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If you are already in Ativan Lorazepam withdrawal click here
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you are new to The Road Back and want more information before you begin, click
Program at the top of this page and you will have free access to How to Get Off
Psychoactive Drugs Safely.If You Are Aleady In Ativan Withdrawal click
hereLorazepam, also sold under the brand name Ativan, is a benzodiazepine
medication commonly prescribed for anxiety, seizures, and insomnia. While it can
be an effective treatment for these conditions, it also carries a number of
potential side effects. In this article, we will explore the various lorazepam
side effects in detail.
1.
Drowsiness and Sedation - One of the most common side effects of lorazepam is
drowsiness or sedation. This effect can be particularly pronounced in the first
few days of treatment, and it may take some time for the body to adjust to the
medication. Individuals taking lorazepam may experience difficulty with
attention and concentration, as well as impaired motor function. Patients should
not operate heavy machinery or drive until they know how the medication affects
them.
2.
Impaired Memory and Cognitive Function Lorazepam can also have an impact on
cognitive function, including memory and concentration. This is particularly
true in the elderly or in patients taking higher doses of the medication. Some
studies have suggested that long-term use of benzodiazepines like lorazepam can
increase the risk of developing dementia.
3.
Confusion and Disorientation In addition to cognitive impairment, lorazepam can
also cause confusion and disorientation. This can be particularly concerning for
elderly patients, who may already be experiencing cognitive decline. Patients
taking lorazepam should be monitored for signs of confusion, as it may indicate
a need to adjust the dosage or discontinue the medication.
4.
Respiratory Depression Lorazepam can also have an impact on the respiratory
system, potentially causing respiratory depression. This effect is more
pronounced in individuals taking higher doses of the medication or those who are
already experiencing respiratory issues. Patients should be monitored for signs
of respiratory distress, including shortness of breath, shallow breathing, and
wheezing.
5.
Addiction and Dependence Lorazepam is a habit-forming medication, and long-term
use can lead to addiction and dependence. Patients taking the medication for an
extended period of time may develop tolerance to the drug, requiring higher
doses to achieve the same effect. Abruptly discontinuing the medication can lead
to withdrawal symptoms, including seizures and hallucinations.
6.
Mood Changes Lorazepam can also cause changes in mood, including depression and
anxiety. This effect is particularly pronounced in individuals taking higher
doses of the medication or those with a history of mental health issues.
Patients should be monitored for signs of depression or anxiety, and the
medication should be discontinued if these symptoms become severe.
7.
Nausea and Vomiting Lorazepam can cause gastrointestinal distress, including
nausea and vomiting. This effect is typically mild and can be managed with
over-the-counter medications, but patients should be monitored for signs of
dehydration or other complications.
8.
Headache and Dizziness Headache and dizziness are common side effects of
lorazepam, particularly in the first few days of treatment. These symptoms may
be related to the sedative effects of the medication, and they should resolve as
the body adjusts to the drug.
9.
Muscle Weakness Lorazepam can also cause muscle weakness, particularly in
individuals taking higher doses of the medication. Patients should be monitored
for signs of weakness or difficulty with motor function, and the medication
should be discontinued if these symptoms become severe.
10.
Skin Rash Lorazepam can cause skin rash or hives, particularly in individuals
with a history of alle
rgies
or sensitivity to benzodiazepines. Patients should be monitored for signs of
rash or itching, and the medication should be discontinued if these symptoms
become severe.11. Hypotension Lorazepam can cause a drop in blood pressure,
leading to hypotension. This effect is more pronounced in individuals taking
Lorazepam.
12.
Sexual Dysfunction Lorazepam can also cause sexual dysfunction, including
decreased libido and erectile dysfunction in men. This effect is more pronounced
in individuals taking higher doses of the medication or those with a history of
sexual dysfunction. Patients should be monitored for signs of sexual
dysfunction, and the medication should be discontinued if these symptoms become
severe.
13.
Liver Damage Lorazepam can cause liver damage in some patients, particularly
those taking higher doses of the medication or those with preexisting liver
disease. Patients should be monitored for signs of liver damage, including
yellowing of the skin or eyes, dark urine, and abdominal pain.
14.
Seizures While lorazepam is often used to treat seizures, it can also cause
seizures in some patients. This effect is more pronounced in individuals taking
higher doses of the medication or those with a history of seizures. Patients
should be monitored for signs of seizure activity, including convulsions or loss
of consciousness.
15.
Allergic Reactions Lorazepam can cause allergic reactions in some patients,
particularly those with a history of allergies or sensitivity to
benzodiazepines. Patients should be monitored for signs of allergic reaction,
including swelling of the face or throat, difficulty breathing, and hives.
16.
Withdrawal Symptoms Abruptly discontinuing lorazepam can lead to withdrawal
symptoms, including seizures, hallucinations, and insomnia. Patients should be
weaned off the medication slowly to avoid these symptoms.
17.
Interactions with Other Medications Lorazepam can interact with other
medications, particularly those that affect the central nervous system, such as
opioids or other benzodiazepines. Patients should inform their healthcare
provider of all medications they are taking to avoid potentially dangerous
interactions.
18.
Tolerance and Dependence As mentioned earlier, long-term use of lorazepam can
lead to tolerance and dependence, requiring higher doses of the medication to
achieve the same effect. Patients should be monitored for signs of tolerance and
dependence, and the medication should be discontinued if these symptoms become
severe.
19.
Suicidal Thoughts Lorazepam can cause suicidal thoughts or behavior in some
patients, particularly those with a history of depression or anxiety. Patients
should be monitored for signs of suicidal ideation, and the medication should be
discontinued if these symptoms become severe.
20.
