How does this medication work? What will it do for me?
Lorazepam belongs to the class of medications called benzodiazepines. Lorazepam is used for the short-term relief of the symptoms of excessive anxiety. It works by slowing down the communication between the nerves in the brain (i.e., the central nervous system).
Some people experience some improvement in anxiety about half an hour after taking lorazepam. Injectable lorazepam can be used as an initial treatment for the control of prolonged seizures (status epilepticus).
This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.
Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.
Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.
What form(s) does this medication come in?
Each white-to-off-white, flat-faced, bevelled-edged, round tablet, engraved with a "P" logo on one side and "0.5" on the other side, contains 0.5 mg of lorazepam. Nonmedicinal ingredients: lactose, magnesium stearate, microcrystalline cellulose, and polacrilin potassium.
Each white-to-off-white, capsule-shaped, flat-faced, bevelled-edged tablet, engraved with a "P" logo, score, "1" on one side and plain on the other side, contains 1 mg of lorazepam. Nonmedicinal ingredients: lactose, magnesium stearate, microcrystalline cellulose, and polacrilin potassium.
Each white-to-off-white, oval-shaped, flat-faced, bevelled-edged tablet, engraved with a "P" logo, score, "2" on one side and plain on the other side, contains 2 mg of lorazepam. Nonmedicinal ingredients: lactose, magnesium stearate, microcrystalline cellulose, and polacrilin potassium.
How should I use this medication?
Anxiety: The recommended starting dose of lorazepam for adults is 2 mg per day, given in divided doses. The dose is individualized according to your specific needs and response to the medication. This dose can be increased by your doctor to as high as a total of 6 mg per day in 2 to 4 divided doses. In general, the lowest effective dose should be used for the shortest treatment duration possible.
If you are taking the sublingual tablets, place the tablet under the tongue. The medication will dissolve in about 20 seconds. You should not swallow for at least 2 minutes to allow the medication to be absorbed into the body.
Seizures: The dose of injectable lorazepam for seizures is based on body weight and given by a trained health care provider in a hospital.
Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.
It is important to take this medication exactly as prescribed by your doctor. If you have been taking this medication regularly, do not stop taking the medication without speaking with your doctor. A gradual reduction in dose is recommended when stopping this medication to avoid withdrawal effects.
If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.
Store lorazepam tablets at room temperature, protect from light and moisture, and keep them out of the reach of children. The lorazepam injection is stored in the fridge.
Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.
Who should NOT take this medication?
Do not take lorazepam if you:
- are allergic to lorazepam, other benzodiazepines, or any ingredients of the medication
- have acute narrow-angle glaucoma
- have myasthenia gravis
What side effects are possible with this medication?
Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.
The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.
The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.
Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.
- clumsiness or unsteadiness
- dizziness or lightheadedness
- sleep disturbance
Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
- abnormal thinking (disorientation, delusions, or loss of sense of reality)
- behavioural changes (e.g., aggressiveness, angry outburst)
- blurred vision or other changes in vision
- false sense of well-being
- hallucinations (seeing or hearing things that are not there)
- inappropriate behavior
- memory problems
- muscle weakness
- signs of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
- signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
Stop taking the medication and seek immediate medical attention if any of the following occur:
- breathing difficulties (slow, shallow, or weak breathing)
- convulsions (seizures)
- signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
- symptoms of myasthenia gravis (e.g., muscle weakness, drooping eyelid, vision changes, difficulty chewing and swallowing, trouble breathing)
- symptoms of taking too much medication (e.g., extreme sleepiness, confusion, slurred speech, slow, shallow breathing, loss of balance and coordination, uncontrolled eye rolling, low blood pressure)
Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.
Are there any other precautions or warnings for this medication?
HEALTH CANADA ADVISORY
December 22, 2017
Health Canada has issued new restrictions concerning the use of Ativan® (lorazepam). To read the full Health Canada Advisory, visit Health Canada's web site at healthycanadians.gc.ca.
Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.
