lorazepam

Lorazepam is a benzodiazepine used in the management of anxiety disorders, for short-term relief of anxiety, and as a sedative or premedication for medical procedures. It also has anticonvulsant and muscle relaxant properties and is sometimes used in the treatment of status epilepticus and alcohol withdrawal. Because of risks of dependence, it is typically prescribed for short durations and should be used at the smallest effective dose.

Pharmacology and pharmacokinetics: Lorazepam enhances the effect of the neurotransmitter GABA at the GABA-A receptor, producing anxiolytic, sedative, and anticonvulsant effects. It is rapidly absorbed when taken by mouth and can be given intravenously or intramuscularly for rapid relief. It is mainly metabolized in the liver by glucuronidation to inactive compounds and has a half-life around 12 hours in healthy adults, which can be longer in older people.

Safety and contraindications: It should not be used in people with hypersensitivity to benzodiazepines, during acute narrow-angle glaucoma, or in those with significant respiratory insufficiency. Caution is advised in the elderly, those with liver impairment, pregnant or breastfeeding individuals, and in people taking other central nervous system depressants. Common adverse effects include drowsiness, dizziness, and slowed reaction times; paradoxical agitation can occur in some patients. Abrupt discontinuation after regular use can lead to withdrawal symptoms and, with chronic use, dependence.

Overdose and regulation: In overdose, treatment is supportive and may involve flumazenil under careful medical supervision. Lorazepam is a prescription medication and, in many jurisdictions, is a controlled substance (for example, schedule IV in the United States), reflecting its potential for abuse and dependence. Brand names include Ativan and various generic formulations.