lorazepam: clinical use

Prescribing considerations

• Confirm that the indication and selected formulation match the relevant product licence.
• Discuss dependence, addiction, rebound and withdrawal before starting, with an individual stopping strategy where applicable.
• Assess concurrent opioids, alcohol and other central nervous system depressants.
• Use particular caution in older or debilitated patients and those with respiratory, renal or hepatic impairment, depression, suicidality, substance dependence or increased falls risk.
• Injection requires trained administration, airway and ventilation facilities, and post-administration observation.

Contraindications and cautions

• Hypersensitivity to lorazepam, another benzodiazepine or formulation excipients.
• Myasthenia gravis.
• Severe respiratory insufficiency or acute pulmonary insufficiency, depending on the product.
• Sleep apnoea syndrome.
• Severe hepatic insufficiency.
• Additional product-specific contraindications apply; for example, the selected orodispersible product excludes acute alcohol or CNS-depressant intoxication, previous alcohol or drug dependence and children below its licensed age threshold.

Monitoring

• Clinical response, excessive sedation, cognition, coordination and falls risk.
• Respiratory status, particularly with injection, opioids or underlying respiratory disease.
• Signs of misuse, tolerance, dependence and withdrawal.
• Mood, behavioural disinhibition, paradoxical reactions and suicidality.
• Infant alertness, breathing, feeding and weight gain when used during breastfeeding.

Clinical pharmacology

Lorazepam is a benzodiazepine GABA-A positive allosteric modulator. Oral absorption is high; it undergoes glucuronidation to a pharmacologically inactive metabolite and has no major active metabolites.

Formulation and product differences

• Conventional tablets are swallowed and selected products contain lactose.
• The oral solution is measured with its supplied syringe, contains ethanol and requires refrigerated storage.
• The orodispersible tablet dissolves in the mouth, may be taken independently of meals and contains lactose.
• The injection is for intravenous or intramuscular professional use and contains benzyl alcohol and propylene glycol; its excipients and respiratory risks require specific precautions.

Dispersible tablet

Route: Oral

Strengths: 1 mg

Oral solution

Route: Oral

Strengths: 1 mg/mL

Tablet

Route: Oral

Strengths: 0.5 mg, 1 mg, 2.5 mg