From the Guidelines
Lorazepam is not typically indicated as a first-line treatment for tremors that are not essential tremor. While lorazepam, a benzodiazepine, may temporarily reduce tremor amplitude due to its muscle relaxant and anxiolytic properties, it is generally not recommended for long-term management of non-essential tremors. For tremors associated with conditions like Parkinson's disease, cerebellar disorders, or drug-induced tremors, specific treatments targeting the underlying cause are preferred. For Parkinsonian tremor, medications like levodopa, dopamine agonists, or anticholinergics would be more appropriate. For cerebellar tremors, treatments addressing the underlying condition are recommended. Lorazepam carries significant risks including sedation, cognitive impairment, dependence, and withdrawal symptoms with long-term use, as noted in the guidelines for managing agitation and behavioral problems 1. Additionally, tolerance can develop, requiring dose escalation and increasing side effect risks. If a tremor is causing significant distress or functional impairment and other treatments have failed, lorazepam might be considered for short-term use at the lowest effective dose (typically 0.5-2mg), but this should be done under close medical supervision with a clear plan for limited duration of use, as suggested by the evaluation and management of children and adolescents with acute mental health or behavioral problems 1.
Some key points to consider when evaluating the use of lorazepam for non-essential tremors include:
- The potential for significant side effects, including sedation, cognitive impairment, and dependence, as highlighted in the guidelines for managing Alzheimer's disease 1
- The importance of targeting the underlying cause of the tremor, rather than relying on symptomatic treatment with lorazepam
- The need for close medical supervision and a clear plan for limited duration of use if lorazepam is considered for short-term use
- The availability of alternative treatments, such as levodopa, dopamine agonists, or anticholinergics, which may be more effective and have a more favorable side effect profile for specific types of tremors.
From the FDA Drug Label
INDICATIONS AND USAGE Lorazepam Oral Concentrate USP is indicated for the management of anxiety disorders or for the short-term relief of the symptoms of anxiety or anxiety associated with depressive symptoms. The FDA drug label does not answer the question.
From the Research
Lorazepam for Non-Essential Tremor
- There is no direct evidence in the provided studies to support the use of lorazepam for a tremor that is not essential tremor 2, 3, 4, 5, 6.
- The studies primarily focus on the treatment of essential tremor, with medications such as propranolol, primidone, and alternative agents like alprazolam being discussed 3, 4, 5.
- Alprazolam, a benzodiazepine, has been shown to be effective in treating essential tremor, particularly in elderly patients who cannot tolerate other medications 3.
- However, there is no mention of lorazepam being used to treat non-essential tremor in the provided studies.
- It is essential to note that the treatment of tremor depends on the underlying cause and severity of the condition, and medications like lorazepam may be used off-label or in specific cases, but this is not supported by the provided evidence.