psychosis Injection contains benzyl alcohol associated with potentially fatal "gasping syndrome" in neonates and an increased incidence of kernicterus, particularly in small preterm infants; if patient requires more than recommended dosages or other medications containing this preservative, practitioner must consider daily metabolic load of benzyl alcohol from combined sources Prolonged use may lead to physical and psychological dependence especially in patients with history of alcohol or drug abuse; risk of dependence is decreased with short-term treatment (eg, 2-4 weeks); evaluate need for continued treatment prior to extending therapy duration Use of drug, particularly in patients at elevated risk, necessitates counseling about risks and proper use of drug along with monitoring for signs and symptoms of abuse, misuse, and addiction; do not exceed recommended dosing frequency Avoid or minimize concomitant use of CNS depressants and other substances associated with abuse, misuse, and addiction (eg, opioid analgesics, stimulants); advise patients on proper disposal of unused drug; if a substance use disorder is suspected, evaluate patient and institute (or refer them for) early treatment, as appropriate For patients using treated more frequently than recommended, to reduce risk of withdrawal reactions, use a gradual taper to discontinue therapy (a patient-specific plan should be used to taper the dose) Patients at an increased risk of withdrawal adverse reactions after benzodiazepine discontinuation or rapid dosage reduction include those who take higher dosages, and those who have had longer durations of use In some cases, benzodiazepine users have developed a protracted withdrawal syndrome with withdrawal symptoms lasting weeks to more than 12 months Use caution in patients with history of suicide attempt or drug abuse Do not withdraw abruptly after prolonged use; terminate dosage gradually Use caution in patients with impaired gag reflex May cause CNS depression, impairing physical and mental abilities; caution patients to not operate dangerous machinery or motor vehicles Anterograde amnesia reported with use Use caution in patients with respiratory disease, including COPD or sleep apnea Hyperactive or aggressive behavior and other paradoxical reactions reported with use Caution patients that tolerance for alcohol and other CNS depressants will be diminished General anesthetics and sedation drugs in young children and pregnant women Brain development Published animal studies demonstrate that administration of anesthetic and sedation drugs that block NMDA receptors and/or potentiate GABA activity increase neuronal apoptosis in developing brain and result in long-term cognitive deficits when used for longer than 3 hours; repeated exposure may also result in negative effects on fetal or young children’s brain development Caution with use during surgeries or procedures in children younger than 3 yr or in pregnant women during their third trimester Assess the risk:benefit ratio in these populations, especially for prolonged procedures (ie, >3 hr) or multiple procedures Pregnancy There is a pregnancy registry that monitors pregnancy outcomes in woman exposed to psychiatric medications; healthcare providers are encouraged to register patients by calling the National Pregnancy Registry for Psychiatric Medication’s at 1-866-961-2388 or visiting online at https://womensmentalhealth.org/pregnancyregistry/Neonates born to mothers using benzodiazepines late in pregnancy have been reported to experience symptoms of sedation and/or neonatal withdrawal; available data from published observational studies of pregnant women exposed to benzodiazepines do not report a clear association with benzodiazepines and major birth defects Benzodiazepines cross the placenta and may produce respiratory depression, hypotonia, and sedation in neonates; monitor neonates exposed to this medication during pregnancy or labor for signs of sedation, respiratory depression, hypotonia, and feeding problems Monitor neonates exposed to therapy during pregnancy for signs of withdrawal; manage these neonates accordingly Advise pregnant females who are administered this medication late in pregnancy that therapy can result in sedation (respiratory depression, lethargy, hypotonia) and/or withdrawal symptoms (hyperreflexia, irritability, restlessness, tremors, inconsolable crying, and feeding difficulties) in newborns; instruct patients to inform their healthcare provider