Ativan

Name: Ativan

How should this medicine be used?

Lorazepam comes as a tablet and concentrate (liquid) to take by mouth. It usually is taken two or three times a day and may be taken with or without food. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take lorazepam exactly as directed.

Lorazepam concentrate (liquid) comes with a specially marked dropper for measuring the dose. Ask your pharmacist to show you how to use the dropper. Dilute the concentrate in 1 ounce (30 milliliters) or more of water, juice, or carbonated beverages just before taking it. It also may be mixed with applesauce or pudding just before taking the dose.

Lorazepam can be habit-forming. Do not take a larger dose, take it more often, or for a longer time than your doctor tells you to. Tolerance may develop with long-term or excessive use, making the drug less effective. Do not take lorazepam for more than 4 months or stop taking this medication without talking to your doctor. Stopping the drug suddenly can worsen your condition and cause withdrawal symptoms (anxiousness, sleeplessness, and irritability). Your doctor probably will decrease your dose gradually.

Do I need a prescription for Ativan (lorazepam)?

Yes

Cautions for Ativan

Contraindications

Pending revision, the material in this section should be considered in light of more recently available information in the MedWatch notification at the beginning of this monograph.

  • Known hypersensitivity to benzodiazepines or any ingredient in the formulation (e.g., benzyl alcohol, polyethylene glycol, or propylene glycol in the injection).

  • Acute angle-closure glaucoma (but may be administered to patients with open-angle glaucoma who are receiving appropriate therapy);c d however, clinical rationale for this contraindication has been questioned.b

  • Injection contraindicated in patients with sleep apnea.

  • Injection contraindicated in patients with severe respiratory insufficiency, except in those patients receiving mechanical ventilation requiring relief of anxiety and/or diminished recall of events.

Warnings/Precautions

Warnings

Respiratory and Cardiovascular Effects

Use oral lorazepam with caution in patients with compromised respiratory function (e.g., chronic pulmonary insufficiency, sleep apnea).b c

Possible apnea, hypotension, bradycardia, or cardiac arrest with parenteral administration, particularly in geriatric or severely ill patients, in patients with limited pulmonary reserve or unstable cardiovascular status, or if the drug is administered IV too rapidly.b

Concomitant use of other CNS depressants may increase the risk of apnea.a c

Administer IV only in settings in which continuous monitoring of respiratory and cardiac function (i.e., pulse oximetry) is possible. Monitoring of vital signs should continue during recovery period.

Facilities, age- and size-appropriate equipment for bag/mask/valve ventilation and intubation, drugs, and skilled personnel necessary for ventilation and intubation, administration of oxygen, assisted or controlled respiration, airway management, and cardiovascular support should be immediately available when lorazepam is administered IV.d

Status Epilepticus

Should be used for the treatment of status epilepticus only by clinicians experienced in the comprehensive management of the disease.

Careful monitoring of respiratory rate and maintenance of an adequate, patent airway is required; ventilatory support may be necessary.

Because of the prolonged duration of action, sedative effects of lorazepam (especially after multiple doses) may increase impairment of consciousness observed in the postictal state.

CNS Effects

Performance of activities requiring mental alertness and physical coordination (operating machinery, driving a motor vehicle) may be impaired.a b c Impairment may persist for 24–48 hours following parenteral administration.a d Premature ambulation may result in falls.d

Concurrent use of other CNS depressants may cause additive or potentiated CNS depression.a b c d (See Specific Drugs under Interactions.)

May interfere with assessment of level of anesthesia when administered IV prior to regional or local anesthesia, especially when given at doses >0.5 mg/kg or when opiate agonists or partial agonists are used concomitantly with recommended lorazepam doses.a d

Psychiatric Indications

Do not use in patients with depressive neuroses or psychotic reactions in which anxiety is not prominent.a c

Abuse Potential

Possible tolerance, psychologic dependence, and physical dependence following prolonged administration.b

Patients with a history of drug or alcohol dependence or abuse are at risk of habituation or dependence; use only with careful surveillance in such patients.b c

Withdrawal

Symptoms of withdrawal (similar to barbiturates or alcohol) may occur if discontinued abruptly.a c Symptoms may be relieved by tapering the dosage.a c

Endoscopic Procedures

Insufficient data to support use for outpatient endoscopic procedures; when used for inpatient endoscopic procedures, adequate recovery room observations required.d

