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Each Loravan tablet contains 0.5 mg, 1 mg, or 2 mg of lorazepam.
The inactive ingredients present are lactose monohydrate, magnesium stearate, microcrystalline cellulose, polacriline potassium.
INDICATIONS
Loravan 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.
DOSAGE AND ADMINISTRATION
Loravan 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 Loravan 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.
WARNINGS
Pre-existing depression may emerge or worsen during use of benzodiazepines including lorazepam. Loravan is not recommended for use in patients with a primary depressive disorder or psychosis.
Use of benzodiazepines, including lorazepam, both used alone and in combination with other CNS depressants, may lead to potentially fatal respiratory depression. (See PRECAUTIONS, Clinically Significant Drug Interactions)
Use of benzodiazepines, including lorazepam, may lead to physical and psychological dependence.
CONTRAINDICATIONS
Loravan is contraindicated in patients with
* hypersensitivity to benzodiazepines or to any components of the formulation.
* acute narrow-angle glaucoma.
SIDE EFFECTS
Drowsiness, dizziness, loss of coordination, headache, nausea, blurred vision, change in sexual interest/ability, hair loss, constipation, heartburn, or change in appetite may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.
Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
STORAGE
Store at room temperature between 68-77 degrees F (20-25 degrees C) away from light and moisture. Do not store in the bathroom. Keep all medicines away from children
Presentation
Loravan Tablets Strip of 10 Tablets
Lorazepam has relatively potent anxiolytic effects and its best known indication is the short-term management of severe chronic anxiety, though in fact the FDA advises against this usage. It is fast acting, and useful in treating fast onset panic anxiety.
Lorazepam has strong sedative/hypnotic effects, and the duration of clinical effects from a single dose makes it an appropriate choice for the short term treatment of insomnia, particularly in the presence of severe anxiety. Withdrawal symptoms, including rebound insomnia and rebound anxiety, may occur after only 7 days' administration of lorazepam.
Its relatively potent amnesic effect, with its anxiolytic and sedative effects, makes lorazepam useful as premedication. It is given before a general anaesthetic to reduce the amount of anaesthetic agent required, or before unpleasant awake procedures, such as in dentistry or endoscopies, to reduce anxiety, to increase compliance, and to induce amnesia for the procedure. Oral lorazepam is given 90 to 120 minutes before procedures, and intravenous lorazepam as late as 10 minutes before procedures.
The marked anticonvulsant properties of lorazepam, and its pharmacokinetic profile, makes intravenous lorazepam a reliable agent for terminating acute seizures, but it has relatively prolonged sedation aftereffects. Oral lorazepam, and other benzodiazepines, have a role in long-term prophylactic treatment of resistant forms of petit mal epilepsy but not as first-line therapies, mainly because of the development of resistance to their effects.
Lorazepam's anticonvulsant, or CNS depressant, properties are useful for the prevention and treatment of alcohol withdrawal syndrome. In this setting it is relevant that impaired liver function is not a hazard with lorazepam since lorazepam does not require oxidation, hepatic or otherwise, for its metabolism.
Where there is need for rapid sedation of violent or agitated patients, including acute delirium, lorazepam may be used, but as it can cause paradoxical effects, it is preferably given together with haloperidol.Lorazepam is absorbed relatively slowly if given intramuscularly, a common route in restraint situations.
Catatonia with inability to speak is responsive and sometimes controlled with a single 2 mg oral, or slow intravenous, dose of lorazepam. Symptoms may recur and treatment for some days may be necessary. Catatonia due to abrupt or too rapid withdrawal from benzodiazepines, as part of the benzodiazepine withdrawal syndrome, should also respond to lorazepam treatment. As lorazepam can have paradoxical effects, haloperidol is sometimes given concomitantly.
It is sometimes used in chemotherapy as an adjunct to antiemetics for treating anticipatory nausea and vomiting, i.e. nausea and vomiting caused or worsened by psychological sensitisation to the thought of being sick. It is also used as adjunct therapy for cyclic vomiting syndrome.
Formulation and administration
0.5mg tablets of the Ativan brand of lorazepam.
Pure lorazepam is an almost white powder that is nearly insoluble in water and oil. In medicinal form, lorazepam is mainly available as tablets and a solution for injection but in some locations it is also available as a skin patch, an oral solution and a sublingual tablet.
Lorazepam tablets and syrups are administered by mouth only. The tablets contain 0.5 mg, 1 mg, or 2 mg lorazepam, with some differences between countries. Lorazepam tablets of the Ativan brand also contain lactose, microcrystalline cellulose, polacrilin potassium, magnesium stearate and colouring agents (indigo carmine—E132—in blue tablets and tartrazine—E102— in yellow tablets).