Pregnancy and Breastfeeding Lorazepam can be harmful to a developing fetus or
nursing infant, and should be avoided during pregnancy and breastfeeding unless
the potential benefits outweigh the risks. Patients should consult with their
healthcare provider before taking lorazepam if they are pregnant or
breastfeeding.In conclusion, lorazepam is a commonly prescribed medication that
can be effective in treating anxiety, seizures, and insomnia. However, it
carries a number of potential side effects, including drowsiness, impaired
memory and cognitive function, confusion, respiratory depression, addiction and
dependence, mood changes, nausea and vomiting, headache and dizziness, muscle
weakness, skin rash, hypotension, sexual dysfunction, liver damage, seizures,
allergic reactions, withdrawal symptoms, interactions with other medications,
tolerance and dependence, suicidal thoughts, and risks to pregnancy and
breastfeeding. Patients taking lorazepam should be closely monitored for these
side effects and should consult with their healthcare provider if they
experience any concerning symptoms.
21.
Falls and Fractures Lorazepam can increase the risk of falls and fractures,
particularly in elderly patients or those with a history of falls. Patients
taking lorazepam should be monitored for signs of dizziness or impaired balance,
and steps should be taken to minimize the risk of falls, such as using assistive
devices or modifying the home environment.
22.
Respiratory Infections Lorazepam can increase the risk of respiratory
infections, particularly in patients with preexisting respiratory issues.
Patients taking lorazepam should be monitored for signs of respiratory
infections, such as coughing or shortness of breath.
23.
Gastrointestinal Bleeding Lorazepam can increase the risk of gastrointestinal
bleeding, particularly in patients taking higher doses of the medication or
those with a history of gastrointestinal issues. Patients should be monitored
for signs of bleeding, including black or tarry stools or vomiting blood.
24.
Cardiovascular Effects Lorazepam can have an impact on the cardiovascular
system, potentially causing changes in heart rate or blood pressure. Patients
with preexisting cardiovascular issues should be closely monitored while taking
lorazepam.
25.
Vision Changes Lorazepam can cause vision changes, including blurred vision or
difficulty focusing. Patients should be monitored for signs of vision changes
and should not operate heavy machinery or drive until these symptoms resolve.
26.
Weight Changes Lorazepam can cause weight changes, including weight gain or
weight loss. Patients should be monitored for changes in weight and should
discuss any concerns with their healthcare provider.
27.
Interference with Laboratory Tests Lorazepam can interfere with certain
laboratory tests, particularly those measuring liver function or drug levels in
the blood. Patients should inform their healthcare provider if they are taking
lorazepam to ensure that accurate test results are obtained.
28.
Impact on Immune Function Lorazepam can have an impact on immune function,
potentially increasing the risk of infections or other immune-related issues.
Patients with preexisting immune system issues should be closely monitored while
taking lorazepam.
29.
Impact on Endocrine System Lorazepam can have an impact on the endocrine system,
potentially causing changes in hormone levels or function. Patients with
preexisting endocrine issues should be closely monitored while taking lorazepam.
30.
Impact on Renal Function Lorazepam can have an impact on renal function,
potentially causing changes in kidney function or urine output. Patients with
preexisting renal issues should be closely monitored while taking lorazepam.In
summary, lorazepam is associated with a variety of side effects that can affect
multiple organ systems and functions. Patients taking lorazepam should be aware
of these potential side effects and should discuss any concerns with their
healthcare provider. Regular monitoring and appropriate dosage adjustments can
help to minimize the risk of side effects and ensure the safe and effective use
of lorazepam.
31.
Behavioral Changes Lorazepam can cause behavioral changes, including
irritability, agitation, and aggression. These symptoms may be more pronounced
in patients taking higher doses of the medication or those with a history of
behavioral issues. Patients should be monitored for signs of behavioral changes,
and the medication should be discontinued if these symptoms become severe.
32.
Anaphylaxis Lorazepam can cause anaphylaxis, a severe and potentially
life-threatening allergic reaction. Patients should be monitored for signs of
anaphylaxis, including swelling of the face or throat, difficulty breathing, and
hives, and should seek immediate medical attention if these symptoms occur.
33.
Respiratory Failure In rare cases, lorazepam can cause respiratory failure, a
serious condition in which the lungs fail to function properly. Patients should
be monitored for signs of respiratory failure, including difficulty breathing,
cyanosis (bluish discoloration of the skin), and confusion.
34.
Jaundice Lorazepam can cause jaundice, a condition in which the skin and whites
of the eyes become yellow due to increased levels of bilirubin in the blood.
Patients should be monitored for signs of jaundice, including yellowing of the
skin or eyes, dark urine, and pale stools.
35.
Stevens-Johnson Syndrome Lorazepam can cause Stevens-Johnson Syndrome, a rare
and potentially life-threatening skin condition that can cause blistering and
peeling of the skin, as well as mucous membranes such as the mouth and eyes.
Patients should be monitored for signs of Stevens-Johnson Syndrome, including
rash, blisters, and skin peeling, and should seek immediate medical attention if
these symptoms occur.
36.
Thrombocytopenia Lorazepam can cause thrombocytopenia, a condition in which
there is a low level of platelets in the blood, leading to an increased risk of
bleeding. Patients should be monitored for signs of thrombocytopenia, including
bruising, bleeding gums, and petechiae (small red or purple spots on the skin).
37.
Pancreatitis Lorazepam can cause pancreatitis, a condition in which the pancreas
becomes inflamed and swollen, leading to severe abdominal pain, nausea, and
vomiting. Patients should be monitored for signs of pancreatitis, and the
medication should be discontinued if these symptoms occur.
38.
Hypersensitivity Syndrome Lorazepam can cause hypersensitivity syndrome, a rare
but potentially life-threatening condition that can cause fever, rash, and
multiple organ failure. Patients should be monitored for signs of
hypersensitivity syndrome, and the medication should be discontinued if these
symptoms occur.
39.
Interference with Psychomotor Testing Lorazepam can interfere with psychomotor
testing, such as driving tests or other tests of coordination and reaction time.
Patients should not participate in these tests until the sedative effects of the
medication have worn off.
40.
