Lorazepam 2mg Tablets

• Opioids (increased risk of profound sedation, respiratory depression, coma, and death)
• Other CNS depressants (e.g., alcohol, barbiturates, other benzodiazepines, tricyclic antidepressants, antihistamines, antipsychotics, general anesthetics, skeletal muscle relaxants) - increased risk of additive CNS depression.
• Valproate (increases lorazepam plasma concentrations and effects by inhibiting glucuronidation)
• Probenecid (increases lorazepam plasma concentrations and effects by inhibiting glucuronidation)

• Scopolamine (increased incidence of sedation, hallucinations, and irrational behavior)
• Theophylline/Aminophylline (may antagonize sedative effects of lorazepam)
• Loxapine (may cause stupor, respiratory distress, and hypotension)

• Oral contraceptives (may slightly increase lorazepam clearance, but generally not clinically significant)

• Excessive sedation
• Dizziness
• Ataxia (impaired coordination)
• Slurred speech
• Confusion
• Memory impairment
• Respiratory depression (slow, shallow breathing)
• Paradoxical reactions (e.g., agitation, aggression, hallucinations, increased anxiety)
• Signs of withdrawal upon discontinuation (e.g., rebound anxiety, insomnia, 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). Neonatal flaccidity, respiratory and feeding difficulties, and hypothermia have been reported in infants born to mothers who have received benzodiazepines late in pregnancy.

L3 (Moderate risk). Lorazepam is excreted into breast milk. Due to its long half-life and potential for accumulation, it can cause sedation, poor feeding, and weight loss in breastfed infants. Use with caution; monitor infant for sedation and feeding difficulties. Consider alternatives or use the lowest effective dose for the shortest duration.

Use in pediatric patients is generally limited due to lack of established safety and efficacy, especially for anxiety/insomnia. IV lorazepam is used for status epilepticus in children. Oral use for anxiety is off-label and should be done with extreme caution, starting with very low doses and close monitoring. IV formulation contains propylene glycol and polyethylene glycol, which can cause toxicity (e.g., metabolic acidosis, renal dysfunction) in neonates and young children, especially with high doses or prolonged infusions.

Elderly patients are more sensitive to the effects of benzodiazepines and are at increased risk for adverse effects such as sedation, dizziness, ataxia, falls, and cognitive impairment. Start with the lowest effective dose (e.g., 0.5 mg) and titrate slowly. Monitor closely for CNS depression and falls. Avoid long-term use if possible.

• Lorazepam is often preferred in patients with liver impairment compared to other benzodiazepines because it undergoes direct glucuronidation, which is less affected by liver disease than oxidative metabolism.
• IV lorazepam is a first-line treatment for status epilepticus due to its rapid onset of action.
• Due to the risk of dependence and withdrawal, lorazepam should generally be used for short-term treatment (2-4 weeks) of anxiety or insomnia. Tapering is essential upon discontinuation after prolonged use.
• The IV formulation contains propylene glycol, which can accumulate and cause toxicity (e.g., metabolic acidosis, acute kidney injury) with high doses or prolonged infusions, especially in patients with renal impairment or in neonates/children.
• Paradoxical reactions (e.g., agitation, aggression, disinhibition) can occur, particularly in pediatric, elderly, or psychiatric patients.

• Other benzodiazepines (e.g., alprazolam, clonazepam, diazepam, oxazepam)
• SSRIs (e.g., escitalopram, sertraline) for long-term anxiety management
• SNRIs (e.g., venlafaxine, duloxetine) for long-term anxiety management
• Buspirone (for anxiety, non-sedating)
• Hydroxyzine (for anxiety, sedating antihistamine)
• Z-drugs (e.g., zolpidem, eszopiclone) for insomnia
• Antidepressants (e.g., trazodone, mirtazapine) for insomnia
• Non-pharmacological therapies (e.g., cognitive behavioral therapy for anxiety/insomnia, relaxation techniques, lifestyle modifications)