clinically indicated.
Target: Maintain within patient's normal range, avoid significant hypotension.
Action Threshold: Systolic BP <90 mmHg or significant drop from baseline; administer fluids, consider vasopressors if severe.
Frequency: Continuously during acute administration, then every 1-4 hours or as clinically indicated.
Target: Desired level of sedation (e.g., drowsy but arousable for anxiety, deeply sedated for procedures).
Action Threshold: Excessive sedation (unarousable), paradoxical excitation; reduce dose, consider flumazenil if severe.
Frequency: Continuous pulse oximetry during IV administration and for 1-2 hours post-administration, then as clinically indicated.
Target: >92-94%
Action Threshold: <90% or significant drop from baseline; administer oxygen, consider airway support.
Symptom Monitoring
- Excessive sedation
- Respiratory depression (slow, shallow breathing)
- Hypotension
- Bradycardia
- Paradoxical reactions (agitation, aggression, hallucinations)
- Ataxia or uncoordination
- Slurred speech
- Dizziness
Special Patient Groups
Pregnancy
Lorazepam is classified as Pregnancy Category D. It should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Benzodiazepines can cross the placenta and may cause fetal harm.
Trimester-Specific Risks:
Lactation
Lorazepam is excreted into breast milk. The American Academy of Pediatrics considers it to have an unknown effect on the nursing infant but may be of concern. The risk-benefit should be carefully weighed. Monitor the infant for sedation, poor feeding, and weight gain.
Pediatric Use
Use with extreme caution, especially in neonates and infants, due to the risk of propylene glycol toxicity (a solvent in the injection formulation) and potential for paradoxical reactions (e.g., hyperactivity, agitation). Dosing must be carefully calculated based on weight. Long-term safety and efficacy in pediatric patients are not well-established.
Geriatric Use
Elderly patients are more sensitive to the effects of benzodiazepines and may experience increased sedation, dizziness, ataxia, and an increased risk of falls. Lower initial doses (e.g., 0.5-1 mg) are recommended, and patients should be closely monitored. Renal and hepatic impairment, which are more common in the elderly, can further affect drug clearance.
Clinical Information
Clinical Pearls
- For IV administration, lorazepam injection should be diluted with an equal volume of compatible diluent (e.g., Sterile Water for Injection, Normal Saline, Dextrose 5% in Water) immediately before use. Administer slowly (no faster than 2 mg/min) to minimize the risk of respiratory depression and hypotension.
- Ensure resuscitation equipment and personnel are readily available when administering IV lorazepam, especially for acute indications like status epilepticus.
- Lorazepam injection contains propylene glycol and polyethylene glycol, which can cause toxicity (e.g., metabolic acidosis, renal dysfunction, CNS depression) with high doses or prolonged infusions, particularly in patients with renal impairment or in neonates/infants.
- Paradoxical reactions (e.g., agitation, aggression, hallucinations) can occur, especially in pediatric or elderly patients, or those with underlying psychiatric conditions.
- Abrupt discontinuation after prolonged use can lead to withdrawal symptoms (e.g., seizures, tremor, anxiety, insomnia). Tapering is necessary for chronic use.
- Flumazenil is the antidote for benzodiazepine overdose but should be used with caution, especially in patients with a history of seizures or chronic benzodiazepine use, as it can precipitate acute withdrawal seizures.
Alternative Therapies
- For anxiety: Diazepam, alprazolam, oxazepam (other benzodiazepines); buspirone (non-benzodiazepine anxiolytic); SSRIs/SNRIs (for chronic anxiety).
- For status epilepticus: Diazepam (IV/rectal), midazolam (IV/IM/buccal/intranasal), phenobarbital, fosphenytoin/phenytoin, levetiracetam.
- For procedural sedation/premedication: Midazolam, propofol, etomidate, ketamine.
Cost & Coverage
General Drug Facts
Store all medications in a secure location, out of the reach of children and pets, to prevent accidental ingestion or exposure. Dispose of unused or expired medications properly. Unless instructed to do so by a healthcare professional or pharmacist, avoid flushing medications down the toilet or pouring them down the drain. If you are unsure about the proper disposal method, consult with your pharmacist, who can provide guidance on safe disposal practices or inform you about potential drug take-back programs in your area.
This medication is accompanied by a Medication Guide, which is a comprehensive patient fact sheet. It is crucial to read this guide carefully and review it again each time your prescription is refilled. If you have any questions or concerns about this medication, do not hesitate to discuss them with your doctor, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately contact your local poison control center or seek emergency medical attention. Be prepared to provide information about the medication taken, the amount, and the time it occurred, as this will facilitate prompt and effective treatment.