Disinhibition Lorazepam can cause disinhibition, a condition in which patients
exhibit impulsive or inappropriate behavior, such as making inappropriate
comments or engaging in risky behaviors. Patients should be monitored for signs
of disinhibition, and the medication should be discontinued if these symptoms
occur.In conclusion, lorazepam can cause a wide range of potential side effects,
including respiratory depression, addiction and dependence, mood changes, nausea
and vomiting, headache and dizziness, muscle weakness, skin rash, hypotension,
sexual dysfunction, liver damage, seizures, allergic reactions, withdrawal
symptoms, interactions with other medications, tolerance and dependence,
suicidal thoughts, risks to pregnancy and breastfeeding, falls and fractures,
respiratory infections, gastrointestinal bleeding, cardiovascular effects,
vision changes, weight changes, interference with laboratory tests, impact on
immune system, impact on endocrine system, impact on renal function, behavioral
changes, anaphylaxis, respiratory failure, jaundice, Stevens-Johnson Syndrome,
thrombocytopenia, pancreatitis, hypersensitivity syndrome, interference with
psychomotor testing, and disinhibition. Patients taking lorazepam should be
closely monitored for these side effects and should discuss any concerns with
their healthcare provider. It is important to weigh the potential benefits of
the medication against the potential risks and to use lorazepam only under the
guidance of a qualified healthcare professional. Regular monitoring and
appropriate dosage adjustments can help to minimize the risk of side effects and
ensure the safe and effective use of lorazepam.
41.
Withdrawal Seizures in Neonates Lorazepam can cause withdrawal seizures in
neonates born to mothers who used benzodiazepines during pregnancy. These
seizures can be life-threatening and require prompt medical attention.
42.
Paradoxical Reactions Lorazepam can cause paradoxical reactions, a rare but
potentially serious condition in which patients exhibit the opposite of the
desired effect of the medication. For example, instead of feeling sedated,
patients may become agitated or hyperactive. Patients should be monitored for
signs of paradoxical reactions, and the medication should be discontinued if
these symptoms occur.
43.
Respiratory Arrest In rare cases, lorazepam can cause respiratory arrest, a
serious condition in which breathing stops completely. Patients should be
monitored for signs of respiratory distress, and emergency medical attention
should be sought if respiratory arrest occurs.
44.
Serotonin Syndrome Lorazepam can cause serotonin syndrome, a rare but
potentially life-threatening condition in which there is an excessive
accumulation of serotonin in the body. Symptoms can include fever, agitation,
confusion, tremors, and muscle rigidity. Patients should be monitored for signs
of serotonin syndrome, and emergency medical attention should be sought if these
symptoms occur.
45.
Hyponatremia Lorazepam can cause hyponatremia, a condition in which there is a
low level of sodium in the blood. Symptoms can include headache, nausea,
vomiting, confusion, and seizures. Patients should be monitored for signs of
hyponatremia, and the medication should be discontinued if these symptoms occur.
46.
Drug-Induced Psychosis Lorazepam can cause drug-induced psychosis, a condition
in which patients experience hallucinations, delusions, and other psychotic
symptoms. This effect is more pronounced in individuals taking higher doses of
the medication or those with a history of mental health issues. Patients should
be monitored for signs of drug-induced psychosis, and the medication should be
discontinued if these symptoms become severe.
47.
Acute Narrow-Angle Glaucoma Lorazepam can cause acute narrow-angle glaucoma, a
serious condition in which there is a sudden increase in pressure inside the
eye. Symptoms can include severe eye pain, headache, nausea, and blurred vision.
Patients should be monitored for signs of acute narrow-angle glaucoma, and
emergency medical attention should be sought if these symptoms occur.
48.
Severe Hypotension and Shock Lorazepam can cause severe hypotension and shock,
particularly in patients with preexisting cardiovascular issues. Symptoms can
include dizziness, lightheadedness, fainting, and rapid heartbeat. Patients
should be monitored for signs of severe hypotension and shock, and emergency
medical attention should be sought if these symptoms occur.
49.
Adverse Effects on Fertility Lorazepam can have adverse effects on fertility in
both men and women, including decreased libido, erectile dysfunction, and
menstrual irregularities. Patients should discuss any concerns about fertility
with their healthcare provider before taking lorazepam.
50.
Adverse Effects on Hematopoiesis Lorazepam can have adverse effects on
hematopoiesis, the process of blood cell formation. This can result in anemia,
leukopenia, or thrombocytopenia, all of which can cause serious health problems.
Patients should be monitored for signs of hematopoietic dysfunction, and the
medication should be discontinued if these symptoms occur.In conclusion,
lorazepam is associated with a wide range of potential side effects, including
respiratory depression, addiction and dependence, mood changes, nausea and
vomiting, headache and dizziness, muscle weakness, skin rash, hypotension,
sexual dysfunction, liver damage, seizures, allergic reactions, withdrawal
symptoms, interactions with other medications, tolerance and dependence,
suicidal thoughts, risks to pregnancy and breastfeeding, falls and fractures,
respiratory infections, gastrointestinal bleeding, cardiovascular effects,
vision changes, weight changes, interference with laboratory tests, impact on
immune system, impact on endocrine system, impact on renal function, behavioral
changes, anaphylaxis, respiratory failure, jaundice, Stevens-Johnson Syndrome,
thrombocytopenia, pancreatitis, hypersensitivity syndrome, interference with
psychomotor testing, disinhibition, withdrawal seizures in neonates, paradoxical
reactions, respiratory arrest, serotonin syndrome, hyponatremia, drug-induced
psychosis, acute narrow-angle glaucoma, severe hypotension and shock, adverse
effects on fertility, and adverse effects on hematopoiesis. Patients taking
lorazepam should be aware of these potential side effects and should discuss any
concerns with their healthcare provider. Regular monitoring and appropriate
dosage adjustments can help to minimize the risk of side effects and ensure the
safe and effective use of lorazepam. Patients should not abruptly stop taking
the medication, and should instead work with their healthcare provider to
gradually taper the dose to avoid withdrawal symptoms.
51.
Increased Risk of Infection Lorazepam can increase the risk of infection,
particularly in patients with preexisting immune system issues or those taking
higher doses of the medication. Patients taking lorazepam should be monitored
for signs of infection, such as fever, chills, or sore throat, and should seek
medical attention if these symptoms occur.