General Precautions

Suicide

Possibility of suicide in depressed patients; prescribe drug in the smallest feasible quantity.b c

Paradoxical Reactions

Paradoxical reactions (e.g., anxiety, excitation, hostility, aggression, rage, sleep disturbances/insomnia, sexual arousal, hallucinations) may occur, particularly in children and geriatric patients.b c Discontinue drug if such reactions occur.b c

Propylene Glycol or Polyethylene Glycol Toxicity

Possible adverse effects associated with propylene glycol (e.g., lactic acidosis, hyperosmolality, hypotension) or polyethylene glycol (e.g., acute tubular necrosis) in patients receiving higher than recommended parenteral dosages. More likely to occur in patients with renal impairment.

Specific Populations

Pregnancy

Category D.d

Lactation

Distributed into milk.d

Administer orally to nursing women only if the potential benefits to the woman outweigh the possible risk to the infant. Monitor nursing infants for adverse effects (e.g., sedation, irritability).

Do not administer lorazepam injection to nursing women, because of possible adverse effects (e.g., sedation).

Pediatric Use

Safety and efficacy of tablets and oral concentrate solution not established in children <12 years of age.

Safety of the injection for treatment of status epilepticus or efficacy for preoperative sedation not established in children <18 years of age.

Paradoxical excitation (e.g., tremors, agitation, euphoria, logorrhea, brief episodes of visual hallucinations) reported in 10–30% of children <8 years of age.

Seizures and myoclonus reported in pediatric patients, especially low birth weight neonates, receiving lorazepam injection. Brief tonic-clonic seizures reported in children receiving lorazepam for the management of atypical petit mal status epilepticus.

Some pediatric patients (premature and low-birth weight infants or those receiving high doses of the injection) may be susceptible to adverse effects associated with benzyl alcohol, polyethylene glycol, and propylene glycol. Large amounts of benzyl alcohol (i.e., 100–400 mg/kg daily) have been associated with toxicity in neonates; each mL of lorazepam injection contains 2 mg of benzyl alcohol.d (See Propylene Glycol or Polyethylene Glycol Toxicity under Cautions.)

Geriatric Use

Insufficient experience in patients ≥65 years of age to determine whether geriatric patients respond differently than younger adults. Possibility of greater sensitivity to the drug (e.g., respiratory or CNS depression) in some geriatric individuals.d

Select initial dosages at the lower end of the usual range because of potential for greater sensitivity and age-related decreases in hepatic or renal function. (See Geriatric Patients under Dosage and Administration.)

May cause excessive sedation for 6–8 hours or longer after surgery in this population.

Possible paradoxical excitation (e.g., anxiety, excitation, hostility, aggression, rage, sleep disturbances/insomnia, sexual arousal, hallucinations).b c

Hepatic Impairment

Lorazepam injection is not recommended for use in patients with hepatic failure; may be used in patients with mild to moderately severe hepatic disease.d (See Hepatic Impairment under Dosage and Administration.)

Oral lorazepam may exacerbate hepatic encephalopathy; therefore, use with caution in patients with severe hepatic insufficiency and/or encephalopathy.

Renal Impairment

Lorazepam injection is not recommended for use in renal failure; use with caution in patients with mild to moderate renal disease.a d (See Renal Impairment under Dosage and Administration.)

Common Adverse Effects

With oral therapy, sedation, dizziness, weakness, unsteadiness.c

With parenteral therapy for the management of status epilepticus, hypotension, somnolence, respiratory failure; with parenteral therapy for preoperative use, excessive sleepiness, drowsiness.d

Ativan Pharmacokinetics

Absorption

Bioavailability

Readily absorbed from the GI tract following oral administration; absolute bioavailability is 90%.c

Completely and rapidly absorbed following IM administration.d

Peak plasma concentrations are attained in approximately 2 hours following oral administrationc and within 3 hours following IM administration.d

Onset

After IV administration, the onset of anticonvulsant, anxiolytic, or sedative action occurs in 1–5 minutes.b

After IM administration, the onset of action is 15–30 minutes.b

Duration

After IV or IM administration, the duration of anticonvulsant, anxiolytic, or sedative action is 12–24 hours.b

