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Lorazepam, also sold under the brand name Ativan, is a benzodiazepine medication
commonly prescribed for anxiety, seizures, and insomnia. While it can be an
effective treatment for these conditions, it also carries a number of potential
side effects. In this article, we will explore the various lorazepam side
effects in detail.
1.
Drowsiness and Sedation - One of the most common side effects of lorazepam is
drowsiness or sedation. This effect can be particularly pronounced in the first
few days of treatment, and it may take some time for the body to adjust to the
medication. Individuals taking lorazepam may experience difficulty with
attention and concentration, as well as impaired motor function. Patients should
not operate heavy machinery or drive until they know how the medication affects
them
2.
Impaired Memory and Cognitive Function Lorazepam can also have an impact on
cognitive function, including memory and concentration. This is particularly
true in the elderly or in patients taking higher doses of the medication. Some
studies have suggested that long-term use of benzodiazepines like lorazepam can
increase the risk of developing dementia.
3.
Confusion and Disorientation In addition to cognitive impairment, lorazepam can
also cause confusion and disorientation. This can be particularly concerning for
elderly patients, who may already be experiencing cognitive decline. Patients
taking lorazepam should be monitored for signs of confusion, as it may indicate
a need to adjust the dosage or discontinue the medication.
4.
Respiratory Depression Lorazepam can also have an impact on the respiratory
system, potentially causing respiratory depression. This effect is more
pronounced in individuals taking higher doses of the medication or those who are
already experiencing respiratory issues. Patients should be monitored for signs
of respiratory distress, including shortness of breath, shallow breathing, and
wheezing.
5.
Addiction and Dependence Lorazepam is a habit-forming medication, and long-term
use can lead to addiction and dependence. Patients taking the medication for an
extended period of time may develop tolerance to the drug, requiring higher
doses to achieve the same effect. Abruptly discontinuing the medication can lead
to withdrawal symptoms, including seizures and hallucinations.
6.
Mood Changes Lorazepam can also cause changes in mood, including depression and
anxiety. This effect is particularly pronounced in individuals taking higher
doses of the medication or those with a history of mental health issues.
Patients should be monitored for signs of depression or anxiety, and the
medication should be discontinued if these symptoms become severe.
7.
Nausea and Vomiting Lorazepam can cause gastrointestinal distress, including
nausea and vomiting. This effect is typically mild and can be managed with
over-the-counter medications, but patients should be monitored for signs of
dehydration or other complications.
8.
Headache and Dizziness Headache and dizziness are common side effects of
lorazepam, particularly in the first few days of treatment. These symptoms may
be related to the sedative effects of the medication, and they should resolve as
the body adjusts to the drug.
9.
Muscle Weakness Lorazepam can also cause muscle weakness, particularly in
individuals taking higher doses of the medication. Patients should be monitored
for signs of weakness or difficulty with motor function, and the medication
should be discontinued if these symptoms become severe.
10.
Skin Rash Lorazepam can cause skin rash or hives, particularly in individuals
with a history of allergies or sensitivity to benzodiazepines. Patients should
be monitored for signs of rash or itching, and the medication should be
discontinued if these symptoms become severe.
11.
Hypotension Lorazepam can cause a drop in blood pressure, leading to
hypotension. This effect is more pronounced in individuals taking Lorazepam.
12.
Sexual Dysfunction Lorazepam can also cause sexual dysfunction, including
decreased libido and erectile dysfunction in men. This effect is more pronounced
in individuals taking higher doses of the medication or those with a history of
sexual dysfunction. Patients should be monitored for signs of sexual
dysfunction, and the medication should be discontinued if these symptoms become
severe.
13.
Liver Damage Lorazepam can cause liver damage in some patients, particularly
those taking higher doses of the medication or those with preexisting liver
disease. Patients should be monitored for signs of liver damage, including
yellowing of the skin or eyes, dark urine, and abdominal pain.
14.
Seizures While lorazepam is often used to treat seizures, it can also cause
seizures in some patients. This effect is more pronounced in individuals taking
higher doses of the medication or those with a history of seizures. Patients
should be monitored for signs of seizure activity, including convulsions or loss
of consciousness.
15.
Allergic Reactions Lorazepam can cause allergic reactions in some patients,
particularly those with a history of allergies or sensitivity to
benzodiazepines. Patients should be monitored for signs of allergic reaction,
including swelling of the face or throat, difficulty breathing, and hives.
16.
Withdrawal Symptoms Abruptly discontinuing lorazepam can lead to withdrawal
symptoms, including seizures, hallucinations, and insomnia. Patients should be
weaned off the medication slowly to avoid these symptoms.
