Lorazepam
Mechanism of action
Counseling
Monitoring
Adverse drug reactions
Interactions
Warnings/Precautions/Contraindications
Binds to GABA receptors to increase the frequency of opening of the chloride channel --> hyperpolarization
*No active metabolites
Sedation
CNS depressants (alcohol, antidepressants)
Beer's Criteria: avoid use in older adults due to increased BZD sensitivity & risk of impairment
3P
Monitor: Heart rate, BP, liver function, and LDH.
Tmax: 1-6 hours
Indications
Off-label
Concomitant used of BZD w/ opioids: can result In profound sedation, respiratory depression, coma & death
Concomitant used w/ medications that decrease the seizure threshold
Changes in mental alertness and symptoms of anxiety
Concomitant use with alcohol or other CNS depressants
Do not use in later stages of pregnancy as can result in sedation & neonatal withdrawal syndrom
Withdrawal syndrome
Anterograde amnesia
Worsening depression
Patients w/ compromised respiratory function have an increased risk of respiratory depression
On label
Alcohol withdrawal syndrome
Chemotherapy induced N/V
Anxiety
Half-life: 10-20 hours
Advise patient against sudden discontinuation of drug
Instruct patient to avoid alcohol & other CNS depressants
Educate patient on the risks & symptoms of abuse, misuse, addiction & to report symptoms
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CYP3A4 metabolism
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Special Populations
Avoid in older adults, pediatrics, and pregnancy/lactating populations
Regimen
Duration
Initial, 2 to 3 mg/day orally divided into 2 to 3 daily doses
Maintenance, 2 to 6 mg/day orally divided into 2 to 3 daily doses; dose may vary from 1 to 10 mg/day
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Warn female patients to avoid during pregnancy
Generally used short term for symptom relief until preferred therapy (eg, SSRI) is effective (eg, 4 to 6 weeks followed by tapering). Long-term, low-dose (0.5 mg/day) therapy may be considered in select patients when preferred treatments are ineffective or poorly tolerated
Oral Bioavailability: 90 to 93%