Lorazepam

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How does it work?

This medicine contains the active ingredient lorazepam, which is a type of medicine called a benzodiazepine. Benzodiazepines are used for their sedative and anxiety-relieving effects. Lorazepam works by acting on receptors in the brain called GABA receptors. This causes the release of a neurotransmitter called GABA in the brain. Neurotransmitters are chemicals that are stored in nerve cells in the brain and nervous system. They are involved in transmitting messages between the nerve cells. GABA is a neurotransmitter that acts as a natural 'nerve-calming' agent. It helps keep the nerve activity in the brain in balance, and is involved in inducing sleepiness and reducing anxiety. As lorazepam increases the activity of GABA in the brain, it increases its calming effect and results in sleepiness, a decrease in anxiety and relaxation of muscles. Lorazepam is used to calm severe anxiety and related conditions, such as acute mania, excitement or agitation. Benzodiazepines such as lorazepam are effective at quickly reducing the symptoms of anxiety and agitation that occur in a manic or hypomanic episode of the psychiatric illness, bipolar affective disorder. Benzodiazepines help calm the individual while the main medicines for this condition (mood stabilisers) begin to take effect. Lorazepam is also given for its sedating and anxiety-relieving effects as a pre-med before surgery or medical investigations that may be uncomfortable or prolonged, for example bronchoscopy or endoscopy. Lorazepam injection is also sometimes used to control repeated epileptic fits or seizures when a patient does not recover conciousness between fits (status epilepticus). It works in this instance because the increased activity of GABA in the brain helps to calm excessive electrical nerve activity in the brain that is responsible for causing seizures.

What is it used for?

- Acute anxiety states
- Acute excitement
- Acute mania
- Relieving anxiety and causing sedation prior to surgery or medical procedures (pre-med)
- Repeated fitting with no recovery of conciousness between seizures

Warning!

- This medicine is generally only suitable for short-term use. If it is used for long periods or in high doses, tolerance to and dependence upon the medicine may develop, and withdrawal symptoms may occur if treatment is stopped suddenly. For this reason, treatment with this medicine should usually be stopped gradually, following the instructions given by your doctor, in order to avoid withdrawal symptoms such as rebound insomnia or anxiety, confusion, sweating, tremor, loss of appetite, irritability or convulsions.
- This medicine causes drowsiness, muscle weakness and impairs concentration and alertness. These effects may continue into the following day and are made worse by drinking alcohol. If you are affected you should avoid potentially hazardous tasks such as driving or operating machinary. Avoid alcohol.
- This medicine is not recommended as a pre-med or to treat acute anxiety states in children under 12 years of age. Ativan injection must not be given to children under three years of age.

Use with caution in

- Closed angle glaucoma
- Decreased kidney function
- Decreased liver function
- Depression
- Disease affecting the airways or lungs (respiratory disease)
- Disease involving the heart and blood vessels
- Disease of the blood vessels in and around the brain
- Elderly people
- History of alcoholism or drug abuse
- Personality disorders
- Weak or debilitated people

Not to be used in

- A sudden worsening of any underlying lung disease (acute pulmonary insufficiency)
- Abnormal muscle weakness
- Allergy to benzodiazepines
- Breastfeeding
- Severely decreased liver function
- Slow, shallow breathing (respiratory depression)
- Syndrome involving short spells when breathing stops during sleep

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and Breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

- This medicine may be harmful to an unborn baby and so should be avoided during pregnancy, particularly in the first and third trimesters and during labour, unless your doctor considers there are compelling medical reasons for its use. Seek further medical advice from your doctor.
- Significant amounts of this medicine may pass into breast milk. It should not be used by breastfeeding mothers as it may be harmful to the nursing infant. Seek medical advice from your doctor.

Label warnings

- This medication causes drowsiness which may continue the next day. If affected do not drive or operate machinery. Avoid alcoholic drink.

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