Distribution

Extent

Widely distributed into body tissues; crosses the blood-brain barrier.b d

Crosses the placenta and is distributed into milk.b d

Plasma Protein Binding

Approximately 85–91%.b c d

Elimination

Metabolism

Extensively metabolized in the liver to inactive metabolites.c d

Elimination Route

Excreted principally in urine as metabolites.c d

Half-life

10–20 hours.b c d

Special Populations

In neonates, clearance reduced by 80% compared with healthy adults.d

In geriatric patients or patients with hepatic cirrhosis, clearance not substantially altered.b d

In patients with renal impairment, clearance of lorazepam glucuronide is reduced, but total clearance of lorazepam is not altered following single IV dose.d

Precautions

General

The additive central-nervous-system effects of other drugs, such as phenothiazines, narcotic analgesics, barbiturates, antidepressants, scopolamine, and monoamine-oxidase inhibitors, should be borne in mind when these other drugs are used concomitantly with or during the period of recovery from Ativan Injection (see CLINICAL PHARMACOLOGY and WARNINGS).

Extreme caution must be used when administering Ativan Injection to elderly patients, very ill patients, or to patients with limited pulmonary reserve because of the possibility that hypoventilation and/or hypoxic cardiac arrest may occur. Resuscitative equipment for ventilatory support should be readily available (see WARNINGS and DOSAGE AND ADMINISTRATION).

When lorazepam injection is used IV as the premedicant prior to regional or local anesthesia, the possibility of excessive sleepiness or drowsiness may interfere with patient cooperation in determining levels of anesthesia. This is most likely to occur when greater than 0.05 mg/kg is given and when narcotic analgesics are used concomitantly with the recommended dose (see ADVERSE REACTIONS).

As with all benzodiazepines, paradoxical reactions may occur in rare instances and in an unpredictable fashion (see ADVERSE REACTIONS). In these instances, further use of the drug in these patients should be considered with caution.

There have been reports of possible propylene glycol toxicity (e.g., lactic acidosis, hyperosmolality, hypotension) and possible polyethylene glycol toxicity (e.g., acute tubular necrosis) during administration of Ativan Injection at higher than recommended doses. Symptoms may be more likely to develop in patients with renal impairment.

Information for Patients

Patients should be informed of the pharmacological effects of the drug, including sedation, relief of anxiety, and lack of recall, the duration of these effects (about 8 hours), and be apprised of the risks as well as the benefits of therapy.

Patients who receive Ativan Injection as a premedicant should be cautioned that driving a motor vehicle, operating machinery, or engaging in hazardous or other activities requiring attention and coordination, should be delayed for 24 to 48 hours following the injection or until the effects of the drug, such as drowsiness, have subsided, whichever is longer. Sedatives, tranquilizers and narcotic analgesics may produce a more prolonged and profound effect when administered along with injectable Ativan. This effect may take the form of excessive sleepiness or drowsiness and, on rare occasions, interfere with recall and recognition of events of the day of surgery and the day after.

Patients should be advised that getting out of bed unassisted may result in falling and injury if undertaken within 8 hours of receiving lorazepam injection. Since tolerance for CNS depressants will be diminished in the presence of Ativan Injection, these substances should either be avoided or taken in reduced dosage. Alcoholic beverages should not be consumed for at least 24 to 48 hours after receiving lorazepam injectable due to the additive effects on central-nervous-system depression seen with benzodiazepines in general. Elderly patients should be told that Ativan Injection may make them very sleepy for a period longer than 6 to 8 hours following surgery.

EFFECT OF ANESTHETIC AND SEDATION DRUGS ON EARLY BRAIN DEVELOPMENT

Studies conducted in young animals and children suggest repeated or prolonged use of general anesthetic or sedation drugs in children younger than 3 years may have negative effects on their developing brains. Discuss with parents and caregivers the benefits, risks, and timing and duration of surgery or procedures requiring anesthetic and sedation drug (See WARNINGS/Pediatric Neurotoxicity).

Laboratory Tests

In clinical trials, no laboratory test abnormalities were identified with either single or multiple doses of Ativan Injection. These tests included: CBC, urinalysis, SGOT, SGPT, bilirubin, alkaline phosphatase, LDH, cholesterol, uric acid, BUN, glucose, calcium, phosphorus, and total proteins.

