Lorazepam (oral): Difference between revisions

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|offLabelPedGuideSupport=There is limited information regarding <i>Off-Label Guideline-Supported Use</i> of {{PAGENAME}} in pediatric patients.
|offLabelPedGuideSupport=There is limited information regarding <i>Off-Label Guideline-Supported Use</i> of {{PAGENAME}} in pediatric patients.
|offLabelPedNoGuideSupport=There is limited information regarding <i>Off-Label Non–Guideline-Supported Use</i> of {{PAGENAME}} in pediatric patients.
|offLabelPedNoGuideSupport=There is limited information regarding <i>Off-Label Non–Guideline-Supported Use</i> of {{PAGENAME}} in pediatric patients.
|clinicalTrials=* Most adverse reactions to benzodiazepines, including CNS effects and [[respiratory depression]] are dose dependent, with more severe effects occurring with high doses.
|alcohol=Alcohol-Lorazepam (oral) interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.
 
* In a sample of about 3500 patients treated for [[anxiety]], the most frequent adverse reaction to lorazepam was [[sedation]] (15.9%), followed by [[dizziness]] (6.9%), [[weakness]] (4.2%), and unsteadiness (3.4%). The incidence of [[sedation]] and unsteadiness increased with age.
 
* Other adverse reactions to benzodiazepines, including lorazepam are [[fatigue]], [[drowsiness]], [[amnesia]], memory impairment, [[confusion]], [[disorientation]], [[depression]], unmasking of [[depression]], [[disinhibition]][, [[euphoria]], [[suicidal ideation]]/attempt, [[ataxia]], [[asthenia]], [[extrapyramidal symptoms]], [[convulsions]]/[[seizures]] [[tremor]], [[vertigo]], eye-function/[[visual disturbance]] (including [[diplopia]] and [[blurred vision]]), [[dysarthria]]/[[slurred speech]], change in [[libido]], [[impotence]], decreased orgasm; [[headache]], [[coma]]; [[respiratory depression]], [[apnea]], worsening of [[sleep apnea]], worsening of [[obstructive pulmonary disease]]; gastrointestinal symptoms including [[nausea]], change in appetite, [[constipation]], [[jaundice]], increase in bilirubin, increase in liver transaminases, increase in alkaline phosphatase; [[hypersensitivity|hypersensitivity reactions]], [[anaphylactic]]/oid reactions; dermatological symptoms, [[allergy|allergic skin reactions]], [[alopecia]]; [[SIADH]], [[hyponatremia]]; [[thrombocytopenia]], [[agranulocytosis]], [[pancytopenia]]; [[hypothermia]]; and autonomic manifestations.
 
* Paradoxical reactions, including [[anxiety]], excitation, [[agitation]], hostility, aggression, rage, sleep disturbances/[[insomnia]], sexual arousal, and [[hallucinations]] may occur. Small decreases in blood pressure and [[hypotension]] may occur but are usually not clinically significant, probably being related to the relief of [[anxiety]] produced by lorazepam.
|postmarketing=There is limited information regarding <i>Postmarketing Experience</i> of {{PAGENAME}} in the drug label.
|drugInteractions=* The benzodiazepines, including lorazepam, produce increased CNS-depressant effects when administered with other CNS depressants such as alcohol, barbiturates, [[antipsychotics]], [[sedative]]/[[hypnotics]], [[anxiolytics]], [[antidepressants]], narcotic analgesics, [[sedative]] [[antihistamines]], [[anticonvulsants]], and anesthetics.
 
* Concomitant use of clozapine and lorazepam may produce marked [[sedation]], excessive [[salivation]], [[hypotension]], [[ataxia]], [[delirium]], and respiratory arrest.
 
* Concurrent administration of lorazepam with valproate results in increased plasma concentrations and reduced clearance of lorazepam. Lorazepam dosage should be reduced to approximately 50% when coadministered with valproate.
 
* Concurrent administration of lorazepam with probenecid may result in a more rapid onset or prolonged effect of lorazepam due to increased half-life and decreased total clearance. Lorazepam dosage needs to be reduced by approximately 50% when coadministered with probenecid.
 
* The effects of probenecid and valproate on lorazepam may be due to inhibition of glucuronidation.
 
