Lorazepam Adverse Reactions
- amnesia
- ataxia
- confusion
- depression
- dizziness
- drowsiness
- dysarthria
- euphoria
- fatigue
- headache
- libido decrease
- mania
- nightmares
- physiological dependence
- respiratory depression
- restlessness
- syncope
- teratogenesis
- tolerance
- tremor
- vertigo
- withdrawal
Lorazepam Adverse Reactions
Most of the CNS-related adverse effects associated with lorazepam therapy are dose-dependent. These include headache, drowsiness, ataxia, dizziness, confusion, depression, dysarthria (slurred speech), syncope, lightheadedness, fatigue, tremor, and vertigo. Tolerance may develop to these effects. Short-term amnesia is greater after lorazepam when used as a premedicant than after placebo but is generally considered a benefit. Additionally, tolerance may develop to the sedative or anti-anxiety effects of benzodiazepines.
Occasionally, paradoxical CNS stimulation can occur, particularly in psychiatric patients, the elderly and hyperactive children. Symptoms of paradoxical CNS stimulation include hostility, nightmares, talkativeness, excitement, mania, tremulousness, sleep disturbances, increased muscle spasticity, acute rage reactions, anxiety, restlessness, euphoria, and hyperflexia. Benzodiazepine therapy should be discontinued if any of the signs of paradoxical CNS excitement occur.
Other less frequently reported adverse reactions to lorazepam therapy include bradycardia, hypotension, rash, urticaria, blurred vision, diplopia, flushing, constipation, nausea/vomiting, libido decrease, hepatic dysfunction, and abdominal pain.
Apnea, hypotension, and cardiac arrest have been reported following parenteral administration of benzodiazepines to the elderly, to severely ill patients, or to patients with compromised respiratory function. Respiratory depression also has occurred in these patients during benzodiazepine therapy, occasionally resulting in death.
Even after short-term use of lorazepam, there is evidence of physiological dependence and consequent adverse withdrawal symptoms. Abrupt withdrawal of benzodiazepine therapy has been reported to cause withdrawal symptoms including headaches, irritability, nervousness, and insomnia. Benzodiazepine withdrawal is more likely to occur following abrupt cessation of excessive or prolonged doses, but it can occur following the discontinuance of therapeutic doses that have been administered for as few as 1 - 2 weeks. Abdominal cramps, confusion, depression, perceptual disturbances, sweating, nausea/vomiting, parasthesias, photophobia, hyperacusis, tachycardia, and trembling also occur during benzodiazepine withdrawal, but these reactions are less frequent. Convulsions, hallucinations, delirium, and paranoia also can occur. Benzodiazepines should be withdrawn cautiously and gradually, using a very gradual dosage-tapering schedule.
Lorazepam is classified as FDA pregnancy risk category D. Many benzodiazepines have been associated with teratogenesis. Use of benzodiazepines during pregnancy, particularly in the first trimester, increases the risk of congenital malformations and decreases viability. Lorazepam injection should generally not be given to a pregnant women except in serious or life-threatening situations (e.g., status epilepticus).
[ Last revised: 1/21/2003 11:19:00 AM ]
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