Drug Interactions

INTERACTION WITH BENZODIAZEPINES AND OTHER CNS DEPRESSANTS

The concomitant use of benzodiazepines and opioids increases the risk of respiratory depression because of actions at different receptor sites in the CNS that control respiration. Benzodiazepines interact at GABAA sites and opioids interact primarily at mu receptors. When benzodiazepines and opioids are combined, the potential for benzodiazepines to significantly worsen opioid-related respiratory depression exists. Monitor patients closely for respiratory depression and sedation.

Ativan Injection, like other injectable benzodiazepines, produces additive depression of the central nervous system when administered with other CNS depressants such as ethyl alcohol, phenothiazines, barbiturates, MAO inhibitors, and other antidepressants.

When scopolamine is used concomitantly with injectable lorazepam, an increased incidence of sedation, hallucinations and irrational behavior has been observed.

There have been rare reports of significant respiratory depression, stupor and/or hypotension with the concomitant use of loxapine and lorazepam.

Marked sedation, excessive salivation, ataxia, and, rarely, death have been reported with the concomitant use of clozapine and lorazepam.

Apnea, coma, bradycardia, arrhythmia, heart arrest, and death have been reported with the concomitant use of haloperidol and lorazepam.

The risk of using lorazepam in combination with scopolamine, loxapine, clozapine, haloperidol, or other CNS-depressant drugs has not been systematically evaluated. Therefore, caution is advised if the concomitant administration of lorazepam and these drugs is required.

Concurrent administration of any of the following drugs with lorazepam had no effect on the pharmacokinetics of lorazepam: metoprolol, cimetidine, ranitidine, disulfiram, propranolol, metronidazole, and propoxyphene. No change in Ativan dosage is necessary when concomitantly given with any of these drugs.

LORAZEPAM-VALPROATE INTERACTION

Concurrent administration of lorazepam (2 mg intravenously) with valproate (250 mg twice daily orally for 3 days) to 6 healthy male subjects resulted in decreased total clearance of lorazepam by 40% and decreased formation rate of lorazepam glucuronide by 55%, as compared with lorazepam administered alone. Accordingly, lorazepam plasma concentrations were about two-fold higher for at least 12 hours post-dose administration during valproate treatment. Lorazepam dosage should be reduced to 50% of the normal adult dose when this drug combination is prescribed in patients (see also DOSAGE AND ADMINISTRATION).

LORAZEPAM-ORAL CONTRACEPTIVE STEROIDS INTERACTION

Coadministration of lorazepam (2 mg intravenously) with oral contraceptive steroids (norethindrone acetate, 1 mg, and ethinyl estradiol, 50 μg, for at least 6 months) to healthy females (n=7) was associated with a 55% decrease in half-life, a 50% increase in the volume of distribution, thereby resulting in an almost 3.7-fold increase in total clearance of lorazepam as compared with control healthy females (n=8). It may be necessary to increase the dose of Ativan in female patients who are concomitantly taking oral contraceptives (see also DOSAGE AND ADMINISTRATION).

LORAZEPAM-PROBENECID INTERACTION

Concurrent administration of lorazepam (2 mg intravenously) with probenecid (500 mg orally every 6 hours) to 9 healthy volunteers resulted in a prolongation of lorazepam half-life by 130% and a decrease in its total clearance by 45%. No change in volume of distribution was noted during probenecid co-treatment. Ativan dosage needs to be reduced by 50% when coadministered with probenecid (see also DOSAGE AND ADMINISTRATION).

Drug/Laboratory Test Interactions

No laboratory test abnormalities were identified when lorazepam was given alone or concomitantly with another drug, such as narcotic analgesics, inhalation anesthetics, scopolamine, atropine, and a variety of tranquilizing agents.

Carcinogenesis, Mutagenesis, Impairment of Fertility

No evidence of carcinogenic potential emerged in rats and mice during an 18-month study with oral lorazepam. No studies regarding mutagenesis have been performed. The results of a preimplantation study in rats, in which the oral lorazepam dose was 20 mg/kg, showed no impairment of fertility.

Pregnancy

Teratogenic EffectsPregnancy Category D (See WARNINGS.)

Published studies in pregnant primates demonstrate that the administration of anesthetic and sedation drugs that block NMDA receptors and/or potentiate GABA activity during the period of peak brain development increases neuronal apoptosis in the developing brain of the offspring when used for longer than 3 hours. There are no data on pregnancy exposures in primates corresponding to periods prior to the third trimester in humans.

