LORAZEPAM

Drugs in Pregnancy and Lactation.

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Name: LORAZEPAM
Class: Sedative
Risk Factor:    DM

Fetal Risk Summary

Lorazepam is a benzodiazepine indicated for the treatment of status epilepticus and as a preanesthetic sedative. Reproduction studies have been conducted in mice, rats, and two strains of rabbits (1). Occasional, non-dose-related malformations (reduction of tarsals, tibia, metatarsals, malrotated limbs, gastroschisis, malformed skull, and microphthalmia) were observed in rabbits, but these defects have also randomly occurred in controls. Fetal resorptions and increased fetal loss occurred in rabbits at oral (40 mg/kg) and IV (4 mg/kg) doses and higher (1).

Lorazepam crosses the placenta, achieving cord levels similar to maternal serum concentrations (2,3,4 and 5). Placental transfer is slower than that of diazepam, but high IV doses may produce the “floppy infant” syndrome (3). (See Diazepam for a description of this syndrome.) A case reported in 1996 described an otherwise healthy male infant, who had been exposed throughout gestation to lorazepam (7.5–12.5 mg/day) and clozapine (200–300 mg/day), who developed transient, mild floppy infant syndrome after delivery at 37 weeks' gestation (6). The mother had taken the combination therapy for the treatment of schizophrenia. The hypotonia, attributed to lorazepam because of the absence of such reports in pregnancies exposed to clozapine alone, resolved 5 days after birth.

An abstract published in 1999 found an association between lorazepam and anal atresia (7). Using data from a French pregnancy registry, the investigators reported that among infants exposed to benzodiazepines 5 of 6 cases of anal atresia were exposed to lorazepam (p=0.01) (7).

Lorazepam has been used in labor to potentiate the effects of narcotic analgesics (8). Although not statistically significant, a higher incidence of respiratory depression occurred in the exposed newborn infants.

Breast Feeding Summary

Lorazepam is excreted into breast milk in low concentrations (9,10). In one study, no effects on the nursing infant were reported (9), but the slight delay in establishing feeding was a cause for concern (11). Milk:plasma ratios in four women who had received 3.5 mg orally of lorazepam 4 hours earlier ranged from 0.15 to 0.26 (9). The mean milk concentration was 8.5 ng/mL. In another study, 5 mg of oral lorazepam was given 1 hour before labor induction and the effects on feeding behavior were measured in the newborn infants (12). During the first 48 hours, no significant effect was observed on volume of milk consumed or duration of feeding. The American Academy of Pediatrics considers the effects of lorazepam on the nursing infant to be unknown, but they may be of concern if exposure is prolonged (13).

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References

  1. Product information. Ativan. Wyeth-Ayerst Pharmaceuticals, 2000.
  2. de Groot G, Maes RAA, Defoort P, Thiery M. Placental transfer of lorazepam. IRCS Med Sci 1975;3:290.
  3. McBride RJ, Dundee JW, Moore J, Toner W, Howard PJ. A study of the plasma concentrations of lorazepam in mother and neonate. Br J Anaesth 1979;51:971–8.
  4. Kanto J, Aaltonen L, Liukko P, Maenpaa K. Transfer of lorazepam and its conjugate across the human placenta. Acta Pharmacol Toxicol (Copenh) 1980;47:130–4.
  5. Kanto JH. Use of benzodiazepines during pregnancy, labour and lactation, with particular Reference to pharmacokinetic considerations. Drugs 1982;23:354–80.
  6. Di Michele V, Ramenghi LA, Sabatino G. Clozapine and lorazepam administration in pregnancy. Eur Psychiatry 1996;11:214.
  7. Bonnot O, Vollset SE, Godet PF, Robert E. Maternal exposure to lorazepam and anal atresia in newborns? Results from a hypothesis generating study of benzodiazepines and malformations (abstract). Teratology 1999;59:439–40.
  8. McAuley DM, O'Neill MP, Moore J, Dundee JW. Lorazepam premedication for labour. Br J Obstet Gynaecol 1982;89:149–54.
  9. Whitelaw AGL, Cummings AJ, McFadyen IR. Effect of maternal lorazepam on the neonate. Br Med J 1981;282:1106–8.
  10. Summerfield RJ, Nielsen MS. Excretion of lorazepam into breast milk. Br J Anaesth 1985;57:1042–3.
  11. Johnstone M. Effect of maternal lorazepam on the neonate. Br Med J 1981;282:1973.
  12. Johnstone MJ. The effect of lorazepam on neonatal feeding behaviour at term. Pharmatherapeutica 1982;3:259–62.
  13. Committee on Drugs, American Academy of Pediatrics. The transfer of drugs and other chemicals into human milk. Pediatrics 1994;93:137–50.

