Overview Of Lorazepam

Lorazepam is a strong prescription medication. Depending on the setting, patients may take this medication as an oral tablet or injection at the hospital. Patients dealing with an anxiety disorder typically receive this medication as an oral tablet that they take daily. Injections of this medication through an intravenous line are typically used before surgical procedures. The injections appear to be a treatment for seizures as well.

As mentioned, many patients receive lorazepam as a sedative before surgery or anxiety treatment. In fact, many consider it to be the best anxiety medication. However, there are also other anxiety medications and anxiety remedies.  Some patients may try natural anxiety medication as well as psychotherapy for anxiety. Of course, patients should understand how lorazepam works as a treatment for anxiety and other conditions.

Class Of Medication

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Lorazepam belongs to a group of medicines known as benzodiazepines. This includes alprazolam (Xanax) and diazepam. First developed in the 1960s, this medication class works by increasing the amount of a neurotransmitter called gamma-aminobutyric acid (GABA) in the brain. This slows the nervous system down and produces a feeling of relaxation and calm. 

Some benzodiazepines are more effective for particular conditions than others. For example, alprazolam is particularly effective for anxiety. Clonazepam is beneficial for seizures, nerve pain, and panic disorder. All medications in this class are regulated as controlled substances due to the risk of dependency. They are typically prescribed for only two to four weeks to reduce this risk.

How It Works

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As mentioned, lorazepam is one of the common benzodiazepines. Thus, it works similar to most of them and boosts the activity of gamma-aminobutyric acid in an individual’s body. This neurotransmitter is responsible for transmitting messages between various cells around the body. A higher level of this neurotransmitter relieves significant amounts of anxiety and stress. In other words, it calms individuals down. 

Evidence indicates that lorazepam is a particularly rapid medication in regards to how fast it takes to have a beneficial effect on a patient. Many patients say that they experience immediate effects from lorazepam. However, reports show that lorazepam’s peak effects come after one to one and a half hours after patients take their dose.

Uses

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Lorazepam is used for a wide variety of mental and physical health conditions. It is one of the most commonly prescribed medicines for patients with anxiety disorders. This medication is also widely used in the treatment of bipolar disorder and panic attacks. Some doctors prescribe it as part of a combination of drugs to treat schizophrenia. Lorazepam also helps ease the symptoms associated with alcohol withdrawal. Patients with certain types of epilepsy could benefit from lorazepam as well, and it is used to stop active seizures. This medication is an effective sleep aid that can reduce the symptoms of insomnia. Finally, it reduces feelings of aggression in patients with mental health concerns.

Potential Side Effects

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The most commonly reported potential side effects of lorazepam include sedation, drowsiness, and a feeling of relaxation and calm. Patients have also experienced headaches, nausea, blurry vision, appetite changes, heartburn, and constipation. In certain patients, more serious side effects could occur. Examples include slurred speech, hallucinations, depression, suicidal thoughts, weakness, and memory problems. These side effects may be accompanied by coordination and walking difficulties, and the patient may also display signs of infection, such as a fever or persistent sore throat. Side effects, especially drowsiness and loss of coordination, may worsen in elderly patients and in individuals with multiple chronic health conditions. The side effects also seem to be worse in individuals who are taking multiple medications.

Rare side effects include slow or shallow breathing, seizures, and jaundice. If serious or rare side effects occur, patients should inform their doctor immediately. Emergency medical care should be obtained if the patient has a seizure, jaundice, or breathing difficulties. Patients with troubling mental health changes, such as suicidal thoughts or hallucinations, should inform their healthcare team. This allows them to check if it may be possible to switch to another medicine that does not cause these effects. Any troublesome or persistent side effects should be discussed with a doctor so the effects can be minimized.

Lorazepam And Allergies

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Thankfully, most patients will not experience a serious allergic reaction to lorazepam. Allergic reactions are quite rare on this medication.  However, they can happen. Symptoms of an allergic reaction to lorazepam include trouble breathing, significant dizziness, rash and hives, swelling, and itching. The swelling and itching are particularly severe when they affect the patient’s face, tongue, or throat. Individuals should call for emergency medical attention if they experience any of these symptoms. In addition to initial treatment, patients often need to stop taking lorazepam. Their doctor will prescribe them an alternative medication that will not cause this type of reaction.