In a published study in primates, administration of an anesthetic dose of ketamine for 24 hours on Gestation Day 122 increased neuronal apoptosis in the developing brain of the fetus. In other published studies, administration of either isoflurane or propofol for 5 hours on Gestation Day 120 resulted in increased neuronal and oligodendrocyte apoptosis in the developing brain of the offspring. With respect to brain development, this time period corresponds to the third trimester of gestation in the human. The clinical significance of these findings is not clear; however, studies in juvenile animals suggest neuroapoptosis correlates with long-term cognitive deficits (See WARNINGS/Pediatric Neurotoxicity, Pediatric Use, and ANIMAL TOXICOLOGY AND/OR PHARMACOLOGY).

Labor and Delivery

There are insufficient data to support the use of Ativan (lorazepam) Injection during labor and delivery, including cesarean section; therefore, its use in this clinical circumstance is not recommended.

Nursing Mothers

Lorazepam has been detected in human breast milk. Therefore, lorazepam should not be administered to nursing mothers because, like other benzodiazepines, the possibility exists that lorazepam may sedate or otherwise adversely affect the infant.

Pediatric Use

STATUS EPILEPTICUS

The safety and effectiveness of Ativan for status epilepticus have not been established in pediatric patients. A randomized, double-blind, superiority-design clinical trial of Ativan versus intravenous diazepam in 273 pediatric patients ages 3 months to 17 years failed to establish the efficacy of Ativan for the treatment of status epilepticus. In that trial, assisted ventilation was required in 18% of patients treated with Ativan versus 16% of patients treated with diazepam. Patients treated with Ativan were also more likely to be reported as sedated (67% for Ativan vs. 50% for diazepam), and the time for return to baseline mental status was, on average, 2 hours longer for Ativan than for diazepam. 

Open-label studies described in the medical literature included 273 pediatric patients; the age range was from a few hours old to 18 years of age. Paradoxical excitation was observed in 10% to 30% of the pediatric patients under 8 years of age and was characterized by tremors, agitation, euphoria, logorrhea, and brief episodes of visual hallucinations. Paradoxical excitation in pediatric patients also has been reported with other benzodiazepines when used for status epilepticus, as an anesthesia, or for pre-chemotherapy treatment.

Pediatric patients (as well as adults) with atypical petit mal status epilepticus have developed brief tonic-clonic seizures shortly after Ativan was given. This “paradoxical” effect was also reported for diazepam and clonazepam. Nevertheless, the development of seizures after treatment with benzodiazepines is probably rare, based on the incidence in the uncontrolled treatment series reported (i.e., seizures were not observed for 112 pediatric patients and 18 adults or during approximately 400 doses).

Ativan Injection contains benzyl alcohol as a preservative. Benzyl alcohol, a component of this product, has been associated with serious adverse events and death, particularly in pediatric patients. The “gasping syndrome”, (characterized by central nervous system depression, metabolic acidosis, gasping respirations, and high levels of benzyl alcohol and its metabolites found in the blood and urine) has been associated with benzyl alcohol dosages greater than 99 mg/kg/day in neonates and low-birth-weight neonates. Additional symptoms may include gradual neurological deterioration, seizures, intracranial hemorrhage, hematologic abnormalities, skin breakdown, hepatic and renal failure, hypotension, bradycardia, and cardiovascular collapse. Although normal therapeutic doses of this product deliver amounts of benzyl alcohol that are substantially lower than those reported in association with the “gasping syndrome”, the minimum amount of benzyl alcohol at which toxicity may occur is not known. Premature and low-birth-weight infants, as well as patients receiving high dosages, may be more likely to develop toxicity. Practitioners administering this and other medications containing benzyl alcohol should consider the combined daily metabolic load of benzyl alcohol from all sources.

PREANESTHETIC

There are insufficient data to support the efficacy of injectable lorazepam as a preanesthetic agent in patients less than 18 years of age.

GENERAL

Seizure activity and myoclonus have been reported to occur following administration of Ativan Injection, especially in very low birth weight neonates.

