From the Guidelines
Yes, lorazepam is on the Beers Criteria list. The Beers Criteria is a guideline that identifies potentially inappropriate medications for older adults (typically those 65 years and older) [ 1 ]. Lorazepam, like other benzodiazepines, is included on this list because it poses higher risks for older patients. These risks include increased falls, fractures, cognitive impairment, and delirium [ 1 ]. Older adults are more sensitive to these effects due to age-related changes in drug metabolism and clearance. If lorazepam must be used in older adults, it should be at the lowest effective dose for the shortest duration possible, with careful monitoring for adverse effects. Clinicians should consider alternative treatments when appropriate, such as non-pharmacological approaches for anxiety or insomnia, or medications with better safety profiles in the elderly. Despite being on the Beers list, there may still be specific clinical situations where the benefits of lorazepam outweigh the risks, requiring individualized assessment [ 1 ].
Some key points to consider when managing older adults on lorazepam include:
- Gradual tapering of the medication to minimize withdrawal symptoms [ 1 ]
- Monitoring for potential drug-drug or drug-disease interactions [ 1 ]
- Considering alternative treatments, such as cognitive-behavioral therapy or medications with better safety profiles [ 1 ]
- Educating patients about the risks and benefits of lorazepam and the importance of careful monitoring [ 1 ]
Overall, the use of lorazepam in older adults requires careful consideration of the potential risks and benefits, as well as individualized assessment and monitoring to minimize adverse effects.
From the Research
Lorazepam and the BEERS List
- Lorazepam is a benzodiazepine, and according to the study 2, benzodiazepines are considered potentially inappropriate medications (PIMs) for older adults.
- The American Geriatrics Society (AGS) Beers Criteria 3 is a list of PIMs that are typically best avoided by older adults in most circumstances.
- While the study 3 does not explicitly mention lorazepam, it does mention that the AGS Beers Criteria is an explicit list of PIMs, and benzodiazepines are included in this list.
- Another study 4 mentions the use of lorazepam in older patients with delirium, but it does not specifically address whether lorazepam is on the BEERS list.
- However, based on the information provided in the studies, it can be inferred that lorazepam, as a benzodiazepine, is likely to be considered a potentially inappropriate medication for older adults, and therefore, may be included on the BEERS list 2, 3.
Potentially Inappropriate Medications
- The BEERS list is used to identify medications that are potentially inappropriate for older adults, and benzodiazepines, such as lorazepam, are considered PIMs 2.
- The use of PIMs, including benzodiazepines, can lead to increased risks of adverse outcomes, such as prolonged hospital stay, post-discharge institutionalization, and in-hospital mortality 4.
- Clinicians should be cautious when prescribing PIMs, including lorazepam, to older adults, and should consider alternative treatments whenever possible 4, 3.
Benzodiazepines and Cognitive Effects
- Benzodiazepines, including lorazepam, have been shown to have negative cognitive effects, particularly with long-term use 5.
- These cognitive effects can include impairment in visuospatial ability, speed of processing, and verbal learning 5.
- While the cognitive effects of benzodiazepines may be insignificant in the daily functioning of most patients, patients should be advised of the potential risks when treated long-term with these medications 5.