17.
Interactions with Other Medications Lorazepam can interact with other
medications, particularly those that affect the central nervous system, such as
opioids or other benzodiazepines. Patients should inform their healthcare
provider of all medications they are taking to avoid potentially dangerous
interactions.
18.
Tolerance and Dependence As mentioned earlier, long-term use of lorazepam can
lead to tolerance and dependence, requiring higher doses of the medication to
achieve the same effect. Patients should be monitored for signs of tolerance and
dependence, and the medication should be discontinued if these symptoms become
severe.
19.
Suicidal Thoughts Lorazepam can cause suicidal thoughts or behavior in some
patients, particularly those with a history of depression or anxiety. Patients
should be monitored for signs of suicidal ideation, and the medication should be
discontinued if these symptoms become severe.
20.
Pregnancy and Breastfeeding Lorazepam can be harmful to a developing fetus or
nursing infant, and should be avoided during pregnancy and breastfeeding unless
the potential benefits outweigh the risks. Patients should consult with their
healthcare provider before taking lorazepam if they are pregnant or
breastfeeding.
21.
Falls and Fractures Lorazepam can increase the risk of falls and fractures,
particularly in elderly patients or those with a history of falls. Patients
taking lorazepam should be monitored for signs of dizziness or impaired balance,
and steps should be taken to minimize the risk of falls, such as using assistive
devices or modifying the home environment.
22.
Respiratory Infections Lorazepam can increase the risk of respiratory
infections, particularly in patients with preexisting respiratory issues.
Patients taking lorazepam should be monitored for signs of respiratory
infections, such as coughing or shortness of breath.
23.
Gastrointestinal Bleeding Lorazepam can increase the risk of gastrointestinal
bleeding, particularly in patients taking higher doses of the medication or
those with a history of gastrointestinal issues. Patients should be monitored
for signs of bleeding, including black or tarry stools or vomiting blood.
24.
Cardiovascular Effects Lorazepam can have an impact on the cardiovascular
system, potentially causing changes in heart rate or blood pressure. Patients
with preexisting cardiovascular issues should be closely monitored while taking
lorazepam.
25.
Vision Changes Lorazepam can cause vision changes, including blurred vision or
difficulty focusing. Patients should be monitored for signs of vision changes
and should not operate heavy machinery or drive until these symptoms resolve.
26.
Weight Changes Lorazepam can cause weight changes, including weight gain or
weight loss. Patients should be monitored for changes in weight and should
discuss any concerns with their healthcare provider.
27.
Interference with Laboratory Tests Lorazepam can interfere with certain
laboratory tests, particularly those measuring liver function or drug levels in
the blood. Patients should inform their healthcare provider if they are taking
lorazepam to ensure that accurate test results are obtained.
28.
Impact on Immune Function Lorazepam can have an impact on immune function,
potentially increasing the risk of infections or other immune-related issues.
Patients with preexisting immune system issues should be closely monitored while
taking lorazepam.
29.
Impact on Endocrine System Lorazepam can have an impact on the endocrine system,
potentially causing changes in hormone levels or function. Patients with
preexisting endocrine issues should be closely monitored while taking lorazepam.
30.
Impact on Renal Function Lorazepam can have an impact on renal function,
potentially causing changes in kidney function or urine output. Patients with
preexisting renal issues should be closely monitored while taking lorazepam.
31.
Behavioral Changes Lorazepam can cause behavioral changes, including
irritability, agitation, and aggression. These symptoms may be more pronounced
in patients taking higher doses of the medication or those with a history of
behavioral issues. Patients should be monitored for signs of behavioral changes,
and the medication should be discontinued if these symptoms become severe.
32.
Anaphylaxis Lorazepam can cause anaphylaxis, a severe and potentially
life-threatening allergic reaction. Patients should be monitored for signs of
anaphylaxis, including swelling of the face or throat, difficulty breathing, and
hives, and should seek immediate medical attention if these symptoms occur.
33.
Respiratory Failure In rare cases, lorazepam can cause respiratory failure, a
serious condition in which the lungs fail to function properly. Patients should
be monitored for signs of respiratory failure, including difficulty breathing,
cyanosis (bluish discoloration of the skin), and confusion.
34.
Jaundice Lorazepam can cause jaundice, a condition in which the skin and whites
of the eyes become yellow due to increased levels of bilirubin in the blood.
Patients should be monitored for signs of jaundice, including yellowing of the
skin or eyes, dark urine, and pale stools.
35.
Stevens-Johnson Syndrome Lorazepam can cause Stevens-Johnson Syndrome, a rare
and potentially life-threatening skin condition that can cause blistering and
peeling of the skin, as well as mucous membranes such as the mouth and eyes.