Pediatric patients may exhibit a sensitivity to benzyl alcohol, polyethylene glycol and propylene glycol, components of Ativan Injection (see also CONTRAINDICATIONS). The “gasping syndrome”, characterized by central nervous system depression, metabolic acidosis, gasping respirations, and high levels of benzyl alcohol and its metabolites found in the blood and urine, has been associated with the administration of intravenous solutions containing the preservative benzyl alcohol in neonates. Additional symptoms may include gradual neurological deterioration, seizures, intracranial hemorrhage, hematologic abnormalities, skin breakdown, hepatic and renal failure, hypotension, bradycardia, and cardiovascular collapse. Central nervous system toxicity, including seizures and intraventricular hemorrhage, as well as unresponsiveness, tachypnea, tachycardia, and diaphoresis have been associated with propylene glycol toxicity. Although normal therapeutic doses of Ativan Injection contain very small amounts of these compounds, premature and low-birth-weight infants as well as pediatric patients receiving high doses may be more susceptible to their effects.

Published juvenile animal studies demonstrate that the administration of anesthetic and sedation drugs, such as Ativan that either block NMDA receptors or potentiate the activity of GABA during the period of rapid brain growth or synaptogenesis, results in widespread neuronal and oligodendrocyte cell loss in the developing brain and alterations in synaptic morphology and neurogenesis. Based on comparisons across species, the window of vulnerability to these changes is believed to correlate with exposures in the third trimester of gestation through the first several months of life, but may extend out to approximately 3 years of age in humans.

In primates, exposure to 3 hours of ketamine that produced a light surgical plane of anesthesia did not increase neuronal cell loss, however, treatment regimens of 5 hours or longer of isoflurane increased neuronal cell loss. Data from isoflurane-treated rodents and ketamine-treated primates suggest that the neuronal and oligodendrocyte cell losses are associated with prolonged cognitive deficits in learning and memory. The clinical significance of these nonclinical findings is not known, and healthcare providers should balance the benefits of appropriate anesthesia in pregnant women, neonates and young children who require procedures with the potential risks suggested by the nonclinical data. (See WARNINGS, Pediatric Neurotoxicity; PRECAUTIONS, Pregnancy; ANIMAL TOXICOLOGY AND/OR PHARMACOLOGY).

Geriatric Use

Clinical studies of Ativan generally were not adequate to determine whether subjects aged 65 and over respond differently than younger subjects; however, age over 65 may be associated with a greater incidence of central nervous system depression and more respiratory depression (see WARNINGS–Preanesthetic Use , PRECAUTIONS–General and ADVERSE REACTIONS–Preanesthetic).

Age does not appear to have a clinically significant effect on lorazepam kinetics (see CLINICAL PHARMACOLOGY).

Clinical circumstances, some of which may be more common in the elderly, such as hepatic or renal impairment, should be considered. Greater sensitivity (e.g., sedation) of some older individuals cannot be ruled out. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range (see DOSAGE AND ADMINISTRATION).

How is Ativan Supplied

Ativan Injection (lorazepam injection, USP) is available in the following dosage strengths in single-dose and multiple-dose vials:

2 mg per mL, NDC 0641-6001-25, 25 x 1 mL vial
                     NDC 0641-6000-10, 10 x 10 mL vial
4 mg per mL, NDC 0641-6003-25, 25 x 1 mL vial
                     NDC 0641-6002-10, 10 x 10 mL vial

For IM or IV injection.
Store in a refrigerator.
PROTECT FROM LIGHT.
Use carton to protect contents from light.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of lorazepam injection in the pediatric population. Safety and efficacy have not been established.

Pregnancy

Information about this lorazepam-oral-route
Pregnancy Category Explanation
All Trimesters D Studies in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy in a life threatening situation or a serious disease, may outweigh the potential risk.

Other Interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

  • Anxiety
  • Benzodiazepines
  • Pain Management Medication Types
  • Prescription Anxiety Medications
  • Seizure (Epilepsy)
  • Seizures Symptoms and Types
  • Stress
  • Stress Management Techniques

Before taking this medicine

It is dangerous to purchase Ativan on the Internet or from vendors outside the United States. Medications distributed from Internet sales may contain dangerous ingredients, or may not be distributed by a licensed pharmacy. The sale and distribution of Ativan outside the U.S. does not comply with the regulations of the Food and Drug Administration (FDA) for the safe use of this medication.

You should not take Ativan if you have:

  • narrow-angle glaucoma;

  • myasthenia gravis; or

  • a history of allergic reaction to any benzodiazepine, such as diazepam (Valium), chlordiazepoxide, clonazepam, flurazepam, and others.