if they are pregnant There are insufficient data regarding obstetrical safety of parenteral lorazepam, including use in cesarean section; such use, therefore, is not recommended Lactation This drug is present in breast milk; there are reports of sedation. poor feeding and poor weight gain in infants exposed to benzodiazepines through breast milk; effects of this drug on milk production are unknown; developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for therapy and any potential adverse effects on breastfed infant from therapy or from the underlying maternal condition Instruct patients to notify their healthcare provider if they are breastfeeding or intend to breastfeed; instruct breastfeeding patients who are administered this therapy to monitor infants for excessive sedation, poor feeding and poor weight gain, and to seek medical attention if they notice these signsPregnancy Categories A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk. B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available. Mechanism of Action Sedative hypnotic with short onset of effects and relatively long half-life; by increasing the action of gamma-aminobutyric acid (GABA), which is a major inhibitory neurotransmitter in the brain, lorazepam may depress all levels of the CNS, including limbic and reticular formation Absorption Bioavailability: 90% Onset: 1-3 min (IV in sedation); 15-30 min (IM in hypnosis) Duration: Up to 8 hr Peak plasma time: 2 hr (tablets); 14 hr (capsules); <3 hr (IM) Peak plasma concentration: 41 ng/mL (tablets); 25 ng/mL (capsules Trough concentration: 29 ng/mL (tablets); 25 ng/mL (capsules) AUC: 765 ng⋅h/mL (tablets); 695 ng⋅h/mL (capsules) Steady-state: 5 days (capsules) Distribution Protein bound: 85-93% Vd: 1.9 L/kg (adolescents); 1.3 L/kg (adults); 0.78 L/kg (neonates); 177 L (capsules) Metabolism Metabolites: Inactive Undergoes glucuronic acid conjugation Elimination Half-life: 18 hr (children 2-12 years); 42 hr (neonates); 28 hr (adolescents); 18 hr (end stage renal disease); 12 hr (tablets, adults); 20.2 hr (capsules, adults) Excretion: Urine (88% mainly as inactive metabolites); feces (7%) IV Incompatibilities Additive: Buprenorphine, dexamethasone sodium phosphate with diphenhydramine and metoclopramide Syringe: Sufentanil Y-site: Aldesleukin, aztreonam, floxacillin, foscarnet, idarubicin, imipenem/cilastatin, omeprazole, ondansetron, sargramostim, sufentanil IV Preparation Parenteral admixture stable for 24 hr at room temp (25°C) Usually given IVP Standard IVP dilution: dilute immediately before use with equal amount of NS or SWI Usual dilution for continuous infusion: 1 mg in 100 mL D5W Discard if discoloration or precipitate IV/IM Administration IM administration Administer deep into muscle mass IV administration Prior to use, dilute injection solution with an equal amount of compatible diluent (D5W, NS, SWFI) Administer IV injection slowly, directly into a vein or into tubing of a free-flowing, compatible IV infusion (eg, NS, D5W), at no more than 2 mg/min Validate patent venous catheter with repeated aspiration during infusion to visualize venous blood return Inadvertent intra-arterial injection may produce arteriospasm resulting in gangrene, potentially requiring amputation Rapid IV infusion may result in apnea, bradycardia, hypotension, cardiac arrest Continuous infusion solutions should have an in-line filter and should be checked frequently for possible precipitation Emergency resuscitative equipment should be available when administering IV Oral Administration Capsules May take with or without food Swallow whole, do not crush or chew Unable to swallow capsule Capsule may be opened and entire contents sprinkled onto a tablespoon of applesauce Swallow mixture without chewing Swallow within 2 hours of mixing; do not store mixture for future use Drink a glass of water after swallowing mixture Discontinuation Gradually taper dose to reduce risk of withdrawal reactions If withdrawal reactions occur, consider pausing the taper or increasing the dosage to the previous tapered dosage level; subsequently decrease dosage more slowly Storage IV/IM injection: Refrigerate intact vials at 2-8°C (36-46°F) and protect contents from light Tablets: Keep tightly closed; store at 25°C (77°F) Oral concentrate: Store at cold temperature; refrigerate at 2-8°C (36-46°F); discard open bottle after 90 days BRAND FORM. UNIT PRICE PILL IMAGE Lorazepam Intensol oral- 2 mg/mL liquidlorazepam injection- 2 mg/mL viallorazepam