Lorazepam injectable solution is administered either by deep intramuscular injection or by intravenous injection. The injectable solution comes in 1 mL ampoules containing 2 mg or 4 mg lorazepam. The solvents used are polyethylene glycol 400 and propylene glycol. As a preservative, the injectable solution contains benzyl alcohol. Toxicity from propylene glycol has been reported in the case of a patient receiving a continuous lorazepam infusion. Intravenous injections should be given slowly and patients closely monitored for side-effects, such as respiratory depression, hypotension, or loss of airway control.
Peak effects roughly coincide with peak serum levels, which occur 10 minutes after intravenous injection, up to 60 minutes after intramuscular injection, and 90 to 120 minutes after oral administration, but initial effects will be noted before this. A clinically relevant lorazepam dose will normally be effective for 6 to 12 hours, making it unsuitable for regular once-daily administration, so it is usually prescribed as two to four daily doses when taken regularly.
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.
Other uses for this medicine
Lorazepam is also used to treat irritable bowel syndrome, epilepsy, insomnia, and 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 drug for your condition.
What special precautions should I follow?
Before taking lorazepam,
* tell your doctor and pharmacist if you are allergic to lorazepam, alprazolam (Xanax), chlordiazepoxide (Librium, Librax), clonazepam (Klonopin), clorazepate (Tranxene), diazepam (Valium), estazolam (ProSom), flurazepam (Dalmane), oxazepam (Serax), prazepam (Centrax), temazepam (Restoril), triazolam (Halcion), or any other drugs.
* tell your doctor and pharmacist what prescription and nonprescription medications you are taking, especially antihistamines; digoxin (Lanoxin); levodopa (Larodopa, Sinemet); medications for depression, seizures, pain, Parkinson's disease, asthma, colds, or allergies; muscle relaxants; oral contraceptives; probenecid (Benemid); rifampin (Rifadin); sedatives; sleeping pills; theophylline (Theo-Dur); tranquilizers; valproic acid (Depakene); and vitamins. These medications may add to the drowsiness caused by lorazepam.
* tell your doctor if you have or have ever had glaucoma; seizures; or lung, heart, or liver disease.
* tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking lorazepam, call your doctor immediately.
* if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking lorazepam.
* you should know that this drug may make you drowsy. Do not drive a car or operate machinery until you know how this drug affects you.
* remember that alcohol can add to the drowsiness caused by this drug.
* tell your doctor if you use tobacco products. Cigarette smoking may decrease the effectiveness of this drug.
What should I do if I forget 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 medication cause?
Side effects from lorazepam may occur and include:
* drowsiness
* dizziness
* tiredness
* weakness
* dry mouth
* diarrhea
* nausea
* changes in appetite
Tell your doctor if any of these symptoms are severe or do not go away:
* restlessness or excitement
* constipation
* difficulty urinating
* frequent urination
* blurred vision
* changes in sex drive or ability
If you experience any of the following symptoms, call your doctor immediately:
* shuffling walk
* persistent, fine tremor or inability to sit still
* fever
* difficulty breathing or swallowing
* severe skin rash
* yellowing of the skin or eyes
* irregular heartbeat,
Important information about lorazepam
Do not use this medication if you are allergic to lorazepam or to other benzodiazepines, such as alprazolam (Xanax), chlordiazepoxide (Librium), clorazepate (Tranxene), diazepam (Valium), or oxazepam (Serax). This medication can cause birth defects in an unborn baby. Do not use lorazepam if you are pregnant.
Before taking lorazepam, tell your doctor if you have any breathing problems, glaucoma, kidney or liver disease, or a history of depression, suicidal thoughts, or addiction to drugs or alcohol.
Do not drink alcohol while taking lorazepam. This medication can increase the effects of alcohol.
Avoid using other medicines that make you sleepy. They can add to sleepiness caused by lorazepam.
Lorazepam may be habit-forming and should be used only by the person it was prescribed for. Lorazepam should never be shared with another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it.
It is dangerous to try and purchase this medicine on the Internet or from vendors outside of the
Brand Name: Ativan
Lorazepam, Ativan is an anti-anxiety medication to relieve anxiety and anxiety associated with depressive symptoms. Usage, dosage, side effects of Lorazepam.
Contents:
Description
Pharmacology
Indications and Usage
Contraindications
Warnings
Precautions
Drug Interactions
Adverse Reactions
Overdose
Dosage
Supplied
Ativan patient information (in plain English)
Description
Lorazepam (Ativan) is a benzodiazepine used to relieve anxiety.
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Pharmacology
Studies in healthy volunteers show that in single high doses Lorazepam has a tranquilizing action on the central nervous system with no appreciable effect on the respiratory or cardiovascular systems. Peak concentrations in plasma occur approximately 2 hours following administration. The peak plasma level of lorazepam from a 2 mg dose is approximately 20 ng/ml.
Anterograde amnesia, decreased or lack of recall of events during period of drug action, has been reported after administration of lorazepam and appears to be dose-related.
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Indications and Usage
Ativan (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.