* Administration of theophylline or aminophylline may reduce the sedative effects of benzodiazepines, including lorazepam.
|useInPregnancyAUS=* '''Australian Drug Evaluation Committee (ADEC) Pregnancy Category'''
 
There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of {{PAGENAME}} in women who are pregnant.
|useInLaborDelivery=There is no FDA guidance on use of {{PAGENAME}} during labor and delivery.
|useInNursing=There is no FDA guidance on the use of {{PAGENAME}} with respect to nursing mothers.
|useInPed=There is no FDA guidance on the use of {{PAGENAME}} with respect to pediatric patients.
|useInGeri=There is no FDA guidance on the use of {{PAGENAME}} with respect to geriatric patients.
|useInGender=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific gender populations.
|useInRace=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific racial populations.
|useInRenalImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with renal impairment.
|useInHepaticImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with hepatic impairment.
|useInReproPotential=There is no FDA guidance on the use of {{PAGENAME}} in women of reproductive potentials and males.
|useInImmunocomp=There is no FDA guidance one the use of {{PAGENAME}} in patients who are immunocompromised.
|administration=* Oral
|monitoring=There is limited information regarding <i>Monitoring</i> of {{PAGENAME}} in the drug label.
|IVCompat=There is limited information regarding <i>IV Compatibility</i> of {{PAGENAME}} in the drug label.
|overdose=* In postmarketing experience, overdose with lorazepam has occurred predominantly in combination with alcohol and/or other drugs. Therefore, in the management of overdosage, it should be borne in mind that multiple agents may have been taken.
Symptoms
 
* Overdosage of benzodiazepines is usually manifested by varying degrees of central nervous system depression ranging from drowsiness to coma. In mild cases, symptoms include drowsiness, mental confusion, paradoxical reactions, dysarthria and lethargy. In more serious cases, and especially when other drugs or alcohol were ingested, symptoms may include ataxia, hypotonia, hypotension, cardiovascular depression, respiratory depression, hypnotic state, coma, and death.
 
'''MANAGEMENT'''
 
* General supportive and symptomatic measures are recommended; vital signs must be monitored and the patient closely observed. When there is a risk of aspiration, induction of emesis is not recommended. Gastric lavage may be indicated if performed soon after ingestion or in symptomatic patients. Administration of activated charcoal may also limit drug absorption. Hypotension, though unlikely, usually may be controlled with norepinephrine bitartrate injection. Lorazepam is poorly dialyzable. Lorazepam glucuronide, the inactive metabolite, may be highly dialyzable.
 
* The benzodiazepine antagonist flumazenil may be used in hospitalized patients as an adjunct to, not as a substitute for, proper management of benzodiazepine overdose. The prescriber should be aware of a risk of seizure in association with flumazenil treatment, particularly in long-term benzodiazepine users and in cyclic antidepressant overdose.
|drugBox=<!--Mechanism of Action-->
|mechAction=*
 
<!--Structure-->
|structure=*
 
: [[File:{{PAGENAME}}01.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]
 
<!--Pharmacodynamics-->
|PD=There is limited information regarding <i>Pharmacodynamics</i> of {{PAGENAME}} in the drug label.
 
<!--Pharmacokinetics-->
|PK=There is limited information regarding <i>Pharmacokinetics</i> of {{PAGENAME}} in the drug label.
 
<!--Nonclinical Toxicology-->
|nonClinToxic=There is limited information regarding <i>Nonclinical Toxicology</i> of {{PAGENAME}} in the drug label.
 
<!--Clinical Studies-->
|clinicalStudies=There is limited information regarding <i>Clinical Studies</i> of {{PAGENAME}} in the drug label.
 
<!--How Supplied-->
|howSupplied=* Lorazepam Tablets USP are available in the following dosage strengths:
 
:*0.5 mg: white, scored, round flat faced beveled edge, debossed with 240 over 0.5 on one side and WATSON on the other side, supplied in bottles of 100, 500 and 1000.
 
* 1 mg: white, scored, round flat faced beveled edge, debossed with 241 over 1 on one side and WATSON on the other side, supplied in bottles of 100, 500 and 1000.
2 mg: white, scored, round flat faced beveled edge, debossed with 242 over 2 on one side and WATSON on the other side, supplied in bottles of 100, 500 and 1000.
|storage=* Store at 20°-25°C (68°-77°F).
 