Alcohol and other medications that cause drowsiness: People taking this medication should not combine it with alcohol and avoid combining it with other medications, such as narcotic pain relievers, or sedatives or sleeping pills that cause drowsiness. Doing so can cause additive drowsiness and reduced breathing, as well as other side effects, which can be dangerous and possible fatal.
Dependence and withdrawal: Physical dependence (a need to take regular doses to prevent physical symptoms) has been associated with benzodiazepines such as lorazepam. Severe withdrawal symptoms may be experienced if the dose is significantly reduced or suddenly discontinued. Withdrawal symptoms can include:
- abdominal cramps
- extreme anxiety
- memory impairment
- muscle pain
- sleep problems
Reducing the dose gradually under medical supervision can help prevent or decrease these withdrawal symptoms. If you have a history of addiction or substance use problems, discuss the risks and benefits of the medication with your doctor.
Depression: People who have preexisting depression may experience emerging or worsening symptoms of depression while taking this medication. If you experience this, contact your doctor as soon as possible. People with depression should be treated with appropriate antidepressant therapy.
If you experience symptoms of depression such as poor concentration, changes in weight, changes in sleep, decreased interest in activities, or notice them in a family member who is taking this medication, contact your doctor as soon as possible.
Drowsiness/reduced alertness: If you are taking lorazepam do not drive a car or perform hazardous tasks until you determine that this medication does not impair your ability to perform these tasks safely. Avoid drinking alcohol, as it can increase the drowsiness effects of this medication.
Falls and fractures: Lorazepam can cause drowsiness or dizziness that can affect your balance and increase your risk of falling. This can result in fractures or other injuries. Your risk of falls is increased if you drink alcohol or take sedatives while taking this medication, if you are elderly or if you have a condition that causes weakness or frailty.
Kidney function: Kidney disease or reduced kidney function may cause this medication to build up in the body, causing side effects. If you have reduced kidney function or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Lactose: Certain forms or brands of this medication contain lactose. If you have hereditary problems of galactose intolerance, lactase deficiency, or glucose-galactose malabsorption, talk to your doctor or pharmacist about whether this medication is appropriate for you.
Liver function: Liver disease or reduced liver function may cause this medication to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking this medication.
If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.
Lung disease: If you have underlying lung disease (e.g., chronic obstructive pulmonary disease, sleep apnea), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Pregnancy: Taking lorazepam during the first trimester of pregnancy may result in an increased risk of certain birth defects. This medication should not be used during pregnancy. If you become pregnant while taking this medication, contact your doctor immediately.
Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking lorazepam, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.
Children and adolescents: The safety and effectiveness of using this medication have not been established for those under 18 years of age.
Seniors: Seniors may be more likely to experience side effects of lorazepam, such as sedation (drowsiness) and impaired coordination. Seniors should discuss with their doctor the risks and benefits of taking this medication.
What other drugs could interact with this medication?
There may be an interaction between lorazepam and any of the following:
- antihistamines (e.g., cetirizine, chlorpheniramine, doxylamine, diphenhydramine, hydroxyzine, loratadine)
- antipsychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone)
- barbiturates (e.g., butalbital, phenobarbital, secobarbital)
- benzodiazepines (e.g., alprazolam, diazepam, lorazepam)
- chloral hydrate
- general anesthetics (medications used to put people to sleep before surgery)
- kava kava
- muscle relaxants (e.g., baclofen, cyclobenzaprine, methocarbamol, orphenadrine, tizanidine)
- narcotics (e.g., codeine, fentanyl, morphine, oxycodone)
- seizure medications (e.g., carbamazepine, clobazam, levetiracetam, phenobarbital, phenytoin, primidone, rufinamide, topiramate, valproic acid, zonisamide)
- selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, fluoxetine, paroxetine, sertraline)
- sodium oxybate
- theophyllines (e.g., aminophylline, oxtriphylline, theophylline)
- tricyclic antidepressants (e.g., amitriptyline, clomipramine, desipramine, imipramine, nortriptyline)
If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:
- stop taking one of the medications,
- change one of the medications to another,
- change how you are taking one or both of the medications, or
- leave everything as is.
An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.
Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications; you should let your prescriber know if you use them.
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