52.
Cognitive Impairment in the Elderly Lorazepam can cause cognitive impairment in
the elderly, particularly in patients taking higher doses of the medication.
This can lead to confusion, memory problems, and difficulty with attention and
concentration. Elderly patients taking lorazepam should be closely monitored for
signs of cognitive impairment.
53.
Development of Anterograde Amnesia Lorazepam can cause anterograde amnesia, a
condition in which patients have difficulty forming new memories. This effect is
more pronounced in patients taking higher doses of the medication or those with
a history of memory problems. Patients taking lorazepam should be monitored for
signs of anterograde amnesia, and the medication should be discontinued if these
symptoms become severe.
54.
Psychiatric Symptoms in Children Lorazepam can cause psychiatric symptoms in
children, including behavioral changes, mood swings, and aggression. Patients
should be monitored for signs of psychiatric symptoms, and the medication should
be discontinued if these symptoms become severe.
55.
Teratogenicity Lorazepam can be teratogenic, meaning it can cause birth defects
or developmental issues in a developing fetus. Patients should avoid taking
lorazepam during pregnancy unless the potential benefits outweigh the risks, and
should consult with their healthcare provider about alternative treatments.
56.
Impact on Sleep Architecture Lorazepam can impact sleep architecture,
potentially causing changes in the timing and quality of sleep. Patients taking
lorazepam should be monitored for signs of sleep disturbances and should discuss
any concerns with their healthcare provider.
57.
Gastrointestinal Distress Lorazepam can cause gastrointestinal distress,
including nausea, vomiting, and diarrhea. Patients should be monitored for signs
of gastrointestinal distress, and the medication should be discontinued if these
symptoms become severe.
58.
Impact on Driving and Operating Heavy Machinery Lorazepam can cause drowsiness,
dizziness, and impaired coordination, making it unsafe to drive or operate heavy
machinery while taking the medication. Patients should avoid these activities
until the sedative effects of the medication have worn off.
59.
Impact on Athletic Performance Lorazepam can impact athletic performance,
potentially causing decreased reaction time, impaired coordination, and reduced
physical endurance. Athletes taking lorazepam should be aware of these potential
side effects and should consult with their healthcare provider before taking the
medication.
60.
Risk of Overdose Lorazepam can be lethal in overdose, particularly when taken
with other central nervous system depressants, such as opioids or alcohol.
Patients should be aware of the potential for overdose and should seek immediate
medical attention if they experience symptoms of overdose, such as severe
drowsiness, confusion, or respiratory depression.In summary, lorazepam is
associated with a variety of potential side effects that can affect multiple
organ systems and functions, including respiratory depression, addiction and
dependence, mood changes, nausea and vomiting, headache and dizziness, muscle
weakness, skin rash, hypotension, sexual dysfunction, liver damage, seizures,
allergic reactions, withdrawal symptoms, interactions with other medications,
tolerance and dependence, suicidal thoughts, risks to pregnancy and
breastfeeding, falls and fractures, respiratory infections, gastrointestinal
bleeding, cardiovascular effects, vision changes, weight changes, interference
with laboratory tests, impact on immune system, impact on endocrine system,
impact on renal function, behavioral changes, anaphylaxis, respiratory failure,
jaundice, Stevens-Johnson Syndrome, thrombocytopenia, pancreatitis,
hypersensitivity syndrome, interference with psychomotor testing, disinhibition,
withdrawal seizures in neonates, paradoxical reactions, respiratory arrest,
serotonin syndrome, hyponatremia, drug-induced psychosis, acute narrow-angle
glaucoma, severe hypotension and shock, adverse effects on fertility, adverse
effects on hematopoiesis, increased risk of infection, cognitive impairment in
the elderly, development of anterograde amnesia, psychiatric symptoms in
children, teratogenicity, impact on sleep architecture, gastrointestinal
distress, impact on driving and operating heavy machinery, impact on athletic
performance, and risk of overdose. Patients taking lorazepam should be aware of
these potential side effects and should discuss any concerns with their
healthcare provider. Regular monitoring and appropriate dosage adjustments can
help to minimize the risk of side effects and ensure the safe and effective use
of lorazepam. Patients should not abruptly stop taking the medication, and
should instead work with their healthcare provider to gradually taper the dose
to avoid withdrawal symptoms. In addition, patients should avoid drinking
alcohol or taking other central nervous system depressants while taking
lorazepam, as this can increase the risk of side effects and overdose. It is
important to follow all instructions from the healthcare provider and to report
any unusual symptoms or side effects to ensure the safe and effective use of
lorazepam.
61.
Metabolic Acidosis Lorazepam can cause metabolic acidosis, a condition in which
there is an accumulation of acid in the body. Symptoms can include rapid
breathing, confusion, and fatigue. Patients should be monitored for signs of
metabolic acidosis, and the medication should be discontinued if these symptoms
occur.
62.
Adverse Effects on Bone Health Lorazepam can have adverse effects on bone
health, particularly in postmenopausal women. Long-term use of the medication
has been associated with an increased risk of osteoporosis and fractures.
Patients taking lorazepam for an extended period of time should discuss the
potential risks with their healthcare provider and may need to undergo bone
density testing.
63.
Rebound Anxiety and Insomnia Lorazepam can cause rebound anxiety and insomnia,
particularly when the medication is abruptly discontinued. Patients should work
with their healthcare provider to gradually taper the dose to avoid these
symptoms.
64.
Adverse Effects on Hearing Lorazepam can have adverse effects on hearing,
potentially causing tinnitus (ringing in the ears) or hearing loss. Patients
should be monitored for signs of hearing impairment, and the medication should
be discontinued if these symptoms occur.
65.
Adverse Effects on Taste and Smell Lorazepam can have adverse effects on taste
and smell, potentially causing changes in the perception of taste or smell.
Patients should be monitored for signs of changes in taste or smell, and the
medication should be discontinued if these symptoms become severe.