* Dispense in a tight, light-resistant container as defined in the USP.
|packLabel=<!--Patient Counseling Information-->
|fdaPatientInfo=There is limited information regarding <i>Patient Counseling Information</i> of {{PAGENAME}} in the drug label.
 
<!--Precautions with Alcohol-->
|alcohol=* Alcohol-{{PAGENAME}} interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.
 
<!--Brand Names-->
|brandNames=* LORAZEPAM®<ref>{{Cite web | title =lorazepam tablet  | url =http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=3af556f7-3d8c-4079-b6bc-5051966e5f3b }}</ref>
|lookAlike=* A® — B®<ref name="www.ismp.org">{{Cite web  | last =  | first =  | title = http://www.ismp.org | url = http://www.ismp.org | publisher =  | date =  }}</ref>
 
<!--Drug Shortage Status-->
|drugShortage=
}}
}}
{{PillImage
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{{LabelImage
|fileName={{PAGENAME}}11.png
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{{LabelImage
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[[Category:Drug]]

Revision as of 13:14, 18 May 2015

Lorazepam (oral)
Adult Indications & Dosage
Pediatric Indications & Dosage
Contraindications
Warnings & Precautions
Adverse Reactions
Drug Interactions
Use in Specific Populations
Administration & Monitoring
Overdosage
Pharmacology
Clinical Studies
How Supplied
Images
Patient Counseling Information
Precautions with Alcohol
Brand Names
Look-Alike Names

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]

Disclaimer

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Overview

Lorazepam (oral) is an antianxiety drug that is FDA approved for the treatment of anxiety disorders, status epilepticus, insomnia and as premedication for anesthetic procedure. Common adverse reactions include fatigue, drowsiness, amnesia, confusion, disorientation, depression, euphoria, ataxia, asthenia, tremor, and vertigo.

Adult Indications and Dosage

FDA-Labeled Indications and Dosage (Adult)

Indications

  • Lorazepam is indicated for the management of anxiety disorders or for the short-term relief of the symptoms of anxiety or anxiety associated with depressive symptoms. Anxiety or tension associated with the stress of everyday life usually does not require treatment with an anxiolytic.
  • The effectiveness of lorazepam in long-term use, that is, more than 4 months, has not been assessed by systematic clinical studies. The physician should periodically reassess the usefulness of the drug for the individual patient.

Dosage

  • Lorazepam is administered orally. For optimal results, dose, frequency of administration, and duration of therapy should be individualized according to patient response. To facilitate this, 0.5 mg, 1 mg, and 2 mg tablets are available.
  • The usual range is 2 to 6 mg/day given in divided doses, the largest dose being taken before bedtime, but the daily dosage may vary from 1 to 10 mg/day.
  • For anxiety, most patients require an initial dose of 2 to 3 mg/day given b.i.d. or t.i.d.
  • For insomnia due to anxiety or transient situational stress, a single daily dose of 2 to 4 mg may be given, usually at bedtime.
  • For elderly or debilitated patients, an initial dosage of 1 to 2 mg/day in divided doses is recommended, to be adjusted as needed and tolerated.
  • The dosage of lorazepam should be increased gradually when needed to help avoid adverse effects. When higher dosage is indicated, the evening dose should be increased before the daytime doses.

Off-Label Use and Dosage (Adult)

Guideline-Supported Use

There is limited information regarding Off-Label Guideline-Supported Use of Lorazepam (oral) in adult patients.

Non–Guideline-Supported Use

There is limited information regarding Off-Label Non–Guideline-Supported Use of Lorazepam (oral) in adult patients.

Pediatric Indications and Dosage

FDA-Labeled Indications and Dosage (Pediatric)

There is limited information regarding FDA-Labeled Use of Lorazepam (oral) in pediatric patients.

Off-Label Use and Dosage (Pediatric)

Guideline-Supported Use

There is limited information regarding Off-Label Guideline-Supported Use of Lorazepam (oral) in pediatric patients.

Non–Guideline-Supported Use

There is limited information regarding Off-Label Non–Guideline-Supported Use of Lorazepam (oral) in pediatric patients.

Contraindications

There is limited information regarding Lorazepam (oral) Contraindications in the drug label.