Patients should be monitored for signs of Stevens-Johnson Syndrome, including
rash, blisters, and skin peeling, and should seek immediate medical attention if
these symptoms occur.
36.
Thrombocytopenia Lorazepam can cause thrombocytopenia, a condition in which
there is a low level of platelets in the blood, leading to an increased risk of
bleeding. Patients should be monitored for signs of thrombocytopenia, including
bruising, bleeding gums, and petechiae (small red or purple spots on the skin).
37.
Pancreatitis Lorazepam can cause pancreatitis, a condition in which the pancreas
becomes inflamed and swollen, leading to severe abdominal pain, nausea, and
vomiting. Patients should be monitored for signs of pancreatitis, and the
medication should be discontinued if these symptoms occur.
38.
Hypersensitivity Syndrome Lorazepam can cause hypersensitivity syndrome, a rare
but potentially life-threatening condition that can cause fever, rash, and
multiple organ failure. Patients should be monitored for signs of
hypersensitivity syndrome, and the medication should be discontinued if these
symptoms occur.
39.
Interference with Psychomotor Testing Lorazepam can interfere with psychomotor
testing, such as driving tests or other tests of coordination and reaction time.
Patients should not participate in these tests until the sedative effects of the
medication have worn off.
40.
Disinhibition Lorazepam can cause disinhibition, a condition in which patients
exhibit impulsive or inappropriate behavior, such as making inappropriate
comments or engaging in risky behaviors. Patients should be monitored for signs
of disinhibition, and the medication should be discontinued if these symptoms
occur.
41.
Withdrawal Seizures in Neonates Lorazepam can cause withdrawal seizures in
neonates born to mothers who used benzodiazepines during pregnancy. These
seizures can be life-threatening and require prompt medical attention.
42.
Paradoxical Reactions Lorazepam can cause paradoxical reactions, a rare but
potentially serious condition in which patients exhibit the opposite of the
desired effect of the medication. For example, instead of feeling sedated,
patients may become agitated or hyperactive. Patients should be monitored for
signs of paradoxical reactions, and the medication should be discontinued if
these symptoms occur.
43.
Respiratory Arrest In rare cases, lorazepam can cause respiratory arrest, a
serious condition in which breathing stops completely. Patients should be
monitored for signs of respiratory distress, and emergency medical attention
should be sought if respiratory arrest occurs.
44.
Serotonin Syndrome Lorazepam can cause serotonin syndrome, a rare but
potentially life-threatening condition in which there is an excessive
accumulation of serotonin in the body. Symptoms can include fever, agitation,
confusion, tremors, and muscle rigidity. Patients should be monitored for signs
of serotonin syndrome, and emergency medical attention should be sought if these
symptoms occur.
45.
Hyponatremia Lorazepam can cause hyponatremia, a condition in which there is a
low level of sodium in the blood. Symptoms can include headache, nausea,
vomiting, confusion, and seizures. Patients should be monitored for signs of
hyponatremia, and the medication should be discontinued if these symptoms occur.
46.
Drug-Induced Psychosis Lorazepam can cause drug-induced psychosis, a condition
in which patients experience hallucinations, delusions, and other psychotic
symptoms. This effect is more pronounced in individuals taking higher doses of
the medication or those with a history of mental health issues. Patients should
be monitored for signs of drug-induced psychosis, and the medication should be
discontinued if these symptoms become severe.
47.
Acute Narrow-Angle Glaucoma Lorazepam can cause acute narrow-angle glaucoma, a
serious condition in which there is a sudden increase in pressure inside the
eye. Symptoms can include severe eye pain, headache, nausea, and blurred vision.
Patients should be monitored for signs of acute narrow-angle glaucoma, and
emergency medical attention should be sought if these symptoms occur.
48.
Severe Hypotension and Shock Lorazepam can cause severe hypotension and shock,
particularly in patients with preexisting cardiovascular issues. Symptoms can
include dizziness, lightheadedness, fainting, and rapid heartbeat. Patients
should be monitored for signs of severe hypotension and shock, and emergency
medical attention should be sought if these symptoms occur.
49.
Adverse Effects on Fertility Lorazepam can have adverse effects on fertility in
both men and women, including decreased libido, erectile dysfunction, and
menstrual irregularities. Patients should discuss any concerns about fertility
with their healthcare provider before taking lorazepam.
50.
Adverse Effects on Hematopoiesis Lorazepam can have adverse effects on
hematopoiesis, the process of blood cell formation. This can result in anemia,
leukopenia, or thrombocytopenia, all of which can cause serious health problems.
