What is the role of lorazepam (Ativan) in medical treatment?

From the Guidelines

Lorazepam should be used at a dose of 0.5-1 mg orally four times a day as required, with a maximum of 4 mg in 24 hours, for the management of anxiety or agitation in patients who are able to swallow, as recommended by the most recent guidelines 1.

Key Considerations

• The dose of lorazepam should be reduced to 0.25-0.5 mg in elderly or debilitated patients, with a maximum of 2 mg in 24 hours, due to the increased risk of adverse effects in these populations 1.
• Oral tablets of lorazepam can be used sublingually, although this is considered an off-label use 1.
• Lorazepam is a benzodiazepine medication that works by enhancing the effect of gamma-aminobutyric acid (GABA), resulting in sedative, hypnotic, anxiolytic, anticonvulsant, and muscle relaxant effects.
• The use of lorazepam should be carefully considered in patients with a history of substance abuse or dependence, as it has the potential for abuse and dependence.
• Patients should be monitored for signs of withdrawal symptoms, including rebound anxiety, insomnia, and seizures, when stopping lorazepam after prolonged use.

Clinical Context

• Lorazepam is commonly used in the management of anxiety disorders, insomnia, and acute seizures.
• It is also used for alcohol withdrawal symptoms, pre-surgical anxiety, and as an adjunct for nausea in chemotherapy patients.
• The medication should be used with caution in patients with respiratory depression, sleep apnea, or other conditions that may be exacerbated by its sedative effects.
• Patients should avoid alcohol while taking lorazepam, as it can increase the risk of adverse effects.
• The medication should not be stopped abruptly after prolonged use, as this can cause withdrawal symptoms.

From the FDA Drug Label

Lorazepam injection is indicated for the treatment of status epilepticus. Lorazepam injection is indicated in adult patients for preanesthetic medication, producing sedation (sleepiness or drowsiness), relief of anxiety, and a decreased ability to recall events related to the day of surgery. Lorazepam Oral Concentrate is a prescription medicine used: to treat anxiety disorders for the short-term relief of the symptoms of anxiety or anxiety that can happen with symptoms of depression

The primary roles of lorazepam are:

• Treatment of status epilepticus
• Preanesthetic medication to produce sedation, relief of anxiety, and decreased recall of events related to the day of surgery
• Treatment of anxiety disorders for the short-term relief of anxiety symptoms 2, 2, 3

From the Research

Role of Lorazepam

• Lorazepam is a benzodiazepine that acts on the GABAA receptor by increasing the conductance of chloride through ionic channels, promoting a state of central nervous system depression 4.
• It is commonly used as an anxiolytic, sedative, and anticonvulsant, and is the first-line treatment for status epilepticus 4.
• Lorazepam has been shown to be effective in the management of anxiety, with a mean dose of approximately 3 mg on a b.i.d. regimen being significantly and clinically more effective than placebo 5.
• The drug has a dose-dependent effect, and repeated administration can cause dependence, which may be caused by increased dopaminergic neurotransmission and altered 5-HT metabolism 6.
• Lorazepam is also used off-label for the treatment of seizure clusters, although its effectiveness and safety for this indication have not been established 7.
• As with other benzodiazepines, lorazepam has a potential for addiction and misuse, and its use can lead to severe withdrawal symptoms, requiring careful tapering of the medication when prescribed 8.

Clinical Uses

• Anxiety management: lorazepam has been shown to be effective in reducing anxiety symptoms, with a significant and clinical improvement compared to placebo 5.
• Seizure treatment: lorazepam is used as a first-line treatment for status epilepticus, and is also used off-label for the treatment of seizure clusters 4, 7.
• Sedation: lorazepam has a sedative effect, which can be beneficial in certain clinical situations, such as prior to medical procedures 4.

Safety and Efficacy

• Lorazepam has been shown to be generally well-tolerated, although it can cause sedation, tolerance, and potential for addiction and misuse 4, 5.
• The drug's effectiveness and safety for certain indications, such as seizure clusters, have not been established, and its use for these conditions is off-label 7.
• Careful tapering of lorazepam is required when prescribed, due to the potential for severe withdrawal symptoms 8.