66.
Adverse Effects on Blood Sugar Control Lorazepam can have adverse effects on
blood sugar control, potentially causing hypoglycemia (low blood sugar) in
patients with diabetes. Patients with diabetes taking lorazepam should be
closely monitored for signs of hypoglycemia, and the medication should be
discontinued if these symptoms occur.
67.
Adverse Effects on Immune Function Lorazepam can have adverse effects on immune
function, potentially increasing the risk of infections or other immune-related
disorders. Patients taking lorazepam should be monitored for signs of immune
dysfunction, and the medication should be discontinued if these symptoms occur.
68.
Adverse Effects on Wound Healing Lorazepam can have adverse effects on wound
healing, potentially delaying the healing process and increasing the risk of
complications. Patients undergoing surgery or with wounds should avoid taking
lorazepam unless absolutely necessary, and should discuss any concerns with
their healthcare provider.
69.
Adverse Effects on Liver Function Lorazepam can have adverse effects on liver
function, potentially causing liver damage or dysfunction. Patients with
preexisting liver issues should avoid taking lorazepam, and all patients taking
the medication should be monitored for signs of liver dysfunction, such as
jaundice or elevated liver enzymes.
70.
Adverse Effects on Renal Function Lorazepam can have adverse effects on renal
function, potentially causing kidney damage or dysfunction. Patients with
preexisting kidney issues should avoid taking lorazepam, and all patients taking
the medication should be monitored for signs of renal dysfunction, such as
decreased urine output or elevated creatinine levels.In conclusion, lorazepam
can cause a wide range of potential side effects that can affect multiple organ
systems and functions, including respiratory depression, addiction and
dependence, mood changes, nausea and vomiting, headache and dizziness, muscle
weakness, skin rash, hypotension, sexual dysfunction, liver damage, seizures,
allergic reactions, withdrawal symptoms, interactions with other medications,
tolerance and dependence, suicidal thoughts, risks to pregnancy and
breastfeeding, falls and fractures, respiratory infections, gastrointestinal
bleeding, cardiovascular effects, vision changes, weight changes, interference
with laboratory tests, impact on immune system, impact on endocrine system,
impact on renal function, behavioral changes, anaphylaxis, respiratory failure,
jaundice, paradoxical reactions, respiratory arrest, serotonin syndrome,
hyponatremia, drug-induced psychosis, acute narrow-angle glaucoma, severe
hypotension and shock, adverse effects on fertility, adverse effects on
hematopoiesis, increased risk of infection, cognitive impairment in the elderly,
development of anterograde amnesia, psychiatric symptoms in children,
teratogenicity, impact on sleep architecture, gastrointestinal distress, impact
on driving and operating heavy machinery, impact on athletic performance, risk
of overdose, metabolic acidosis, adverse effects on bone health, rebound anxiety
and insomnia, adverse effects on hearing, adverse effects on taste and smell,
adverse effects on blood sugar control, adverse effects on immune function,
adverse effects on wound healing, adverse effects on liver function, and adverse
effects on renal function. Patients taking lorazepam should be aware of these
potential side effects and should discuss any concerns with their healthcare
provider. Regular monitoring and appropriate dosage adjustments can help to
minimize the risk of side effects and ensure the safe and effective use of
lorazepam. Patients should not abruptly stop taking the medication, and should
instead work with their healthcare provider to gradually taper the dose to avoid
withdrawal symptoms. In addition, patients should avoid drinking alcohol or
taking other central nervous system depressants while taking lorazepam, as this
can increase the risk of side effects and overdose. It is important to follow
all instructions from the healthcare provider and to report any unusual symptoms
or side effects to ensure the safe and effective use of lorazepam.
71.
Adverse Effects on Sexual Function Lorazepam can have adverse effects on sexual
function, potentially causing decreased libido, erectile dysfunction, or
difficulty achieving orgasm. Patients should be monitored for signs of sexual
dysfunction, and the medication should be discontinued if these symptoms become
severe.
72.
Adverse Effects on Mood and Behavior Lorazepam can have adverse effects on mood
and behavior, potentially causing irritability, aggression, or other changes in
behavior. Patients should be monitored for signs of mood or behavior changes,
and the medication should be discontinued if these symptoms become severe.
73.
Development of Dependence and Withdrawal Symptoms Lorazepam can cause physical
and psychological dependence, particularly when taken at high doses or for an
extended period of time. Patients who stop taking lorazepam may experience
withdrawal symptoms, including anxiety, insomnia, seizures, and hallucinations.
Patients should work with their healthcare provider to gradually taper the dose
of lorazepam to avoid withdrawal symptoms.
74.
Paradoxical Reactions in Pediatric Patients Lorazepam can cause paradoxical
reactions in pediatric patients, particularly those with attention deficit
hyperactivity disorder (ADHD) or developmental disorders. Paradoxical reactions
can include hyperactivity, agitation, and aggressive behavior. Pediatric
patients taking lorazepam should be closely monitored for signs of paradoxical
reactions, and the medication should be discontinued if these symptoms occur.
75.
Adverse Effects on Memory and Learning Lorazepam can have adverse effects on
memory and learning, potentially causing difficulties with memory recall and
retention. Patients taking lorazepam should be monitored for signs of memory or
learning difficulties, and the medication should be discontinued if these
symptoms become severe.
76.
Adverse Effects on Endocrine Function Lorazepam can have adverse effects on
endocrine function, potentially causing changes in hormone levels or function.
Patients taking lorazepam should be monitored for signs of endocrine
dysfunction, and the medication should be discontinued if these symptoms become
severe.
77.
Adverse Effects on Reproductive Function Lorazepam can have adverse effects on
reproductive function, potentially causing changes in fertility or menstrual
cycles. Patients taking lorazepam should be monitored for signs of reproductive
dysfunction, and the medication should be discontinued if these symptoms become
severe.
78.