Patients should be monitored for signs of hematopoietic dysfunction, and the
medication should be discontinued if these symptoms occur.
51.
Increased Risk of Infection Lorazepam can increase the risk of infection,
particularly in patients with preexisting immune system issues or those taking
higher doses of the medication. Patients taking lorazepam should be monitored
for signs of infection, such as fever, chills, or sore throat, and should seek
medical attention if these symptoms occur.
52.
Cognitive Impairment in the Elderly Lorazepam can cause cognitive impairment in
the elderly, particularly in patients taking higher doses of the medication.
This can lead to confusion, memory problems, and difficulty with attention and
concentration. Elderly patients taking lorazepam should be closely monitored for
signs of cognitive impairment.
53.
Development of Anterograde Amnesia Lorazepam can cause anterograde amnesia, a
condition in which patients have difficulty forming new memories. This effect is
more pronounced in patients taking higher doses of the medication or those with
a history of memory problems. Patients taking lorazepam should be monitored for
signs of anterograde amnesia, and the medication should be discontinued if these
symptoms become severe.
54.
Psychiatric Symptoms in Children Lorazepam can cause psychiatric symptoms in
children, including behavioral changes, mood swings, and aggression. Patients
should be monitored for signs of psychiatric symptoms, and the medication should
be discontinued if these symptoms become severe.
55.
Teratogenicity Lorazepam can be teratogenic, meaning it can cause birth defects
or developmental issues in a developing fetus. Patients should avoid taking
lorazepam during pregnancy unless the potential benefits outweigh the risks, and
should consult with their healthcare provider about alternative treatments.
56.
Impact on Sleep Architecture Lorazepam can impact sleep architecture,
potentially causing changes in the timing and quality of sleep. Patients taking
lorazepam should be monitored for signs of sleep disturbances and should discuss
any concerns with their healthcare provider.
57.
Gastrointestinal Distress Lorazepam can cause gastrointestinal distress,
including nausea, vomiting, and diarrhea. Patients should be monitored for signs
of gastrointestinal distress, and the medication should be discontinued if these
symptoms become severe.
58.
Impact on Driving and Operating Heavy Machinery Lorazepam can cause drowsiness,
dizziness, and impaired coordination, making it unsafe to drive or operate heavy
machinery while taking the medication. Patients should avoid these activities
until the sedative effects of the medication have worn off.
59.
Impact on Athletic Performance Lorazepam can impact athletic performance,
potentially causing decreased reaction time, impaired coordination, and reduced
physical endurance. Athletes taking lorazepam should be aware of these potential
side effects and should consult with their healthcare provider before taking the
medication.
60.
Risk of Overdose Lorazepam can be lethal in overdose, particularly when taken
with other central nervous system depressants, such as opioids or alcohol.
Patients should be aware of the potential for overdose and should seek immediate
medical attention if they experience symptoms of overdose, such as severe
drowsiness, confusion, or respiratory depression.
61.
Metabolic Acidosis Lorazepam can cause metabolic acidosis, a condition in which
there is an accumulation of acid in the body. Symptoms can include rapid
breathing, confusion, and fatigue. Patients should be monitored for signs of
metabolic acidosis, and the medication should be discontinued if these symptoms
occur.
62.
Adverse Effects on Bone Health Lorazepam can have adverse effects on bone
health, particularly in postmenopausal women. Long-term use of the medication
has been associated with an increased risk of osteoporosis and fractures.
Patients taking lorazepam for an extended period of time should discuss the
potential risks with their healthcare provider and may need to undergo bone
density testing.
63.
Rebound Anxiety and Insomnia Lorazepam can cause rebound anxiety and insomnia,
particularly when the medication is abruptly discontinued. Patients should work
with their healthcare provider to gradually taper the dose to avoid these
symptoms.
64.
Adverse Effects on Hearing Lorazepam can have adverse effects on hearing,
potentially causing tinnitus (ringing in the ears) or hearing loss. Patients
should be monitored for signs of hearing impairment, and the medication should
be discontinued if these symptoms occur.
65.
Adverse Effects on Taste and Smell Lorazepam can have adverse effects on taste
and smell, potentially causing changes in the perception of taste or smell.
Patients should be monitored for signs of changes in taste or smell, and the
medication should be discontinued if these symptoms become severe.
66.
Adverse Effects on Blood Sugar Control Lorazepam can have adverse effects on
blood sugar control, potentially causing hypoglycemia (low blood sugar) in
patients with diabetes. Patients with diabetes taking lorazepam should be
closely monitored for signs of hypoglycemia, and the medication should be
discontinued if these symptoms occur.