Index

Q&A about Lorazepam

chocolat...
Lorazepam?
I have to have my wisdom teeth out soon and they prescribed me a lorazepam to take an hour before. I was just wondering how long the effects last and how long it takes to start working?
marm212
Lorazpeam has a number of uses, but it works within fifteen minutes and will last you at least a good four hours. I used to take it to go to sleep and its pretty serious stuff, you may still feel confused and dazed the next day so be careful driving and such if you must but it will probably be better to just stay at home and get better. Hope this helps!
addie
How can I prevent lorazepam/ativan withdrawal symptoms?
I am 13 years old. For several days now I have been taking 1mg of lorazepam once or twice a day. Will I be able to prevent withdrawal symptoms by slowly decreasing, and like reducing it to one a day, then later every other day, etc.? Will that help? Thanks. (:

And if I can't really prevent withdrawal, how long should it go on for and how severe can I expect it to be?
melaniem...
You should ALWAYS see your doctor before taking your self off of an anti depressant. However, if you have only been taking it for a few days, it hasn't had time to fully get into your system yet, so you shouldn't have any withdrawl symptoms. Why are you taking yourself off though? Sounds like you haven't even gave it time to work. Anti depressants take anywhere from 2-6 weeks to start working.
fieldsda...
What can I take to replace my lorazepam?
I have now slowly ween myself completely off the Lorazepam, I am down to taking one 1mg pill a day. I am now looking to replace it with something that would be better on my body, and wont have all the unwanted side effects. I was told to take 5-htp, is there anything else out there that would help? And how long should I wait to start taking something new?
Brenda
What are you taking it for? For nerves, you can use something called "Hydroxyzine". Lorazepam is a narcotic and too strong for my DH to use anymore and the Dr has prescribed the above RX for him and it works fine.
angela
what exactly is the difference between xanax and lorazepam?
which would effect me greater 1 mg of xanax or 1 mg of lorazepam and how big of a difference would it be
Mr. Peachy®
Well now... you've got me curious... hang on while I do a little research on Google.

Okay... they're both benzos and the dosages are practically the same. Apparently the effectiveness is about the same and is limited to four months or so. There are also side affects.

My depression started with anxiety and the drugs were a total waste of time and money. It wasn't until I got "The Feeling Good Handbook" by David Burns, MD that things began to change. I don't like drugs and doctors much because they tend to treat symptoms and not causes. Dr Burns, treats the cause. That's the only lasting cure you're likely to find.
vishnuk
How dose of lorazepam tablets is taken at a time is dangerous dose?
how much of lorazepam tables is the dangerous dose for taken by a person at a time. His weight is 65 k.g's
the.swit...
Lorazepam (Ativan) is a benzodiazepine in the same family of drugs as valium and xanax. The LD50 for this class of drugs is quite high (LD50 is the dose at which 50 percent of people would die)....very high actually. In fact, a professor once told me that it is almost impossible to commit suicide from a benzodiazepine overdose. However, a lot of lorazepam can have undesired side effects and can put stress on the liver. It can also make sleep apnea worse and could lead to death if someone had severe apnea and took a high dose of lorazepam. It can depress breathing in general also, and should never be consumed along with alcohol, especially if either are being consumed in moderate to high doses. The bottom line is that anything beyond 20 mg at a time is way too much, but likely will not cause death if consumed by itself at this level (no other drugs or alcohol). Pills range in dose from .5 mg to 2 mg.
mummy 2 Mia
How long until Lorazepam 1mg starts to work?
I have taken oral Lorazepam 1mg in order to control my anxiety before my dentist appointment. I have a phobia.

