Lorazepam

ATC code

N05BA06

Therapeutic class

Anxiolytic (Benzodiazepine) · Benzodiazepine derivative

Forms

oral tablet

Brand names

Lorazepam (US) · Lorazepam Cinfa (ES) · Temesta (FR) · Ativan (US)

Overall confidence

high

Regulatory sources consulted

openfda-label-22212bf6-1414-4b32-bc67-25d614c357ee
aemps-cima-ft-68477
ansm-bdpm-rcp-67917629
Clinical Pharmacist Knowledge
OpenFDA · N05BA06
RxNorm rxcui 6470 ↗

Approved indications

Management of anxiety disorders or for the short-term relief of the symptoms of anxiety or anxiety associated with depressive symptoms. Effectiveness in long-term use (>4 months) has not been assessed.

Contraindications

Absolute

Hypersensitivity to benzodiazepines or to any components of the formulation.
Acute narrow-angle glaucoma.
Severe respiratory insufficiency.
Sleep apnea syndrome.
Severe hepatic insufficiency.
Myasthenia gravis.

Clinical warnings

Boxed warning · RISKS FROM CONCOMITANT USE WITH OPIOIDS; ABUSE, MISUSE, AND ADDICTION; and DEPENDENCE AND WITHDRAWAL REACTIONS. Concomitant use with opioids may result in profound sedation, respiratory depression, coma, and death. The use of benzodiazepines exposes users to risks of abuse, misuse, and addiction. Continued use may lead to physical dependence and abrupt discontinuation may precipitate life-threatening withdrawal reactions. — FDA

Drug interactions

HighOpioidsN02A
Mechanism: Additive CNS depression at different receptor sites (GABA-A for benzodiazepines, mu for opioids), resulting in profound sedation and respiratory depression.
Recommendation: Reserve concomitant use for patients with no alternative options. Use the lowest effective doses and minimum duration. Closely monitor for sedation and respiratory depression.
FDA label
ModerateValproateN03AG01
Mechanism: Inhibition of lorazepam glucuronidation, resulting in increased plasma concentrations and reduced clearance.
Recommendation: Reduce lorazepam dosage by approximately 50% when coadministered with valproate.
FDA label
HighClozapineN05AH02
Mechanism: Pharmacodynamic, not fully elucidated. May produce marked sedation, excessive salivation, hypotension, ataxia, delirium, and respiratory arrest.
Recommendation: Monitor closely for profound sedation, hypotension, and respiratory/cardiac arrest. Some clinicians recommend avoiding the combination.
FDA labelANSM RCP

Adverse events

Common (≥1%)

sedation · dizziness · weakness · unsteadiness

Rare but serious

respiratory depression · withdrawal reactions · seizures · agranulocytosis · anaphylactoid reactions · cardiac arrest

Pregnancy and lactation

Use during late pregnancy may cause neonatal sedation and/or withdrawal syndrome. Observational data do not show a clear association with major birth defects. Generally should be avoided during pregnancy. Excreted in human milk; breastfeeding is not recommended.