Precautions To Remember

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Before lorazepam is prescribed, patients should let their doctor know about any history of kidney disease, liver issues, breathing problems, sleep apnea, and glaucoma. The doctor will also need to know if the patient has a personal history of mental health conditions such as depression or psychosis. Patients should mention any family or personal history of substance use issues involving alcohol or drugs. Lorazepam may not be safe for patients with a history of these conditions. Thus, doctors will carefully weigh the risks and benefits for the patient before deciding to prescribe it. This medication should not be taken during pregnancy as it could harm the unborn baby. Since it passes into breast milk, it should not be used while breastfeeding. Alcohol and marijuana can increase dizziness and drowsiness, and patients should not use these during treatment with lorazepam.

Stopping this medication abruptly could cause withdrawal symptoms such as vomiting, convulsions, tremors, cramps, sweating, and insomnia. To avoid these effects, patients should speak with their doctor about how to safely taper their dose when coming off the medication. This medication may sometimes increase anxiety, agitation, and restlessness instead of producing a feeling of relaxation in pediatric and elderly patients. These patients should be carefully monitored after starting this medication.

Medication Interactions

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Lorazepam interacts with other benzodiazepines, such as alprazolam, as well as with opioids. Due to the risk of medication interactions, lorazepam should not be used with pain relievers or cough medicines containing codeine or hydrocodone. It should not be used with other medicines that cause sedation. Examples include some antidepressants, antipsychotics, and antihistamines. Experts advise against using lorazepam with muscle relaxants, such as carisoprodol. It has strong interactions with kava, clozapine, and sodium oxybate (GHB) as well. 

Patients should inform their medical team about all medications they take, including over-the-counter medicines, prescriptions, herbal and natural remedies, vitamins, and supplements. This will help them avoid complications from potential medication interactions. Doctors should check the patient's medication list for potential interactions before prescribing lorazepam. The pharmacist should also check for interactions before dispensing this medication.

Common Dosage Recommendations

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Anxiety disorder patients are typically prescribed two to three milligrams of lorazepam every eight to twelve hours. Some patients may need a maintenance dose of up to six milligrams. In most cases, patients cannot exceed ten milligrams daily. Individuals who are given this medication as a sedative before surgery often receive 0.05 milligrams per kilogram of their body weight. A doctor or nurse will provide this medication as an intramuscular injection around two hours before the patient’s operation. Alternatively, a dose of 0.044 milligrams per kilogram of body weight can be administered intravenously fifteen to twenty minutes before surgery.

Some patients can receive this medication for short-term insomnia. In this case, they often receive two to four milligrams before bed. Of course, patients must talk to their doctor about this medication first. Their doctor will determine the most appropriate dose for their needs.

Common Medication Alternatives

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The medication alternatives for lorazepam depend on what condition a patient needs to have treated. The most common is to relieve anxiety symptoms, including generalized anxiety disorder and panic attacks. Two common alternatives for anxiety are alprazolam and diazepam. The former is often sold under the brand Xanax and is one of the most popular anxiety medications. It relieves symptoms within hours and treats anxiety that is associated with depression. Many patients take alprazolam for short-term anxiety or panic attacks. However, it seems to carry a higher risk of withdrawal symptoms. 

Diazepam has fewer withdrawal symptoms and acts quickly, though it interacts with more medications. Of course, it is worth noting diazepam also helps with muscle spasms. Patients with insomnia may be prescribed zolpidem or eszopiclone instead. There are also over-the-counter alternatives. Examples include antihistamines and melatonin.

Advice For Taking It

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In all instances, patients must discuss how best to take lorazepam with their doctor. They will be able to provide instructions that are best suited for the patient’s specific needs. However, there is some general advice that all patients should consider and speak to their doctor about. For instance, most patients will take lorazepam two to three times daily. They should ask about the timing of doses, though the most common is in equal intervals. 

Many patients will take lorazepam with food, as doing so helps to decrease stomach upset as a side effect. Taking their medication with meals can assist in the timing of each dose as well. Of course, patients can take this medication without food if necessary. Patients who struggle to swallow pills may want to ask their doctor or pharmacist about specific lorazepam tablets. Some of them can be split or crushed so they are easier to swallow. However, this is not suitable for all lorazepam tablets, which is why patients must ask first.