Lorazepam

Lorazepam, sold under the brand name Ativan among others, is a benzodiazepine medication. It is used to treat anxiety (including anxiety disorders), insomnia, severe agitation, active seizures including status epilepticus, alcohol withdrawal, and chemotherapy-induced nausea and vomiting. It is also used during surgery to interfere with memory formation, to sedate those who are being mechanically ventilated, and, along with other treatments, for acute coronary syndrome due to cocaine use. It can be given orally (by mouth), transdermally (on the skin via a topical gel or patch), intravenously (injection into a vein), or intramuscularly (injection into a muscle). When given by injection, onset of effects is between one and thirty minutes and effects last for up to a day.

Common side effects include weakness, sleepiness, dizziness, decreased alertness, decreased memory formation, low blood pressure, and a decreased effort to breathe. When given intravenously, the person is typically closely monitored. Among those who are depressed, there may be an increased risk of suicide. With long-term use, tolerance may develop, with larger doses required for the same effect. Physical dependence and psychological dependence may also occur. If stopped suddenly after long-term use, benzodiazepine withdrawal syndrome may occur. Older people more often develop adverse effects. In this age group, lorazepam is associated with falls and hip fractures. Due to these concerns, lorazepam use is generally recommended for up to four weeks.

Lorazepam was initially patented in 1963 and went on sale in the United States in 1977. It is on the World Health Organization's List of Essential Medicines. It is available as a generic medication. In 2023, it was the 100th most commonly prescribed medication in the United States, with more than 6 million prescriptions.

Lorazepam is used in the short-term management of severe anxiety. In the US Food and Drug Administration (FDA) advises against use of benzodiazepines such as lorazepam for longer than four weeks. It is fast-acting, and useful in treating fast-onset anxiety and panic attacks.

Lorazepam can effectively reduce agitation and induce sleep, and the duration of effects from a single dose makes it an appropriate choice for the short-term treatment of insomnia, especially in the presence of severe anxiety or night terrors. It has a fairly short duration of action.

Withdrawal symptoms, including rebound insomnia and rebound anxiety, may occur after seven days of use of lorazepam.

Intravenous diazepam or lorazepam are first-line treatments for convulsive status epilepticus. Lorazepam is more effective than diazepam and intravenous phenytoin in the treatment of status epilepticus and has a lower risk of continuing seizures that might require additional medication. However, phenobarbital has a superior success rate compared to lorazepam and other drugs, at least in the elderly.

Lorazepam's anticonvulsant properties and pharmacokinetic profile make intravenous use reliable for terminating acute seizures, but induce prolonged sedation. Orally administered benzodiazepines, including lorazepam, are occasionally used as long-term prophylactic treatment of resistant absence seizures; because of gradual tolerance to their anti-seizure effects, benzodiazepines are not considered first-line therapies. Additionally, common seizure characteristics (e.g., hypersalivation, jaw-clenching, involuntary swallowing) pose some difficulties with regard to oral administration.