Anti-anxiety: lorazepam, Ativan, Temesta
Generic Name: lorazepam
Brand Name(s): Ativan, Temesta
Common Use: Antianxiety agent
Anxiolytic - Sedative
Lorazepam is a benzodiazepine with CNS depressant, anxiolytic
and sedative properties. Anterograde amnesia, decreased or lack of recall
of events during period of drug action, has been reported after administration
of lorazepam and appears to be dose-related.
The short-term relief of manifestations of excessive anxiety
in patients with anxiety neurosis. Adjunct for the relief of excessive anxiety
that might be present prior to surgical procedures. Anxiety and tension associated
with the stresses of everyday life usually do not require treatment with anxiolytic
drugs.
Contraindications
Myasthenia gravis, acute narrow angle glaucoma, known hypersensitivity
to benzodiazepines. Lorazepam injectable is also contraindicated in patients
with known hypersensitivity to polyethylene glycol, propylene glycol or benzyl
alcohol.
Lorazepam should not be injected intraarterially and care should be taken
to prevent its extravasation into tissue adjacent to an artery because of
the danger of producing arteriospasm resulting in gangrene which may require
amputation.
Adverse Side Effects
Drowsiness is the most frequently reported adverse effect.
Other reported adverse effects are dizziness, weakness, fatigue and lethargy,
disorientation, ataxia, anterograde amnesia, nausea, change in appetite, change
in weight, depression, blurred vision and diplopia, psychomotor agitation,
sleep disturbance, vomiting, sexual disturbance, headache, skin rashes, gastrointestinal,
ear, nose and throat, musculoskeletal and respiratory disturbances. Release
of hostility and other paradoxical effects, such as irritability and excitability
have occurred with benzodiazepines. In addition, hypotension, mental confusion,
slurred speech, oversedation and abnormal liver and kidney function tests
and hematocrit values have been reported with these drugs.
The most frequent adverse effects seen with injectable lorazepam
are an extension of the CNS depressant effects of the drug. Excessive sleepiness
and drowsiness are the main side effects: the incidences reported depended
on the dosage, route of administration, concomitant use of other CNS depressants
and the investigators' expectations concerning the degree and duration of
sedation. When injectable lorazepam was given i.v., patients over 50 years
of age had a higher incidence of excessive sedation than patients under 50
years of age. Restlessness, confusion, depression, crying, sobbing, delerium,
hallucinations, dizziness, diplopia have been reported. Hypertension and hypotension
have occasionally been observed after injectable lorazepam.
Respiratory depression and partial airway obstruction have been
observed after injectable lorazepam. Skin rash, nausea and vomiting have been
noted occasionally in patients who have received injectable lorazepam combined
with other drugs during anesthesia and surgery.
Overdose
With benzodiazepines, including lorazepam, symptoms of mild
overdosage include drowsiness, mental confusion and lethargy. In more serious
overdosage, symptoms may include ataxia, hypotonia, hypotension, hypnosis,
stages I to III coma and, very rarely, death. In the case of an oral overdose,
if vomiting has not occurred spontaneously and the patient is fully awake,
it may be induced with 20 to 30 mL of ipecac syrup USP. Institute gastric
lavage as soon as possible, and introduce 50 to 100 g of activated charcoal
to the stomach and allow it to remain there. Institute general supportive
therapy as indicated.
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