67.
Adverse Effects on Immune Function Lorazepam can have adverse effects on immune
function, potentially increasing the risk of infections or other immune-related
disorders. Patients taking lorazepam should be monitored for signs of immune
dysfunction, and the medication should be discontinued if these symptoms occur.
68.
Adverse Effects on Wound Healing Lorazepam can have adverse effects on wound
healing, potentially delaying the healing process and increasing the risk of
complications. Patients undergoing surgery or with wounds should avoid taking
lorazepam unless absolutely necessary, and should discuss any concerns with
their healthcare provider.
69.
Adverse Effects on Liver Function Lorazepam can have adverse effects on liver
function, potentially causing liver damage or dysfunction. Patients with
preexisting liver issues should avoid taking lorazepam, and all patients taking
the medication should be monitored for signs of liver dysfunction, such as
jaundice or elevated liver enzymes.
70.
Adverse Effects on Renal Function Lorazepam can have adverse effects on renal
function, potentially causing kidney damage or dysfunction. Patients with
preexisting kidney issues should avoid taking lorazepam, and all patients taking
the medication should be monitored for signs of renal dysfunction, such as
decreased urine output or elevated creatinine levels.
71.
Adverse Effects on Sexual Function Lorazepam can have adverse effects on sexual
function, potentially causing decreased libido, erectile dysfunction, or
difficulty achieving orgasm. Patients should be monitored for signs of sexual
dysfunction, and the medication should be discontinued if these symptoms become
severe.
72.
Adverse Effects on Mood and Behavior Lorazepam can have adverse effects on mood
and behavior, potentially causing irritability, aggression, or other changes in
behavior. Patients should be monitored for signs of mood or behavior changes,
and the medication should be discontinued if these symptoms become severe.
73.
Development of Dependence and Withdrawal Symptoms Lorazepam can cause physical
and psychological dependence, particularly when taken at high doses or for an
extended period of time. Patients who stop taking lorazepam may experience
withdrawal symptoms, including anxiety, insomnia, seizures, and hallucinations.
Patients should work with their healthcare provider to gradually taper the dose
of lorazepam to avoid withdrawal symptoms.
74.
Paradoxical Reactions in Pediatric Patients Lorazepam can cause paradoxical
reactions in pediatric patients, particularly those with attention deficit
hyperactivity disorder (ADHD) or developmental disorders. Paradoxical reactions
can include hyperactivity, agitation, and aggressive behavior. Pediatric
patients taking lorazepam should be closely monitored for signs of paradoxical
reactions, and the medication should be discontinued if these symptoms occur.
75.
Adverse Effects on Memory and Learning Lorazepam can have adverse effects on
memory and learning, potentially causing difficulties with memory recall and
retention. Patients taking lorazepam should be monitored for signs of memory or
learning difficulties, and the medication should be discontinued if these
symptoms become severe.
76.
Adverse Effects on Endocrine Function Lorazepam can have adverse effects on
endocrine function, potentially causing changes in hormone levels or function.
Patients taking lorazepam should be monitored for signs of endocrine
dysfunction, and the medication should be discontinued if these symptoms become
severe.
77.
Adverse Effects on Reproductive Function Lorazepam can have adverse effects on
reproductive function, potentially causing changes in fertility or menstrual
cycles. Patients taking lorazepam should be monitored for signs of reproductive
dysfunction, and the medication should be discontinued if these symptoms become
severe.
78.
Adverse Effects on Cognitive Function in Neonates Lorazepam can have adverse
effects on cognitive function in neonates, particularly when used for sedation
or as a treatment for seizures. Neonates taking lorazepam should be closely
monitored for signs of cognitive dysfunction, and the medication should be
discontinued if these symptoms occur.
79.
Adverse Effects on Pulmonary Function Lorazepam can have adverse effects on
pulmonary function, potentially causing respiratory depression or other
breathing problems. Patients taking lorazepam should be monitored for signs of
respiratory distress, and the medication should be discontinued if these
symptoms become severe.
80.
Adverse Effects on Vision and Eye Health Lorazepam can have adverse effects on
vision and eye health, potentially causing blurred vision, double vision, or
other visual disturbances. Patients taking lorazepam should be monitored for
signs of visual disturbances, and the medication should be discontinued if these
symptoms become severe.