Warnings

There is limited information regarding Lorazepam (oral) Warnings' in the drug label.

Adverse Reactions

Clinical Trials Experience

There is limited information regarding Lorazepam (oral) Clinical Trials Experience in the drug label.

Postmarketing Experience

There is limited information regarding Lorazepam (oral) Postmarketing Experience in the drug label.

Drug Interactions

There is limited information regarding Lorazepam (oral) Drug Interactions in the drug label.

Use in Specific Populations

Pregnancy

Pregnancy Category (FDA): There is no FDA guidance on usage of Lorazepam (oral) in women who are pregnant.
Pregnancy Category (AUS): There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Lorazepam (oral) in women who are pregnant.

Labor and Delivery

There is no FDA guidance on use of Lorazepam (oral) during labor and delivery.

Nursing Mothers

There is no FDA guidance on the use of Lorazepam (oral) in women who are nursing.

Pediatric Use

There is no FDA guidance on the use of Lorazepam (oral) in pediatric settings.

Geriatic Use

There is no FDA guidance on the use of Lorazepam (oral) in geriatric settings.

Gender

There is no FDA guidance on the use of Lorazepam (oral) with respect to specific gender populations.

Race

There is no FDA guidance on the use of Lorazepam (oral) with respect to specific racial populations.

Renal Impairment

There is no FDA guidance on the use of Lorazepam (oral) in patients with renal impairment.

Hepatic Impairment

There is no FDA guidance on the use of Lorazepam (oral) in patients with hepatic impairment.

Females of Reproductive Potential and Males

There is no FDA guidance on the use of Lorazepam (oral) in women of reproductive potentials and males.

Immunocompromised Patients

There is no FDA guidance one the use of Lorazepam (oral) in patients who are immunocompromised.

Administration and Monitoring

Administration

There is limited information regarding Lorazepam (oral) Administration in the drug label.

Monitoring

There is limited information regarding Lorazepam (oral) Monitoring in the drug label.

IV Compatibility

There is limited information regarding the compatibility of Lorazepam (oral) and IV administrations.

Overdosage

There is limited information regarding Lorazepam (oral) overdosage. If you suspect drug poisoning or overdose, please contact the National Poison Help hotline (1-800-222-1222) immediately.

Pharmacology

There is limited information regarding Lorazepam (oral) Pharmacology in the drug label.

Mechanism of Action

There is limited information regarding Lorazepam (oral) Mechanism of Action in the drug label.

Structure

There is limited information regarding Lorazepam (oral) Structure in the drug label.

Pharmacodynamics

There is limited information regarding Lorazepam (oral) Pharmacodynamics in the drug label.

Pharmacokinetics

There is limited information regarding Lorazepam (oral) Pharmacokinetics in the drug label.

Nonclinical Toxicology

There is limited information regarding Lorazepam (oral) Nonclinical Toxicology in the drug label.

Clinical Studies

There is limited information regarding Lorazepam (oral) Clinical Studies in the drug label.

How Supplied

There is limited information regarding Lorazepam (oral) How Supplied in the drug label.

Storage

There is limited information regarding Lorazepam (oral) Storage in the drug label.

Images

Drug Images

{{#ask: Page Name::Lorazepam (oral) |?Pill Name |?Drug Name |?Pill Ingred |?Pill Imprint |?Pill Dosage |?Pill Color |?Pill Shape |?Pill Size (mm) |?Pill Scoring |?NDC |?Drug Author |format=template |template=DrugPageImages |mainlabel=- |sort=Pill Name }}

Package and Label Display Panel

{{#ask: Label Page::Lorazepam (oral) |?Label Name |format=template |template=DrugLabelImages |mainlabel=- |sort=Label Page }}

Patient Counseling Information

There is limited information regarding Lorazepam (oral) Patient Counseling Information in the drug label.

Precautions with Alcohol

Alcohol-Lorazepam (oral) interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.

Brand Names

There is limited information regarding Lorazepam (oral) Brand Names in the drug label.

Look-Alike Drug Names

There is limited information regarding Lorazepam (oral) Look-Alike Drug Names in the drug label.

Drug Shortage Status

Price

References

The contents of this FDA label are provided by the National Library of Medicine.

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