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list of medications
Indications
- in conditions of a psychoreactive nature;
- in the treatment of extreme nervous emotional tension and anxiety, in case of psychosomatic disorders, to relieve a panic attack;
- during schizophrenic conditions;
- symptoms of VSD;
- in case of insomnia, which appears due to stress and increased anxiety;
- for the treatment of epileptic conditions (in these cases, the medicine is used as part of a complex treatment);
- during depressive states in which signs of anxiety are observed (used with extreme caution!);
- for headaches that are accompanied by increased muscle tension;
- to eliminate neurosis-like conditions and neuroses in which tension and feelings of anxiety are observed;
- to prevent nausea and vomiting that occurs during chemotherapy;
pharmachologic effect
The active substance of Lorazepam has a central muscle relaxant, hypnotic, anxiolytic, sedative, anticonvulsant and antiemetic effect.
Lorazepam is a medium-acting drug used to treat panic attacks and reduce anxiety. Lorazepam according to the instructions is not effective for acute delusional, hallucinatory, affective disorders, and in the treatment of psychotic disorders such as depression or related anxiety, it is not recommended for use as the main drug.
Long-term use of Lorazepam can lead to tolerance and a gradual decrease in effectiveness, as well as to the development of drug dependence and addiction.
Contraindications
- hypersensitivity to the constituent components of the drug;
- angle-closure glaucoma;
- depressive neuroses;
- myasthenia;
- acute intoxication;
- pregnancy and lactation;
- age up to 13 years (efficacy and safety have not been established);
The medicine is used with caution in the following conditions: during liver damage; heart failure; during hypotensia; with multiple sclerosis; with reduced body weight.
Dosage
Inside. The tablets are taken three times a day. The dosage at one time should be 1 mg.
For a hypnotic effect, the drug is used half an hour before bedtime, the dosage is 1-2 mg. During a state of increased anxiety and excitability, the medicine is taken 6 mg per day.
During premedication, the medication is prescribed one hour before surgery. The dosage of the medicine should be 2.5-5 mg.
When used for seizures, withdrawal of the drug should be done slowly. The treatment period for this disorder is about a week.
Drug interactions
Lorazepam enhances the effect of central nervous system depressants, incl. phenothiazines, narcotic analgesics, barbiturates, antidepressants, hypnotics, anticonvulsants, antihistamines with a sedative effect. Potentiates the effect of general and local anesthetics, enhances the effect of curare-like drugs. When used simultaneously with alcohol, in addition to enhancing the inhibitory effect on the central nervous system, paradoxical reactions are possible (psychomotor agitation, aggressive behavior, state of pathological intoxication). Nicotine inhibits the activity of lorazepam (accelerates its metabolism).
How to use Lorazepam
Adults are usually prescribed Lorazepam in a daily dose of 2 mg, divided into 3 doses. It is recommended to take half the daily dose in the morning and afternoon, and the second half immediately before bed.
Depending on the symptoms, the dosage of Lorazepam may vary:
- In neurological practice – 1 mg up to 3 times a day;
- To relieve agitation, 2 mg of Lorazepam is used as an intravenous injection.
The maximum daily dose for oral administration is 10 mg; for intramuscular and intravenous administration, a single dose should not exceed 4 mg of Lorazepam.
With abrupt withdrawal of Lorazepam, withdrawal syndrome may develop, which manifests itself as:
- Insomnia;
- Increased anxiety;
- Shiver;
- Irritability and increased reaction to auditory, tactile or light stimuli;
- Gastrointestinal disorders;
- Excitation;
- Headache and muscle pain;
- Convulsions and psychotic states.
Caution should be exercised when using Lorazepam simultaneously with drugs that have a depressant effect on the central nervous system and with ethanol-containing drugs, since such a combination of drugs can lead to the development of aggressiveness, psychomotor agitation and pathological intoxication. It should also be taken into account that nicotine reduces the activity of Lorazepam.
Side effects
From the nervous system and sensory organs: lethargy, fatigue, drowsiness, disorientation, headache, dizziness, depression, ataxia, sleep disturbance, agitation, visual impairment, episodes of amnesia.
From the gastrointestinal tract: dry mouth, nausea, vomiting, diarrhea, change in appetite.
From the skin: erythema, urticaria.
Other: changes in blood composition (leukopenia), increased LDH activity.
The development of addiction, drug dependence, withdrawal syndrome, rebound syndrome is possible (see “Special Instructions”).
Indications for use of Lorazepam
According to the instructions, Lorazepam should be used for:
- Sleep disorders caused by anxiety or short-term stressful situations;
- Epilepsy and status epilepticus, most often as part of combination therapy;
- Psychoreactive states and phobias;
- Emotional reactive states;
- Psychosomatic disorders and headaches due to respiratory, gastrointestinal, cardiovascular and other diseases of internal organs;
- Endogenous psychoses, including manic and catatonic states, as well as states of anxiety and agitation in schizophrenia;
- Panic disorders;
- Acute alcoholic delirium;
- Neuroses and neurosis-like states;
- Symptomatic convulsive states.
special instructions
Use with caution in patients with depression, given suicidal tendencies. In patients with drug and alcohol dependence, use under close medical supervision.