In
summary, lorazepam can cause a wide range of potential side effects that can
affect multiple organ systems and functions, including respiratory depression,
addiction and dependence, mood changes, nausea and vomiting, headache and
dizziness, muscle weakness, skin rash, hypotension, sexual dysfunction, liver
damage, seizures, allergic reactions, withdrawal symptoms, interactions with
other medications, tolerance and dependence, suicidal thoughts, risks to
pregnancy and breastfeeding, falls and fractures, respiratory infections,
gastrointestinal bleeding, cardiovascular effects, vision changes, weight
changes, interference with laboratory tests, impact on immune system, impact on
endocrine system, impact on renal function, behavioral changes, anaphylaxis,
respiratory failure, jaundice, Stevens-Johnson Syndrome, thrombocytopenia,
pancreatitis, hypersensitivity syndrome, interference with psychomotor testing,
disinhibition, withdrawal seizures in neonates, paradoxical reactions,
respiratory arrest, serotonin syndrome, hyponatremia, drug-induced psychosis,
acute narrow-angle glaucoma, severe hypotension and shock, adverse effects on
fertility, adverse effects on hematopoiesis, increased risk of infection,
cognitive impairment in the elderly, development of anterograde amnesia,
psychiatric symptoms in children, teratogenicity, impact on sleep architecture,
gastrointestinal distress, impact on driving and operating heavy machinery,
impact on athletic performance, risk of overdose, metabolic acidosis, adverse
effects on bone health, rebound anxiety and insomnia, adverse effects on
hearing, adverse effects on taste and smell, adverse effects on blood sugar
control, adverse effects on immune function, adverse effects on wound healing,
adverse effects on liver function, adverse effects on renal function, adverse
effects on sexual function, adverse effects on mood and behavior, development of
dependence and withdrawal symptoms, paradoxical reactions in pediatric patients,
adverse effects on memory and learning, adverse effects on endocrine function,
adverse effects on reproductive function, adverse effects on cognitive function
in neonates, adverse effects on pulmonary function, and adverse effects on
vision and eye health. Patients taking lorazepam should be aware of these
potential side effects and should discuss any concerns with their healthcare
provider. Regular monitoring and appropriate dosage adjustments can help to
minimize the risk of side effects and ensure the safe and effective use of
lorazepam. Patients should not abruptly stop taking the medication, and should
instead work with their healthcare provider to gradually taper the dose to avoid
withdrawal symptoms. In addition, patients should avoid drinking alcohol or
taking other central nervous system depressants while taking lorazepam, as this
can increase the risk of side effects and overdose. It is important to follow
all instructions from the healthcare provider and to report any unusual symptoms
or side effects to ensure the safe and effective use of lorazepam.
1, Comparison
of the actions of diazepam and lorazepam
Diazepam and lorazepam differ in potency and in the
time-course of their action. As a sedative, diazepam 10 mg is equivalent to
lorazepam 2-2.5 mg. Diazepam is better absorbed after oral than after i.m.
administrations but this does not apply to lorazepam. The clinical effect and
amnesia begin more rapidly with diazepam, but last longer following lorazepam.
Lorazepam is more effective than diazepam in blocking the emergence sequelae
from ketamine. Lorazepam i.v. is followed by a lesser frequency of venous
thrombosis.
2, The
effects of benzodiazepines on cognition
Initially thought to be virtually free of negative effects, benzodiazepines are
now known to carry risks of dependence, withdrawal, and negative side effects.
Among the most controversial of these side effects are cognitive effects.
Long-term treatment with benzodiazepines has been described as causing
impairment in several cognitive domains, such as visuospatial ability, speed of
processing, and verbal learning. Conversely, long-term benzodiazepine use has
also been described as causing no chronic cognitive impairment, with any
cognitive dysfunction in patients ascribed to sedation or inattention or
considered temporary and associated with peak plasma levels. Complicating the
issue are whether anxiety disorders themselves are associated with cognitive
deficits and the extent to which patients are aware of their own cognitive
problems. In an attempt to settle this debate, meta-analyses of peer-reviewed
studies were conducted and found that cognitive dysfunction did in fact occur in
patients treated long term with benzodiazepines, and although cognitive
dysfunction improved after benzodiazepines were withdrawn, patients did not
return to levels of functioning that matched benzodiazepine-free controls.
Neuroimaging studies have found transient changes in the brain after
benzodiazepine administration but no brain abnormalities in patients treated
long term with benzodiazepines. Such findings suggest that patients should be
advised of potential cognitive effects when treated long term with
benzodiazepines, although they should also be informed that the impact of such
effects may be insignificant in the daily functioning of most patients.