Adverse Effects on Cognitive Function in Neonates Lorazepam can have adverse
effects on cognitive function in neonates, particularly when used for sedation
or as a treatment for seizures. Neonates taking lorazepam should be closely
monitored for signs of cognitive dysfunction, and the medication should be
discontinued if these symptoms occur.
79.
Adverse Effects on Pulmonary Function Lorazepam can have adverse effects on
pulmonary function, potentially causing respiratory depression or other
breathing problems. Patients taking lorazepam should be monitored for signs of
respiratory distress, and the medication should be discontinued if these
symptoms become severe.
80.
Adverse Effects on Vision and Eye Health Lorazepam can have adverse effects on
vision and eye health, potentially causing blurred vision, double vision, or
other visual disturbances. Patients taking lorazepam should be monitored for
signs of visual disturbances, and the medication should be discontinued if these
symptoms become severe. In summary, lorazepam can cause a wide range of
potential side effects that can affect multiple organ systems and functions,
including respiratory depression, addiction and dependence, mood changes, nausea
and vomiting, headache and dizziness, muscle weakness, skin rash, hypotension,
sexual dysfunction, liver damage, seizures, allergic reactions, withdrawal
symptoms, interactions with other medications, tolerance and dependence,
suicidal thoughts, risks to pregnancy and breastfeeding, falls and fractures,
respiratory infections, gastrointestinal bleeding, cardiovascular effects,
vision changes, weight changes, interference with laboratory tests, impact on
immune system, impact on endocrine system, impact on renal function, behavioral
changes, anaphylaxis, respiratory failure, jaundice, Stevens-Johnson Syndrome,
thrombocytopenia, pancreatitis, hypersensitivity syndrome, interference with
psychomotor testing, disinhibition, withdrawal seizures in neonates, paradoxical
reactions, respiratory arrest, serotonin syndrome, hyponatremia, drug-induced
psychosis, acute narrow-angle glaucoma, severe hypotension and shock, adverse
effects on fertility, adverse effects on hematopoiesis, increased risk of
infection, cognitive impairment in the elderly, development of anterograde
amnesia, psychiatric symptoms in children, teratogenicity, impact on sleep
architecture, gastrointestinal distress, impact on driving and operating heavy
machinery, impact on athletic performance, risk of overdose, metabolic acidosis,
adverse effects on bone health, rebound anxiety and insomnia, adverse effects on
hearing, adverse effects on taste and smell, adverse effects on blood sugar
control, adverse effects on immune function, adverse effects on wound healing,
adverse effects on liver function, adverse effects on renal function, adverse
effects on sexual function, adverse effects on mood and behavior, development of
dependence and withdrawal symptoms, paradoxical reactions in pediatric patients,
adverse effects on memory and learning, adverse effects on endocrine function,
adverse effects on reproductive function, adverse effects on cognitive function
in neonates, adverse effects on pulmonary function, and adverse effects on
vision and eye health. Patients taking lorazepam should be aware of these
potential side effects and should discuss any concerns with their healthcare
provider. Regular monitoring and appropriate dosage adjustments can help to
minimize the risk of side effects and ensure the safe and effective use of
lorazepam. Patients should not abruptly stop taking the medication, and should
instead work with their healthcare provider to gradually taper the dose to avoid
withdrawal symptoms. In addition, patients should avoid drinking alcohol or
taking other central nervous system depressants while taking lorazepam, as this
can increase the risk of side effects and overdose. It is important to follow
all instructions from the healthcare provider and to report any unusual symptoms
or side effects to ensure the safe and effective use of lorazepam.
1.
Phenobarbital and symptom-triggered lorazepam versus lorazepam alone for severe
alcohol withdrawal in the intensive care unit
A symptom-triggered lorazepam regimen is the standard for treating alcohol
withdrawal syndrome (AWS) in an inpatient setting. However, in severe AWS,
lorazepam requirements can reach significant amounts and lead to risk of
delirium and propylene glycol toxicity. Phenobarbital has been shown to be an
effective adjunctive therapy for AWS, reducing benzodiazepine use, in the
emergency department. The purpose of this study is to determine the efficacy and
safety of phenobarbital in adjunct to symptom-triggered lorazepam for severe AWS
vs. lorazepam alone in the intensive care unit (ICU). A retrospective cohort was
conducted at Cleveland Clinic hospitals from 2013 to 2018 of ICU patients with
AWS receiving either phenobarbital adjunct to symptom-triggered lorazepam or
lorazepam alone. The primary outcome was the total duration of treatment.
Secondary outcomes include ICU length of stay, change in CIWA-Ar score at 24 h,
incidence of hypotension, mechanical ventilation, and serum osmolar gap. A total
of 72 ICU patients were included with 36 patients in each arm. The median
duration of treatment in the phenobarbital adjunct arm was 2.7 days (IQR =
1.7-6.4), compared to 3.1 days (IQR = 1.6-4.8) in the lorazepam arm (p = 0.578).
The median ICU length of stay was similar between both arms [4.1 days (IQR =
2.4-8.4) vs. 4.5 days (IQR = 2.8-6.1), p = 0.727]. The average change in CIWA-Ar
from baseline at 24 h was significantly lower for those who received
phenobarbital (1.8 ± 9.0 vs. 6.5 ± 8.5, p = 0.028). Three patients in the
phenobarbital-adjunct group received mechanical ventilation after starting
phenobarbital treatment. There were no new incidences of hypotension or
increased osmol gap >10 mmol/L after starting treatment in both groups. In
conclusion, phenobarbital is an effective adjunct to symptom-triggered lorazepam
in severe alcohol withdrawal in the ICU with no significant difference in
adverse events.
2.