Injectable lorazepam is useful as an initial anticonvulsant medication for the control of status epilepticus and fpr producing sedation (sleepiness or drowsiness), relief of anxiety, and a decreased ability to recall events related to the day of surgery. It is most useful in those patients who are anxious about their surgical procedure and who would prefer to have diminished recall of the events of the day of surgery
Contraindications
Lorazepam is contraindicated in patients with known sensitivity to the benzodiazepines or with acute narrow-angle glaucoma or myasthenia gravis.
Lorazepam injectable is also contraindicated in patients with known hypersensitivity to polyethylene glycol, propylene glycol or benzyl alcohol.
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Warnings
Lorazepam is not recommended for use in patients with a primary depressive disorder or psychosis. As with all patients on CNS-acting drugs, patients receiving lorazepam should be warned not to operate dangerous machinery or motor vehicles and that their tolerance for alcohol and other CNS depressants will be diminished.
Physical and Psychological Dependence
Withdrawal symptoms, similar in character to those noted with barbiturates and alcohol (convulsions, tremor, abdominal and muscle cramps, vomiting, and sweating), have occurred following abrupt discontinuance of lorazepam. The more severe withdrawal symptoms have usually been limited to those patients who received excessive doses over an extended period of time. Generally milder withdrawal symptoms (e.g., dysphoria and insomnia) have been reported following abrupt discontinuance of benzodiazepines taken continuously at therapeutic levels for several months. Consequently, after extended therapy, abrupt discontinuation should generally be avoided and a gradual dosage-tapering schedule followed. Addiction-prone individuals (such as drug addicts or alcoholics) should be under careful surveillance when receiving lorazepam or other psychotropic agents because of the predisposition of such patients to habituation and dependence.
As with any premedicant, extreme care must be used in administering lorazepam injection to elderly or very ill patients and to those with limited pulmonary reserve, because of the possibility that apnea and/or cardiac arrest may occur. Because of the lack of sufficient clinical experience lorazepam injection is not recommended for use in patients less than 18 years of age.
Since the liver is the most likely site of conjugation of lorazepam and since excretion of conjugated lorazepam (glucuronide) is a renal function, this drug is not recommended for use in patients with hepatic and/or renal failure. This does not preclude use of the drug in patients with mild-to-moderate hepatic or renal disease, the lowest effective dose should be considered since drug effect may be prolonged. Experience with other benzodiazepines and limited experience with parenteral lorazepam has demonstrated that tolerance to alcoholic beverages and other central- nervous-system depressants is diminished when used concomitantly.
As is true of similar CNS-acting drugs, patients receiving injectable lorazepam should not operate machinery or engage in hazardous occupations or drive a motor vehicle for a period of 34 to 48 hours. Impairment of performance may persist for greater intervals because of extremes of age, concomitant use of other drugs, stress of surgery, or the general condition of the patient.
Clinical trials have shown that patients over the age of 50 years may have a more profound and prolonged sedation with intravenous lorazepam. Ordinarily, an initial dose of 2 mg may be adequate unless a greater degree of lack of recall is desired.
As with all central-nervous system depressant drugs, care should be exercised in patients given injectable lorazepam that premature ambulation may result in injury from falling.
There is no added beneficial effect to the addition of scopolamine to injectable lorazepam, and their combined effect may result in an increased incidence of sedation, hallucination, and irrational behavior.
Usage in Pregnancy
LORAZEPAM MAY CAUSE FETAL DAMAGE WHEN ADMINISTERED TO PREGNANT WOMEN. An increased risk of congenital malformations associated with the use of minor tranquilizers (chlordiazepoxide, diazepam, and meprobamate) during the first trimester of pregnancy has been suggested in several studies. In humans, blood levels obtained from umbilical cord blood indicate placental transfer of lorazepam and lorazepam glucuronide.
Lorazepam injection should not be used during pregnancy. There is insufficient data regarding obstetrical safety of parenteral lorazepam, including use in cesarean section. Such use, therefore, is not recommended. It is not known whether oral lorazepam is excreted in human milk like the other benzodiazepine tranquilizers. As a general rule, nursing should not be undertaken while a patient is on a drug, since many drugs are excreted in human milk.
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Precautions
In patients with depression accompanying anxiety, a possibility for suicide should be kept in mind.
For elderly or debilitated patients, the initial daily dosage should not exceed 2 mg in order to avoid oversedation. Elderly and debilitated patients, or those with organic brain syndrome, have been found to be prone to CNS depression after even low doses of benzodiazepines. Therefore, medication should be initiated in these patients with very low initial doses, and increments should be made gradually, depending on the patient's response, in order to avoid oversedation or neurological impairment. Extreme care must be used in administering lorazepam injection to elderly patients, very ill patients, and to patients with limited pulmonary reserve, because of the possibility that underventilation and/or hypoxic cardiac arrest may occur. Resuscitative equipment for ventilatory support should be readily available.