3,
Lorazepam-efficacy, side effects, and rebound phenomena
Lorazepam, 4 mg, was evaluated in an 18-night sleep-laboratory study involving
five insomniac subjects. Hypnotic effectiveness and effects on sleep stages and
related parameters were assessed. Placebo was given on baseline nights 1 to 4,
lorazepam on nights 5 to 11, and placebo was given again on withdrawal nights 12
to 18. Subjective and objective data clearly demonstrated that lorazepam was
effective for both inducing and maintaining sleep. Sleep latency was reduced
from a baseline value of 34.6 min to 17.9 min (P less than 0.01) and total wake
time was reduced from 75.9 to 38.5 min (P less than 0.01). On the third and
fifth nights of drug withdrawal total wake time rose above baseline levels
(termed rebound insomnia) and sleep latency increased by 77% and 60% over
baseline (P less than 0.01). Subjective estimates of daytime anxiety also
increased above baseline (rebound anxiety) during the withdrawal period. All
subjects experienced severe hangover and varying degrees of impaired functioning
during the first 3 days on drug. Three subjects also experienced anterograde
amnesia during the day after the first drug night. These side effects diminished
in intensity over the course of the study. Our results suggest that while 4 mg
lorazepam may be effective in inducing and maintaining sleep, this dose induces
clinically significant side effects that are followed by consistent rebound
phenomena after withdrawal.]
4. Effects
of lorazepam on prosaccades and saccadic adaptation
Background: Benzodiazepines have reliable adverse effects on saccadic eye
movements, but the impact of sex as a potential modulator of these effects is
less clear. A recent study reported stronger adverse effects on the spatial
consistency of saccades in females, which may reflect sex differences in
cerebellar mechanisms.
Aims: We aimed to further examine the role of sex as a potential modulator of
benzodiazepine effects by employing the saccadic adaptation paradigm, which is
known to be sensitive to cerebellar functioning.
Methods: A total of n=50 healthy adults performed a horizontal step prosaccade
task and a saccadic adaptation task under 0.5 mg lorazepam, 1 mg lorazepam and
placebo in a double-blind, within-subjects design.
Results: In the prosaccade task, lorazepam had adverse effects on measures of
peak velocity, latency and spatial consistency. The administration of 0.5 mg
lorazepam led to significant reductions in gain-decrease adaptation, while a
dose of 1 mg did not impair adaptation learning. Gain-increase adaptation was
generally less pronounced, and unaffected by the drug. There were no significant
drug×sex interactions in either task.
Conclusions: We conclude that a low dose of lorazepam impairs gain-decrease
adaptation independent of sex. At higher doses, however, increasing fatigue may
facilitate adaptation and thus counteract the adverse effects observed at lower
doses. With regards to prosaccades, our findings confirm peak velocity as well
as latency and spatial measures as sensitive biomarkers of GABAergic effects.
5. Effects
of Intramuscular Midazolam and Lorazepam on Acute Agitation in Non-Elderly
Subjects - A Systematic Review
Benzodiazepines are commonly used for the treatment of acute agitation in a
psychiatric setting.We searched MEDLINE, EMBASE, PsycINFO, and the Cochrane
Central Register of Controlled Trials (CENTRAL) for relevant publications.
Randomized trials evaluating intramuscular (IM) midazolam or lorazepam given as
monotherapy or as add-on treatment, with more than 10 patients aged 18-65 years,
conducted in a psychiatric setting, and published between January 1, 1980, and
February 3, 2016, were included. 16 studies from a search result of 5 516
studies were included. In total, 577 patients were treated with lorazepam IM 2-4
mg, and 329 patients were treated with midazolam IM 5-15 mg. It is unclear
whether lorazepam IM or midazolam IM is as efficacious as an antipsychotic IM.
It is a bit more certain that the combination of benzodiazepines IM and a low
dose antipsychotic IM is more efficacious than the benzodiazepine and the
antipsychotic alone. However, there is no doubt that benzodiazepines are less
likely to be associated with treatment emergent side effects, as compared to
antipsychotics.
6.
Lorazepam-induced diplopia
Diplopia - seeing double - is a symptom with many potential causes, both
neurological and ophthalmological. Benzodiazepine induced ocular side-effects
are rarely reported. Lorazepam is one of the commonly used benzodiazepine in
psychiatric practice. Visual problems associated with administration of
lorazepam are rarely reported and the frequency of occurrence is not
established. We report a rare case of lorazepam-induced diplopia in a newly
diagnosed case of obsessive compulsive disorder.
