Generic Version of Ativan
The generic version of Ativan is lorazepam. 1
Overview of Lorazepam
Lorazepam is a benzodiazepine medication with several therapeutic applications:
- Used for management of anxiety, insomnia, and status epilepticus 1
- Serves as a pre-anesthetic medication 2
- Functions as an anxiolytic drug with sedative and hypnotic properties 3
- Utilized for breakthrough treatment of chemotherapy-induced nausea and vomiting (0.5-2 mg PO/SL/IV every 6 hours) 1
- Administered for management of delirium in cancer patients (1 mg SC or IV stat, up to 2 mg maximum) 1
Pharmacological Properties
Lorazepam has distinct pharmacological characteristics:
- Acts by potentiating neural inhibition mediated by gamma-aminobutyric acid (GABA) 3
- Directly undergoes glucuronide conjugation, unlike midazolam and diazepam which are metabolized by cytochrome P450 enzymes 3
- Has a half-life of 8-15 hours with no active metabolites 1
- Available in multiple formulations: oral, sublingual, intravenous, and subcutaneous 1
Clinical Considerations
When prescribing lorazepam, clinicians should be aware of:
- Lower doses should be used in older or frail patients, those with COPD, or when co-administered with antipsychotics (0.25-0.5 mg SC/IV) 1
- May cause delirium, drowsiness, paradoxical agitation, and increased risk of falls 1
- Subcutaneous injection may cause irritation 1
- Regular use can lead to tolerance, addiction, depression, and cognitive impairment 1
- Paradoxical agitation occurs in approximately 10% of patients treated with benzodiazepines 1
- Should be avoided in older patients and those with cognitive impairment due to risk of decreased cognitive performance 1
Dosing Information
Dosing varies by indication:
- For insomnia: 0.5-1 mg PO at bedtime 1
- For anxiety management: 0.5-2 mg PO/SL/IV every 6 hours 1
- For delirium in cancer patients: 1 mg SC or IV stat (up to 2 mg maximum) 1
- For chronic insomnia: Some research has explored 0.5 mg TID, though this is not standard practice 4
Important Cautions
- Withdrawal symptoms may occur following discontinuation, including rebound insomnia and increased anxiety 5
- Parenteral formulations contain propylene glycol as a diluent, which can cause toxicity (metabolic acidosis and acute kidney injury) 1
- Elimination half-life and duration of clinical effect are increased in patients with renal failure 1
- Benzodiazepines are classified as Schedule IV controlled substances 1