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Medications

Lorazepam

Brand Name(s): Ativan®, Lorazepam Intensol®, Loreev XR®; also available generically

IMPORTANT WARNING:

Lorazepam may increase the risk of serious or life-threatening breathing problems, sedation, or coma if used along with certain medications. Tell your doctor if you are taking or plan to take certain medications for cough or for pain that contain opiates (e.g. codeine, hydrocodone, morphine, oxycodone, tramadol). Your doctor may need to change the dosages of your medications and will monitor you carefully. If you take lorazepam with any of these medications and you develop any of the following symptoms, call your doctor immediately or seek emergency medical care immediately: unusual dizziness, lightheadedness, extreme sleepiness, slowed or difficult breathing, or unresponsiveness. Be sure that your caregiver or family members know which symptoms may be serious so they can call the doctor or emergency medical care if you are unable to seek treatment on your own.

Lorazepam may be habit forming. Do not take a larger dose, take it more often, or for a longer time than your doctor tells you to. Tell your doctor if you have ever drunk large amounts of alcohol, if you use or have ever used street drugs, or have overused prescription medications. Do not drink alcohol or use street drugs during your treatment. Drinking alcohol or using street drugs during your treatment with lorazepam also increases the risk that you will experience these serious, life-threatening side effects. Also tell your doctor if you have or have ever had depression, another mental illness, or thoughts of harming or killing yourself or trying to do so.

Lorazepam may cause a physical dependence (a condition in which unpleasant physical symptoms occur if a medication is suddenly stopped or taken in smaller doses), especially if you take it for several days to several weeks. Do not stop taking this medication or take fewer doses without talking to your doctor. Stopping lorazepam suddenly can worsen your condition and cause withdrawal symptoms that may last for several weeks to more than 12 months. Your doctor probably will decrease your lorazepam dose gradually. Call your doctor or get emergency medical treatment if you experience any of the following symptoms: unusual movements; ringing in your ears; anxiety; memory problems; difficulty concentrating; sleep problems; seizures; shaking; muscle twitching; changes in mental health; aggression; depression; burning or prickling feeling in your hands, arms, legs or feet; seeing or hearing things that others do not see or hear; thoughts of harming or killing yourself or others; overexcitement; or losing touch with reality.

WHY is this medicine prescribed?

Lorazepam is used to relieve anxiety. Lorazepam is also used to treat insomnia caused by anxiety or temporary situational stress. Lorazepam is in a class of medications called benzodiazepines. It works by slowing activity in the brain to allow for relaxation.

HOW should this medicine be used?

Lorazepam comes as a tablet, an extended release capsule (Loreev), and concentrate (liquid) to take by mouth with or without food. The tablets and concentrate (liquid) are usually taken with or without food two or three times a day. If lorazepam (tablets or concentrate) is used to treat insomnia, it is usually taken at bedtime. The extended release capsules (Loreev) are usually taken with or without food once a day in the morning. 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.

Swallow the extended release capsules whole; do not chew or crush them. If you are unable to swallow the extended release capsule, you may open the capsule and sprinkle the entire contents onto a tablespoon of applesauce. You may prepare the mixture in advance and store it for up to 2 hours. When you are ready to take your medication, swallow all the mixture without chewing. Then drink water to wash down the mixture and be sure that you have swallowed all of it. Do not store the medication mixture for future use.

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 water, juice, or carbonated beverages just before taking it. It also may be mixed with applesauce or pudding just before taking the dose. Stir the mixture gently for a few seconds. Take the entire mixture immediately; do not store it for future use.

Are there OTHER USES for this medicine?

Lorazepam is also sometimes used to treat nausea and vomiting from cancer treatment and to control agitation caused by alcohol withdrawal. Talk to your doctor about the possible risks of using this medication for your condition.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

What SPECIAL PRECAUTIONS should I follow?

Before taking lorazepam,

  • tell your doctor and pharmacist if you are allergic to lorazepam, alprazolam (Xanax), chlordiazepoxide (Librium, in Librax), clonazepam (Klonopin), clorazepate (Tranxene), diazepam (Valium, Valtoco), estazolam, flurazepam, oxazepam, temazepam (Restoril), triazolam (Halcion), any other medications, or any of the ingredients in lorazepam tablets, extended release capsules, or concentrate. If you are taking the extended release capsules, tell your doctor or pharmacist if you are allergic to aspirin or tartrazine (a yellow dye in some processed foods and drugs). Ask your doctor or pharmacist for a list of the ingredients.
  • tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
  • tell your doctor if you have narrow angle glaucoma (a serious eye condition that may cause loss of vision). Your doctor will probably tell you not to take lorazepam.
  • tell your doctor if you have or have ever had seizures, sleep apnea (condition in which a person briefly stops breathing many times during the night), lung problems or any condition that affects your breathing such as asthma or chronic obstructive pulmonary disease (COPD), or heart or liver disease.
  • tell your doctor if you are pregnant or plan to become pregnant. If you take lorazepam late during your pregnancy, your baby may experience sedation and/or withdrawal symptoms after birth. Tell your baby's doctor right away if your baby experiences any of the following symptoms: breathing problems, sluggishness, low muscle tone, jitteriness, irritability, restlessness, shaking, excessive crying, or feeding problems. If you become pregnant while taking lorazepam, call your doctor.
  • tell your doctor if you are breastfeeding. You should not breastfeed while you are taking lorazepam.
  • talk to your doctor about the risks and benefits of taking this medication if you are 65 years of age or older. Older adults should take lower doses of lorazepam because higher doses may not be more effective and are more likely to cause serious side effects.
  • if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking lorazepam.
  • you should know that this medication may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you.

What SPECIAL DIETARY instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What should I do IF I FORGET to take a dose?

If you take several doses per day and miss a dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What SIDE EFFECTS can this medicine cause?

Lorazepam may cause side effects. Call your doctor if any of the following symptoms are severe or do not go away:

  • drowsiness
  • dizziness
  • tiredness
  • weakness
  • unsteadiness
  • diarrhea
  • nausea
  • changes in appetite
  • restlessness or excitement
  • constipation
  • blurred vision
  • changes in sex drive or ability

Some side effects can be serious. If you experience any of these symptoms or those listed in the IMPORTANT WARNINGS section, call your doctor immediately or get emergency medical treatment:

  • shuffling walk
  • persistent, fine tremor or inability to sit still
  • trouble talking
  • rash; hives; itching; swelling of the face, eyes, or mouth; wheezing; or shortness of breath
  • yellowing of skin or eyes
  • irregular heartbeat

Lorazepam may cause other side effects. Call your doctor if you have any unusual problems while you are taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (https://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

What should I know about STORAGE and DISPOSAL of this medication?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. https://www.upandaway.org

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (https://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

What should I do in case of OVERDOSE?

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include:

  • drowsiness
  • confusion
  • tiredness
  • slowed breathing and heartbeat
  • problems with coordination
  • trouble talking
  • loss of consciousness

What OTHER INFORMATION should I know?

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your response to lorazepam.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.

The American Society of Health-System Pharmacists, Inc. represents that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. makes no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug. The information is not a substitute for medical care.

AHFS® Patient Medication Information™. © Copyright, 2024. The American Society of Health-System Pharmacists®, 4500 East-West Highway, Suite 900, Bethesda, Maryland. All Rights Reserved. Duplication for commercial use must be authorized by ASHP.

Selected Revisions: February 15, 2023.

AHFS® Patient Medication Information™. © Copyright, 2024