Phenobarbital Versus Lorazepam for Management of Alcohol Withdrawal Syndrome: A
Retrospective Cohort Study
Introduction Annually, 500,000 episodes of alcohol withdrawal syndrome (AWS) are
severe enough to require clinical attention. A symptom-triggered lorazepam
regimen remains the standard of care for the management of hospitalized AWS
patients. However, phenobarbital has also been shown to be an effective
adjunctive therapy for severe AWS, reducing benzodiazepine use in the emergency
department (ED) and the intensive care unit (ICU). The purpose of this study is
to compare hospital length of stay (LOS) for AWS patients using
phenobarbital-based versus lorazepam-based treatment protocols as monotherapy
for management of AWS on general medical units. Methods This is a retrospective
cohort study over a two-year period (March, 2016 to March, 2018), conducted at
three hospitals within the St. Joseph Mercy Health System. We included 606
patients with a primary diagnosis of AWS or alcohol intoxication who met our
inclusion criteria (543 in the lorazepam cohort and 63 in the phenobarbital
cohort). Adjusted comparisons were done using propensity scoring methods.
Hospital LOS was set as the primary outcome. Secondary outcomes included
all-cause 30-day readmission, alcohol-related 30-day readmission, 30-day ED
visits after discharge, and need for ICU transfer during hospital stay. Results
Patients who received phenobarbital had a statistically significant shorter
hospital LOS as compared to patients who received lorazepam (2.8 versus 3.6
days, P < 0.001). Furthermore, the phenobarbital treatment group had
statistically significant lower rates of all-cause 30-day readmission (11.11%
versus 14.18%, P = 0.020) and 30-day ED visits after discharge (11.11% versus
18.6%, P = 0.015). No statistical significance was detected for alcohol-related
30-day readmission and the need for ICU transfer between the treatment groups.
Conclusion This study suggests that phenobarbital may be a reasonable
alternative to lorazepam in the management of AWS patients admitted to general
medical units. Larger scale, well-executed, and adequately powered prospective
studies and randomized controlled trials are needed to corroborate these
findings.
3.
Acute and
Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic
Medications
Studies on psychotropic medications decrease, discontinuation, or switch have
uncovered withdrawal syndromes. The present overview aimed at analyzing the
literature to illustrate withdrawal after decrease, discontinuation, or switch
of psychotropic medications based on the drug class (i.e., benzodiazepines,
nonbenzodiazepine benzodiazepine receptor agonists, antidepressants, ketamine,
antipsychotics, lithium, mood stabilizers) according to the diagnostic criteria
of Chouinard and Chouinard [Psychother Psychosom. 2015;84(2):63-71], which
encompass new withdrawal symptoms, rebound symptoms, and persistent
post-withdrawal disorders. All these drugs may induce withdrawal syndromes and
rebound upon discontinuation, even with slow tapering. However, only selective
serotonin reuptake inhibitors, serotonin noradrenaline reuptake inhibitors, and
antipsychotics were consistently also associated with persistent post-withdrawal
disorders and potential high severity of symptoms, including alterations of
clinical course, whereas the distress associated with benzodiazepines
discontinuation appears to be short-lived. As a result, the common belief that
benzodiazepines should be substituted by medications that cause less dependence
such as antidepressants and antipsychotics runs counter the available
literature. Ketamine, and probably its derivatives, may be classified as at high
risk for dependence and addiction. Because of the lag phase that has taken place
between the introduction of a drug into the market and the description of
withdrawal symptoms, caution is needed with the use of newer antidepressants and
antipsychotics. Within medication classes, alprazolam, lorazepam, triazolam,
paroxetine, venlafaxine, fluphenazine, perphenazine, clozapine, and quetiapine
are more likely to induce withdrawal. The likelihood of withdrawal
manifestations that may be severe and persistent should thus be taken into
account in clinical practice and also in children and adolescents.
4.
Lorazepam
Lorazepam is FDA-approved for short-term (4 months) relief of anxiety symptoms
related to anxiety disorders, anxiety-associated insomnia, anesthesia
premedication in adults to relieve anxiety or to produce sedation/amnesia, and
treatment of status epilepticus. Off-label (non-FDA-approved) uses for lorazepam
include rapid tranquilization of the agitated patient, alcohol withdrawal
delirium, alcohol withdrawal syndrome, insomnia, panic disorder, delirium,
chemotherapy-associated anticipatory nausea, and vomiting (adjunct or
breakthrough), as well as psychogenic catatonia. This activity covers lorazepam,
including mechanism of action, pharmacology, adverse event profiles, eligible
patient populations, and monitoring. It also highlights the interprofessional
team's role in managing lorazepam therapy.
5.
Benzodiazepines vs barbiturates for alcohol withdrawal: Analysis of 3 different
treatment protocols
Introduction: Alcohol withdrawal treatment varies widely. Benzodiazepines are
the standard of care, with rapid onset and long durations of action. Recent drug
shortages involving IV benzodiazepines have required incorporation of
alternative agents into treatment protocols. Phenobarbital has similar
pharmacokinetics to select benzodiazepines frequently used for alcohol
withdrawal. The objective of this study is to describe the effectiveness and
safety of our institutional protocols during three time periods utilizing
benzodiazepines and barbiturates for the acute treatment of alcohol withdrawal
in the emergency department.
Methods: Adult patients presenting to the ED for acute alcohol withdrawal from
April 1st, 2016 to January 31st, 2018 were reviewed. Patients who received at
least one dose of treatment were included. Treatments were based on availability
of medication and given protocol at time of presentation. The primary outcome
was the rate of ICU admission.
Results: 300 patient encounters were included. Overall baseline characteristics
were equal across groups, except for age. There was no difference in rate of ICU
admission from the ED between groups (D:8, L&P:11, P:13 patients, p = 0.99).
Rate of mechanical ventilation was no different across all groups (D:1, L&P:3,
P:3 patients, p = 0.55).
Conclusion: During benzodiazepine shortages, phenobarbital is a safe and
effective treatment alternative for alcohol withdrawal. Incorporating
phenobarbital into a benzodiazepine based protocol or as sole agent led to
similar rates of ICU admission, length of stay, and need for mechanical
ventilation in patients treated for alcohol withdrawal in the emergency
department.
6.