To make sure Ativan is safe for you, tell your doctor if you have:

  • seizures or epilepsy;

  • kidney or liver disease (especially alcoholic liver disease);

  • asthma or other breathing disorder;

  • open-angle glaucoma;

  • a history of depression or suicidal thoughts or behavior;

  • a history of drug or alcohol addiction; or

  • if you use a narcotic (opioid) medication.

Do not use Ativan if you are pregnant. This medicine can cause birth defects. Your baby could also become dependent on the drug. This can cause life-threatening withdrawal symptoms in the baby after it is born. Babies born dependent on habit-forming medicine may need medical treatment for several weeks. Tell your doctor if you are pregnant or plan to become pregnant. Use effective birth control to prevent pregnancy while you are taking Ativan.

Lorazepam can pass into breast milk and may harm a nursing baby. You should not breast-feed while you are using Ativan.

Ativan is not approved for use by anyone younger than 18 years old.

The sedative effects of lorazepam may last longer in older adults. Accidental falls are common in elderly patients who take benzodiazepines. Use caution to avoid falling or accidental injury while you are taking Ativan.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

Ativan side effects

Get emergency medical help if you have signs of an allergic reaction to Ativan: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • severe drowsiness;

  • thoughts of suicide or hurting yourself;

  • unusual changes in mood or behavior;

  • confusion, aggression, hallucinations;

  • worsened sleep problems;

  • sudden restless feeling or excitement;

  • muscle weakness, drooping eyelids, trouble swallowing;

  • vision changes; or

  • upper stomach pain, dark urine, jaundice (yellowing of the skin or eyes).

Common Ativan side effects may include:

  • dizziness, drowsiness;

  • weakness;

  • slurred speech, lack of balance or coordination;

  • memory problems; or

  • feeling unsteady.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

Bottom Line

Ativan may be used for the treatment of anxiety or as a preoperative medicine. It is potentially addictive and a withdrawal syndrome may be experienced on discontinuation. Sedation is a common side effect.

Lorazepam Breastfeeding Warnings

Use is not recommended and a decision should be made to discontinue breastfeeding or discontinue the drug, taking into account the importance of the drug to the mother. Excreted into human milk: Yes Comments: -Sedation and inability to suckle have occurred in neonates of lactating mothers taking benzodiazepines. -Infants of lactating mothers should be observed for pharmacological effects (including sedation and irritability).

Lorazepam Identification

Substance Name

Lorazepam

CAS Registry Number

846-49-1

Drug Class

Hypnotics and Sedatives

Anti-Anxiety Agents

Benzodiazepines

How should I take lorazepam?

Follow all directions on your prescription label. Never use lorazepam in larger amounts, or for longer than prescribed. Tell your doctor if the medicine seems to stop working as well in treating your symptoms.

Lorazepam may be habit-forming. Never share this medicine with another person, especially someone with a history of drug abuse or addiction. Keep the medication in a place where others cannot get to it.

Misuse of habit-forming medicine can cause addiction, overdose, or death. Selling or giving away this medicine is against the law.

Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.

Lorazepam should be used for only a short time. Do not take this medicine for longer than your doctor recommends.

Do not stop using lorazepam suddenly or you could have unpleasant withdrawal symptoms, including a seizure (convulsions). Ask your doctor how to safely stop using this medicine.

Call your doctor if this medicine seems to stop working as well in treating your anxiety symptoms.

Store lorazepam at room temperature away from moisture, heat, and light.

Keep track of the amount of medicine used from each new bottle. Lorazepam is a drug of abuse and you should be aware if anyone is using your medicine improperly or without a prescription.

Store the liquid form of lorazepam in the refrigerator.

Lorazepam side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • severe drowsiness;

  • thoughts of suicide or hurting yourself;

  • unusual changes in mood or behavior;

  • confusion, aggression, hallucinations;

  • worsened sleep problems;

  • sudden restless feeling or excitement;

  • muscle weakness, drooping eyelids, trouble swallowing;

  • vision changes; or

  • upper stomach pain, dark urine, jaundice (yellowing of the skin or eyes).

Common side effects may include:

  • dizziness, drowsiness;

  • weakness;

  • slurred speech, lack of balance or coordination;

  • memory problems; or

  • feeling unsteady.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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