lor-AZ-e-pam
Therapeutic Classification: analgesic adjuncts, antianxiety agents, sedative/hypnotics
Pharmacologic Classification: benzodiazepines
IV:
BEERS REMS, High Alert
Absorption: Well absorbed following oral administration. Rapidly and completely absorbed following IM administration. Sublingual absorption is more rapid than oral and is similar to IM. IV administration results in complete bioavailability.
Distribution: Widely distributed. Crosses the blood-brain barrier.
Half-Life: Full-term neonates: 18–73 hr; Older children: 6–17 hr; Adults: 10–16 hr.
(sedation)
| ROUTE | ONSET | PEAK | DURATION |
|---|---|---|---|
| PO | 15–60 min | 1–6 hr | 8–12 hr |
| PO-XR | unknown | unknown | unknown |
| IM | 30–60 min | 1–2 hr‡ | 8–12 hr |
| IV | 15–30 min | 15–20 min | 8–12 hr |
‡Amnestic response.
Contraindicated in:
Use Cautiously in:
CV: bradycardia, hypotension, rapid IV use onlyAPNEA, CARDIAC ARREST
Derm: rash
EENT: blurred vision
GI: constipation, diarrhea, nausea, vomiting
Neuro: dizziness, drowsiness, lethargy, ataxia, confusion, forgetfulness, hangover, headache, mental depression, rhythmic myoclonic jerking (in preterm infants), paradoxical excitation, slurred speech
Resp: RESPIRATORY DEPRESSION
Misc: physical dependence, psychological dependence, tolerance
Drug-drug:
Use with opioids or other CNS depressants, including other benzodiazepines, nonbenzodiazepine sedative/hypnotics, anxiolytics, general anesthetics, muscle relaxants, antipsychotics, and alcohol, may cause profound sedation, respiratory depression, coma, and death; reserve concurrent use for when alternative treatment options are inadequate.
Drug-Natural Products:
Status Epilepticus
Preanesthetic
Anxiety
Assess risk for addiction, abuse, or misuse before administration and periodically during therapy.
Prolonged high-dose therapy may lead to psychological or physical dependence. Restrict the amount of drug available to patient. Assess regularly for continued need for treatment.
Lab Test Considerations:
Toxicity and Overdose:
Gradually taper to discontinue or ↓ dose to ↓ risk of withdrawal reactions, seizures, and status epilepticus. If a patient develops withdrawal reactions, consider pausing taper or ↑ dose to previous tapered dose level. Subsequently ↓ dose more slowly. Some patients may require longer tapering period (weeks to >12 mo).
IV Administration:
IV lorazepam is a vesicant. If extravasation occurs, immediately stop infusion. Leave needle/cannula in place temporarily but do not flush the line. Gently aspirate extravasated solution; then remove needle/cannula. Elevate patient's extremity and apply dry cold compresses.
Caution patient not to stop taking lorazepam without consulting health care provider. Abrupt withdrawal may cause sweating, vomiting, muscle cramps, tremors, and seizures; may be life-threatening.
Advise patient that lorazepam is a drug with known abuse potential. Protect it from theft, and never give to anyone other than the individual for whom it was prescribed. Store out of sight and reach of children and in a location not accessible by others.
Advise patient to avoid the use of alcohol or other CNS depressants, including opioids, concurrently with lorazepam; may cause respiratory depression and overdose. Instruct patient to consult health care provider before taking Rx, OTC, or herbal products concurrently with this medication.
