Lorazepam belongs to the class of benzodiazepines and it’s majorly used for the treatment of anxiety and agitation. Ativan is also used for providing relief in acute seizures such as status epilepticus, and in the treatment of insomnia.

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How It Works To Reduce Anxiety

In case of anxiety and other anxiety-related disorders such as panic attacks and phobias, the central nervous system is abnormally active which leads to physical symptoms like shakiness and increased heart beat.

These physical symptoms can be treated by an overall inhibition of the central nervous system and Lorazepam is used for this purpose. However, it must be remembered that different behavioral therapies such as cognitive behavioral therapy and other antidepressants, may also be needed for complete management of anxiety and anxiety-related disorders.

How It Works To Treat Status Epilepticus

Status epilepticus is a condition of epileptic seizures which has the duration of more than five minutes or more than one epileptic seizure occurring within a time period of five minutes. In case of these seizures, there is involuntary contraction and extension of the muscles of the body, especially the arms and legs.

Lorazepam stops these involuntary muscular contractions by inhibiting the nerves of the brain which fire the continuous excitatory action potential, leading to involuntary contractions of the muscles.

How It Works To Treat Insomnia

Insomnia is a medical condition characterized by persistent sleeplessness in an individual. It can also occur as a side effect of anxiety and other anxiety-related disorders such as manias, panic attacks and phobias.

Ativan works as a sedative-hypnotic by relieving the stressed nerves of the central nervous system through the inhibitory effects of GABA. This causes an overall calming effect on the brain, leading to sedation.

Common Contraindications

This drug should not be consumed by patients suffering from narrow-angle glaucoma, because this drug dilates the pupil which can further increase the aqueous humor drainage from the eye, thereby deteriorating the condition.

It must also be avoided by patients of sleep apnea, as the depression of the central nervous system will further decrease the ability of the patient to maintain their open airway during deep sleep.

Ativan is also prohibited for use for patients suffering from ataxia and myasthenia gravis. Ataxia is a condition of clumsy or unsteady motion of a person’s torso and limbs because of lack of proper coordination of the muscles and brain. This condition can be worsened by the further inhibitory effect of this drug on the brain. Myasthenia gravis is a condition of muscular weakness, which can be further increased by a potential muscle relaxant like Lorazepam.

The medication should never be used with alcohol or any alcohol-containing product as it’ll increase the absorption of this drug in the bloodstream which will intensify its effects on the body, leading to harmful reactions and more severe withdrawal effects.

Pregnant and Breast-Feeding Women

This medication is not recommended for use for pregnant and breast-feeding women. It belongs to category D by the Food and Drug Administration, which means that this drug can cross the placental barrier and induce harmful effects in the developing fetus. This drug can lead to neurodevelopmental errors, decreased intelligence, facial structure malformation, and cardiovascular disorders in neonates.

When used in the third trimester of pregnancy, there’s a definite risk of respiratory depression in the newborn which requires immediate ventilation, along with the development of benzodiazepine withdrawal syndrome which is characterized by hypotonia i.e. decreased muscular tone (floppy baby syndrome), impaired metabolic functions, and apneic episodes in the baby.

Drug Dependence and Withdrawal Effects

If Ativan is used for a long time period, it’ll lead to psychological and physical dependence. The chances of dependence are more in patients with a history of drug abuse or alcoholism, or when this drug is used in more than the recommended dose. Hence, Lorazepam is only recommended for short-term use i.e. for two to four weeks, after proper consultation with a registered medical practitioner.

Immediate termination or discontinuation of this drug must always be avoided as it can lead to serious withdrawal symptoms. It’s recommended to go through a gradual dose-tempering schedule of this drug prior to discontinuation of therapy.

The withdrawal symptoms of this drug include; rebound insomnia, severe headache, depression, anxiety, restlessness, dizziness, panic episodes, tremors, convulsions, visual hallucinations, numbness or tingling of the extremities, abdominal cramps, short-term memory loss or dementia, increased body temperature i.e. hyperthermia, increased heartbeat i.e. tachycardia, nausea, vomiting, and vertigo.

Possible Drug Interactions

The adverse effects of this drug can be increased when it’s taken with other sedative-hypnotics and opioid medicines. Valproate stops the metabolism of this drug which can lead to Lorazepam-poisoning in the body, whereas, the rate of metabolism of this drug is increased by carbamazepine, antiepileptic drugs like phenytoin and Phenobarbital, lamotrigine, and rifampin, which can decrease its effects in the body.

Missed Dose

If you miss a dose of Ativan and you’re taking multiple doses in a day, don’t take this drug if the time of the next dose is near. In such cases, it’s recommended to skip the missed dose and continue with the normal dosing schedule. Also, never double the dose in order to catch up on the missed dose.

Overdose and Drug Poisoning

It must be remembered that the overdose of this drug requires immediate action as it may lead to serious drug poisoning which can be lethal. If you suspect an overdose, immediately contact an emergency room or poison control center of your area.

The signs of an overdose include mental disorientation, decreased blood pressure i.e. hypotension, and cardiovascular depression leading to decreased heart beat i.e. bradycardia, excessive drowsiness, hypotonia i.e. loss of muscular tonicity, apnea and respiratory depression.

Hence, it can be concluded that Lorazepam can be highly beneficial in treating different medical conditions like anxiety, panic attacks, and insomnia, when used with care and vigilance and after a proper consultation with a registered medical practitioner.