Side effects are usually observed at the beginning of therapy. The possibility of a more frequent occurrence of side effects in elderly and debilitated patients should be taken into account.
During treatment and for 2 days after its completion, it is necessary to avoid drinking alcoholic beverages; Drivers of vehicles and people whose work requires quick mental and physical reactions, and is also associated with increased concentration, should not engage in professional activities during this period.
With prolonged use, addiction and drug dependence may occur (especially when taking high doses). Therefore, lorazepam should not be used for longer than 4–6 weeks. If long-term treatment is necessary, you should periodically take weekly breaks from taking the drug. If treatment is abruptly stopped, withdrawal syndrome may occur (tremor, convulsions, abdominal or muscle spasms, vomiting, perspiration), and symptoms similar to those of the disease may also occur (anxiety, agitation, irritability, emotional tension, insomnia, convulsions).
With long-term use, it is necessary to periodically monitor the picture of peripheral blood, liver and kidney function.
Please note that anxiety or tension associated with everyday stress does not usually require treatment with anxiolytics.
Lorazepam
Lorazepam must be used under strict medical supervision.
If after 7-14 days of use of the drug there is no relief from the symptoms of the disease or a relapse occurs, the patient should consult a doctor.
Regular use of benzodiazepines or drugs with similar effects, incl. lorazepam, over a period of several weeks, may lead to a decrease in the effectiveness of their action as a result of the development of tolerance.
The use of lorazepam can lead to the development of mental and physical drug dependence. The risk of developing drug dependence increases with the dose and duration of treatment and increases in patients with alcohol dependence, with drug dependence, as well as in patients with dependence on other medications.
If drug dependence develops, abrupt cessation of lorazepam use may lead to withdrawal symptoms.
Characteristic manifestations of withdrawal syndrome are: headache, increased irritability, muscle pain, psychomotor agitation and emotional stress, motor restlessness, confusion and disorientation, sleep disturbance.
In severe cases, the following may appear: loss of a sense of the reality of the environment (derealization), personality disorders (depersonalization), increased sensitivity to touch (tactile hypersthesia), increased sensitivity to auditory and visual stimuli (acoustic and light hypersthesia), a feeling of “crawling” and numbness limbs, hallucinations or seizures.
Abrupt cessation of long-term treatment during which lorazepam is used in higher than average doses can be especially dangerous. In this case, the manifestations of withdrawal syndrome are more pronounced.
There is evidence that in the case of short-acting benzodiazepines and benzodiazepine-like drugs, manifestations of withdrawal symptoms can be observed even between doses, especially if the drug is used in large doses.
After treatment ends, there may be a temporary relapse of symptoms that are more severe than those that caused the initial treatment (so-called rebound insomnia). These symptoms are often accompanied by mood changes, fear, anxiety, and increased physical activity. The likelihood of developing withdrawal symptoms or rebound insomnia increases when the drug is abruptly stopped.
It is recommended to gradually reduce the dose of the drug in order to minimize the risk of such symptoms.
Lorazepam, like benzodiazepines and drugs of similar action, can cause anterograde amnesia. This condition most often occurs several hours after taking the drug, especially in a large dose. In order to minimize the risk of developing amnesia, it is recommended to use lorazepam half an hour before bedtime and ensure conditions for uninterrupted 7-8 hours of sleep.
Lorazepam, like benzodiazepines and drugs of similar action, can cause paradoxical reactions, such as psychomotor agitation, increased irritability, aggressiveness, nightmares, hallucinations, psychosis, somnambulism, depersonalization disorders expressed by sleep disturbances and other behavioral side effects. These reactions are much more common in older patients.
If such symptoms occur, you must immediately stop treatment with the drug.
Lorazepam should be used with great caution in elderly patients (over 65 years of age), due to the increase in adverse events in this age group, mainly impaired orientation and coordination of movements, which can lead to loss of balance.
The drug should be used with caution in patients with chronic respiratory failure, since it has been established that benzodiazepines have a depressant effect on the respiratory center.
Lorazepam should be used with caution in patients with symptoms of depression. These patients may experience suicidal thoughts. Due to the possibility of intentional overdose, these patients should be prescribed lorazepam in the lowest possible doses.
Also, benzodiazepines and drugs with similar effects should not be used as the sole treatment for depression or anxiety associated with depression. Monotherapy with these drugs may increase suicidal tendencies.
Benzodiazepines and drugs with similar effects should be used with great caution in patients with a history of alcohol, drug or drug dependence. These patients should be under strict medical supervision while taking lorazepam, because are at risk of developing addiction, mental and physical dependence.
Lorazepam should be used with caution in patients with non-acute porphyria. The use of the drug may increase the symptoms of this disease.
During long-term therapy with the drug, periodic blood tests (morphological analysis with smear) and urine analysis are indicated.
