Lorazepam

Chemically Lorazepam is identified as 7-chloro-5- (o-chlorophenyl)-1, 3-dihydro-3- hydroxy-2H-1, 4 benzodiazepin 2one. Lorazepam is oral and parenteral benzodiazepine used in the treatment of anxiety and status epilepticus. Other uses include perioperative sedation induction and anterograde amnesia. Intravenous it has replaced intravenous diazepam as the drug of choice for the treatment of status epilepticus because it persists in the CSF longer than diazepam. Some clinicians also prefer it over chlordiazepoxide or diazepam for controlling anxiety and agitation during ethanol withdrawal because Lorazepam is not metabolized to active metabolites. It was approved by the FDA in September 1977. The action is mediated through the inhibitory neurotransmitter gamma-aminobutyric acid (GABA).


Adult Dose
Dose: 1 to 4 mg
Single Dose: 2.5 (2.5)
Frequency: 24 hourly
Route: PO
Instructions:
Neonatal
Dose:
Single Dose:
Frequency:
Route:
Instructions: Not recommended in this age group
Paedriatic
Dose: 50 to 0 ug/kg
Single Dose: 25 (25)
Frequency: As recommended.
Route: Oral
Instructions: Dose for 5-12 Years of Children
Characteristics
. It is of Synthetic origin and belongs to Benzodiazepine. It belongs to Chloride Channel Potentiater (GABA operated) pharmacological group on the basis of mechanism of action and also classified in Psychotherapeutic Drugs and Benzodiazepine pharmacological group.The Molecular Weight of Lorazepam is 321.20. Its pKa is 1.3, 11.5.
Contraindications
Lorazepam is contraindicated in conditions like Hypersensitivity.
Effects
Lorazepam produces potentially life-threatening effects which include Acute anaphylactic reactions. which are responsible for the discontinuation of Lorazepam therapy.The signs and symptoms that are produced after the acute overdosage of Lorazepam include Drowsiness, Ataxia, CNS depression, Dysarthria.The symptomatic adverse reactions produced by Lorazepam are more or less tolerable and if they become severe, they can be treated symptomatically, these include Dizziness, Headache, Drowsiness, Nausea, Blurred vision, Confusion.
Indications
Lorazepam is primarily indicated in conditions like Acute nausea and vomiting, Acute panic attacks, All forms of epilepsy, Anxiety, Anxiety associated with obsessional states, Anxiety associated with phobic states, Convulsions, Insomnia, Myoclonus, Pre-operative anxiety, Psychotic illness, Sedation with amnesia, Status epilepticus, and can also be given in adjunctive therapy as an alternative drug of choice in Premedication.
Interactions
Lorazepam is known to interact with other drugs, the details of drug interactions is as follows:DrugDetailsSeverityOnsetManagementAlcoholClarithromycinLofepramine (HCl)Theoretical potential for LORAZEPAM increasing the SEDATIVE effect of LOFEPRAMINE.ModerateMay need to avoid combinationLoxapineThere have been rare reports of significant respiratory depression, stupor and/or hypotension with the concomitant use of loxapine and lorazepam. PemolinePemoline may decrease seizure threshold. Efficacy of anticonvulsants may be decreased PyrimethamineSilymarinSilymarin may interfere with Lorazepam because both drugs are broken down by the same liver enzymes. These interactions are sometimes beneficial and sometimes may pose threats to life. Always consult your physician for the change of dose regimen or an alternative drug of choice that may strictly be required.
Interfrence
Liver Function Test (LFT) Periodic blood countElevation of LDH
Risks
Drug should not be given to Paediatrics, Pregnant Mothers, patients suffering from Kidney dysfunction, patients suffering from Liver Malfunction, and Neonates.If prescribing authority justifies the benefits of the drug against the possible damages he/she should reevaluate them and consult the reference material and previous studies.
Storage
Tab Store in a well closed container, at room temperature.
Warnings
Perform periodic blood counts and liver function tests during long term therapy with lorazepam. It should be used with caution in patients if increased salivation cause respiratory difficulty, because it may produce an increase in salivation. Give least amount of drug to patients in whom depression accompanies anxiety and suicidal tendencies may be present. It should be used with caution (if it contains tartrazine)in patients with aspirin hypersensitivity because it may cause allergic reaction (including bronchial asthma).
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