7. Acute
lorazepam effects on neurocognitive performance
A double-blind, placebo-controlled, crossover design was employed to determine
whether acute lorazepam (2 mg orally) cognitive side effects would emerge in a
differential age-dependent fashion in 15 young (mean age=22 years) and 12 older
(mean age=64 years) subjects. Acute use of lorazepam is frequently the initial
treatment choice for convulsive status epilepticus or repetitive seizure
clusters. Cognitive assessment was performed during drug and placebo conditions
using a computerized battery of cognitive tests. With the exception of
performance on the reasoning composite score, significant drug effects were
present on all primary cognitive domain measures. However, the only significant
drug-by-age interaction effect was seen for dual-task performance. The
relationship between test performance and plasma lorazepam concentrations was
generally modest and non-significant, suggesting that individual differences in
pharmacokinetics are not a major factor contributing to the emergence of
cognitive side effects. Despite robust lorazepam effects on multiple measures of
neurocognitive function, differential age effects are largely restricted to
dual-task performance. These results indicate that with the exception of
dual-task performance, older individuals in the age range of this study do not
appear to be at increased risk for the emergence of cognitive side effects
following a single 2-mg dose of lorazepam.
8. Efficacy
and side effects of lorazepam, oxazepam, and temazepam as sleeping aids in
psychogeriatric inpatients
The efficacy and side effects of 2 mg of lorazepam, 30 mg of oxazepam, and 20 mg
of temazepam as sleeping aids were investigated in 20 psychogeriatric
inpatients. The drugs were administered in a random order, double-blind, for 7
night each. All of these short half-life benzodiazepines proved efficacious in
maintaining sleep. None of them reduced initial sleep latency. Oxazepam and to a
lesser degree temazepam induced withdrawal insomnia during the first night after
the treatments. The withdrawal of lorazepam induced a delayed but prolonged
insomnia in 3 patients. Both lorazepam and oxazepam had muscle relaxant side
effects after awakening.
9. Effects
of lorazepam on saccadic eye movements: the role of sex, task characteristics
and baseline traits
Background: Saccadic eye movements are controlled by a network of parietal,
frontal, striatal, cerebellar and brainstem regions. The saccadic peak velocity
is an established biomarker of benzodiazepine effects, with benzodiazepines
reliably reducing the peak velocity.
Aims: In this study, we aimed to replicate the effects of benzodiazepines on
peak velocity and we investigated effects on previously less studied measures of
saccades. We also explored the roles of sex, task characteristics and the
baseline variables age, intelligence and trait anxiety in these effects.
Method: Healthy adults ( N = 34) performed a horizontal step prosaccade task
under 1 mg lorazepam, 2 mg lorazepam and placebo in a double-blind,
within-subjects design.
Results: We replicated the dose-dependent reduction in peak velocity with
lorazepam and showed that this effect is stronger for saccades to targets at
smaller eccentricities. We also demonstrated that this effect is independent of
sex and other baseline variables. Lorazepam effects were widespread, however,
occurring on mean and variability measures of most saccadic variables.
Additionally, there were sex-dependent lorazepam effects on spatial consistency
of saccades, indicating more adverse effects in females.
Conclusions: We conclude that saccadic peak velocity is a sensitive and robust
biomarker of benzodiazepine effects. However, lorazepam has pronounced effects
also on other parameters of horizontal saccades. Sex-dependent drug effects on
spatial consistency may reflect cerebellar mechanisms, given the role of the
cerebellum in saccadic spatial accuracy.
10.
Subjective and behavioral effects of diphenhydramine, lorazepam and
methocarbamol: evaluation of abuse liability
The effects of orally administered placebo, diphenhydramine, lorazepam,
methocarbamol and placebo were studied in volunteers with histories of
recreational substance abuse including sedative/hypnotics. Placebo,
diphenhydramine (100, 200 and 400 mg), lorazepam (1 and 4 mg) and methocarbamol
(2.25 and 9 g) were tested in a randomized, double-blind crossover study using
14 subjects. Psychomotor and cognitive performance and subject- and
observer-rated responses were measured daily before and for 5.5 hr after drug
administration. The results showed that each of the drugs exhibited a different
profile of effects on the test battery. Lorazepam produced significant increases
in subjects' ratings of drug effect and liking, increases in measures of
sedation and impairment of psychomotor performance. Methocarbamol also produced
significant increases in subjects' ratings of drug effect and liking and
measures of sedation, but it produced only minor impairment of psychomotor and
cognitive performance. Diphenhydramine increased subjects' and observers'
ratings of drug effect and measures of sedation, but it produced less
psychomotor performance impairment and liking than lorazepam. Diphenhydramine
produced the most side effects. The present study clearly differentiated the
behavioral and subjective profiles of diphenhydramine, lorazepam and
methocarbamol. Consistent with its recognized low abuse liability,
diphenhydramine produced fewer increases in measures of positive mood and more
adverse effects. The considerable overlap in subjective effect measures of
positive mood make further differentiation with respect to abuse liability
difficult.