How long until i start to feel less panicky? I took it half hour ago and i still feel really shaky and panicky.

Thanks
Emily
I would allow 30 to 60 minutes. Your anxiety may be too great for that dose. 1mg was not enough to cure my fear of flying when we went to Vegas this summer.
Mel
How can I prove a false positive from lorazepam on a drug hair test?
I take Lorazepam. Found out today my hair drug testing results came back positive stating my results found Methamphetamine 55.5 cg/10mg (which I'm clueless to this number) What the heck has caused this kind of false info and where is info backing up the impacts Lorazepam has had on my test. I was floored considering I don't use anything but my prescribed meds along with all my other herbal daily meds.
Forgotten Ones
lorazepam is a Benzodiazepine not a methamphetamine. As to why you tested positive for the latter i don't know. Maybe something in your herbal meds are causing this positive result. You need to talk to your doctor and give him a complete list of all meds, otc, prescription, and herbal. If he can't give you any answers talk to your pharmactist, they would probably know could be causing the problem.

Good luck
laughing...
How long does it take for lorazepam to leave the blood?Roughly 53 tablets worth.?
This is the follow up question to my earlier lorazepam queston. Would like to stress this is purely for research not for any other reason. Thanks for all answers.
nikskin
Please can you inform us of the drug content in mg's in each of the tablets!!

Thanks for the further info!

Right, if you were administered 53mg of lorazepam in a single sitting you would be dead.

This is a pre-op drug in high doses and a pre-treatment drug for children on Chemotherapy and is not used away from hospitals.

To answer your question though, Lorzepam has a half life of 12.9 hrs for an adult and a duration of 6-8 hrs for the recommended dose of 0.5- 2mgs.. you can keep topping this up every 4-6 hrs as is needed, you will not be able to self administer this of course as you will have lost use of your CNS.

If my suspicion of you having a hostage and you are keeping them sedated be very careful and do not touch them in their pants!!
anakinja...
What cold medicine can I take if I am currently taking Naprosyn and Lorazepam?
I am taking Naprosyn and Lorazepam for the headaches I have been getting. However since everyone here at work is sick and sneezing, it seems I caught the bug too. What OTC medication can I take that won't interfere with these 2 drugs?
pharmgrl
The only OTC cold medication you should definitely avoid is Aleve Cold & Sinus, as it contains naproxen sodium - a salt of the naproxen you are getting from your Naprosyn. Also, you might want to check for the antihistamines chlorpheniramine and brompheniramine as they could make you very drowsy in combination with the lorazepam. Most night-time OTC cold medications have one of these antihistamines, and they are known to have a moderate interaction with lorazepam. When combined, it could result in CNS or respiratory depression, although this is a higher risk for elderly patients or people who have a serious illness. If you decide to take a product with one of these antihistamines, be sure you don't have to drive or "operate heavy machinery" as the labels say. You can check with your doctor or pharmacist to confirm this.
Big C
What should you do or not do when you have the side effects of using Lorazepam, or Activan?
It only started as a stomach ache. After attending multible clinics, it turned out to be panic. The doctorc recommended taking anethesia drugs to help relax and get calm. Now, after using Lorazepan, or Activan, it's always hard to sleep, trouble breathing(especially during night, stomach pain, unusual weakness, loss of appitite, and almost every possible side effects that Lorazepam could have. Please help.
Bill C
Whoa, I would talk to the doctor that gave them to you. Lorazepam is very mild and you may be having a reaction to it.