injection- 2 mg/mL viallorazepam injection- 4 mg/mL viallorazepam injection- 2 mg/mL viallorazepam injection- 4 mg/mL viallorazepam injection- 2 mg/mL viallorazepam injection- 2 mg/mL viallorazepam injection- 2 mg/mL viallorazepam injection- 2 mg/mL viallorazepam injection- 4 mg/mL viallorazepam injection- 2 mg/mL solutionlorazepam injection- 2 mg/mL viallorazepam injection- 4 mg/mL viallorazepam injection- 2 mg/mL viallorazepam injection- 2 mg/mL vialAtivan oral- 2 mg tabletAtivan oral- 1 mg tabletAtivan oral- 0.5 mg tabletlorazepam oral- 1 mg tabletlorazepam oral- 0.5 mg tabletlorazepam oral- 2 mg tabletlorazepam oral- 1 mg tabletlorazepam oral- 0.5 mg tabletlorazepam oral- 2 mg tabletlorazepam oral- 1 mg tabletlorazepam oral- 1 mg tabletlorazepam oral- 0.5 mg tabletlorazepam oral- 0.5 mg tabletlorazepam oral- 2 mg tabletlorazepam oral- 2 mg tabletlorazepam oral- 2 mg/mL liquidlorazepam oral- 0.5 mg tabletlorazepam oral- 2 mg tabletlorazepam oral- 1 mg tabletlorazepam oral- 2 mg/mL liquidlorazepam oral- 2 mg/mL liquidAtivan injection- 4 mg/mL vialAtivan injection- 2 mg/mL vialAtivan injection- 2 mg/mL vialAtivan injection- 4 mg/mL vialAtivan injection- 4 mg/mL vialAtivan injection- 2 mg/mL vialLoreev XR oral- 3 mg capsuleLoreev XR oral- 2 mg capsuleLoreev XR oral- 1 mg capsuleCopyright © 2010 First DataBank, Inc.Select a drug:lorazepam injectionlorazepam oralPrint Patient Educationlorazepam injection LORAZEPAM - INJECTION (lor-AZ-e-pam) COMMON BRAND NAME(S): Ativan WARNING: Lorazepam has a risk for abuse and addiction, which can lead to overdose and death. Using this medication with alcohol or other drugs that can cause drowsiness or breathing problems (especially opioid medications such as codeine, hydrocodone) may cause very serious side effects, including death. To lower your risk, your doctor should have you use the smallest dose of lorazepam that works, and use it for the shortest possible time. Be sure you know how to use lorazepam and what other drugs you should avoid taking with it. See also Drug Interactions section. Get medical help right away if any of these very serious side effects occur: slow/shallow breathing, unusual lightheadedness, severe drowsiness/dizziness, difficulty waking up.Suddenly stopping this medication may cause serious (possibly fatal) withdrawal, especially if you have used it for a long time or in high doses. To prevent withdrawal, your doctor may lower your dose slowly. Tell your doctor or pharmacist right away if you have any withdrawal symptoms such as headaches, trouble sleeping, restlessness, hallucinations/confusion, depression, nausea, or seizures. Withdrawal symptoms may sometimes last weeks to months. USES: This medication is used to treat serious seizures that do not stop (status epilepticus). It is also used before surgeries or procedures to cause drowsiness, decrease anxiety, and cause forgetfulness about the procedure or surgery.Lorazepam belongs to a class of medications called benzodiazepines, which produce a calming effect on the brain and nerves (central nervous system). It is thought to work by increasing the effect of a certain natural chemical (GABA) in the brain. HOW TO USE: See also Warning section.This medication is given by injection into a vein or muscle as directed by your doctor. The dosage is based on your medical condition, age, and response to treatment.If you are giving this medication to yourself at home, learn all preparation and usage instructions from your health care professional. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn how to store and discard medical supplies safely.Do not suddenly stop using this drug without consulting your doctor. Some conditions may become worse when this drug is abruptly stopped. Your dose may need to be gradually decreased.When this medication is used for a long time, it may not work as well. Talk with your doctor if this medication stops working well.Though it helps many people, this medication may sometimes cause addiction. This risk may be higher if you have a substance use disorder (such as overuse of or addiction to drugs/alcohol). Take this medication exactly as prescribed to lower the risk of addiction. Ask your doctor or pharmacist for more details.Tell your doctor if your condition lasts or gets worse. SIDE EFFECTS: See also Warning section.Drowsiness, dizziness, blurred vision, pain/burning/swelling/redness at the injection site, or unsteadiness may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your