Lorazepam-efficacy, side effects, and rebound phenomena
Lorazepam, 4 mg, was evaluated in an 18-night sleep-laboratory study involving
five insomniac subjects. Hypnotic effectiveness and effects on sleep stages and
related parameters were assessed. Placebo was given on baseline nights 1 to 4,
lorazepam on nights 5 to 11, and placebo was given again on withdrawal nights 12
to 18. Subjective and objective data clearly demonstrated that lorazepam was
effective for both inducing and maintaining sleep. Sleep latency was reduced
from a baseline value of 34.6 min to 17.9 min (P less than 0.01) and total wake
time was reduced from 75.9 to 38.5 min (P less than 0.01). On the third and
fifth nights of drug withdrawal total wake time rose above baseline levels
(termed rebound insomnia) and sleep latency increased by 77% and 60% over
baseline (P less than 0.01). Subjective estimates of daytime anxiety also
increased above baseline (rebound anxiety) during the withdrawal period. All
subjects experienced severe hangover and varying degrees of impaired functioning
during the first 3 days on drug. Three subjects also experienced anterograde
amnesia during the day after the first drug night. These side effects diminished
in intensity over the course of the study. Our results suggest that while 4 mg
lorazepam may be effective in inducing and maintaining sleep, this dose induces
clinically significant side effects that are followed by consistent rebound
phenomena after withdrawal.
7.
Atypical
behavioural effects of lorazepam: clues to the design of novel therapies?
Aside from their pharmacokinetic properties, e.g. their speed of action and the
duration of residual effects, benzodiazepines are still considered as equivalent
in terms of their effects on cognition. Here we review evidence suggesting that
certain benzodiazepines, especially lorazepam, differ in a number of respects,
in particular with respect to their effects on cognition. We focus this review
on memory, attention and visual perception, where impairments may be brought
about by only a subset of benzodiazepines in spite of their administration at
doses inducing similar sedative effects. This precludes an explanation in terms
of sedation. Differences in the effects of benzodiazepines have also been found
in electrophysiological and animal behavioural studies. These studies are
important for therapeutic approaches for two reasons: first, effects of
benzodiazepine prescription on cognitive functions will differ according to the
benzodiazepine, contrary to what is usually believed. Less straightforwardly are
the possible therapeutic implications of specific effects on cognition following
treatment with lorazepam. Indeed, the specific effects this drug has on
cognition may reveal not only side-effects but also effects of potential
therapeutic value. Current research concentrates on a fine scale analysis of the
effects of GABA on different sub-types of GABA(A) receptors. We suggest that
from looking at what makes lorazepam different in a behavioural sense from other
benzodiazepines we may be in a position to design innovative treatments for
major aspects of complex disorders, including schizophrenia.
8.
Acute
lorazepam effects on neurocognitive performance
A double-blind, placebo-controlled, crossover design was employed to determine
whether acute lorazepam (2 mg orally) cognitive side effects would emerge in a
differential age-dependent fashion in 15 young (mean age=22 years) and 12 older
(mean age=64 years) subjects. Acute use of lorazepam is frequently the initial
treatment choice for convulsive status epilepticus or repetitive seizure
clusters. Cognitive assessment was performed during drug and placebo conditions
using a computerized battery of cognitive tests. With the exception of
performance on the reasoning composite score, significant drug effects were
present on all primary cognitive domain measures. However, the only significant
drug-by-age interaction effect was seen for dual-task performance. The
relationship between test performance and plasma lorazepam concentrations was
generally modest and non-significant, suggesting that individual differences in
pharmacokinetics are not a major factor contributing to the emergence of
cognitive side effects. Despite robust lorazepam effects on multiple measures of
neurocognitive function, differential age effects are largely restricted to
dual-task performance. These results indicate that with the exception of
dual-task performance, older individuals in the age range of this study do not
appear to be at increased risk for the emergence of cognitive side effects
following a single 2-mg dose of lorazepam.
9.
Efficacy and
side effects of lorazepam, oxazepam, and temazepam as sleeping aids in
psychogeriatric inpatients
The efficacy and side effects of 2 mg of lorazepam, 30 mg of oxazepam, and 20 mg
of temazepam as sleeping aids were investigated in 20 psychogeriatric
inpatients. The drugs were administered in a random order, double-blind, for 7
night each. All of these short half-life benzodiazepines proved efficacious in
maintaining sleep. None of them reduced initial sleep latency. Oxazepam and to a
lesser degree temazepam induced withdrawal insomnia during the first night after
the treatments. The withdrawal of lorazepam induced a delayed but prolonged
insomnia in 3 patients. Both lorazepam and oxazepam had muscle relaxant side
effects after awakening.
10.
Adverse
performance effects of acute lorazepam administration in elderly long-term
users: pharmacokinetic and clinical predictors
Background: The benzodiazepine lorazepam is widely utilized in the treatment of
elderly individuals with anxiety disorders and related conditions. Negative
effects of acute lorazepam administration on cognitive performance, especially
memory, have been reported in both previously untreated elderly and in
individuals who have received short term (up to three weeks) treatment with
therapeutic doses. However, it remains unclear if these adverse cognitive
effects also persist after long-term use, which is frequently found in clinical
practice.
Methods: Cognitively intact elderly individuals (n=37) on long-term (at least
three months) daily treatment with lorazepam were studied using a double-blind
placebo-controlled cross-over study design. Subjects were administered their
highest daily unit dose of lorazepam (0.25-3.00 mg) or placebo on different
days, approximately 1 week apart in a random order, and were assessed on memory,
psychomotor speed, and subjective mood states.
Results: Subjects had significantly poorer recall and slowed psychomotor
performance following acute lorazepam administration. There were no significant
effects on self-ratings of mood, sedation, or anxiety in the whole group, but
secondary analyses suggested a differential response in subjects with
Generalized Anxiety Disorder.
Conclusions: The reduced recall and psychomotor slowing that we observed, along
with an absence of significant therapeutic benefits, following acute lorazepam
administration in elderly long-term users reinforces the importance of cognitive
toxicity as a clinical factor in benzodiazepine use, especially in this
population.
Keywords: Aging; Benzodiazepines; Cognitive toxicity; Lorazepam; Memory loss;
Psychomotor slowing.