Ativan Lorazepam Withdrawal and Side Effects

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Lorazepam, also sold under the brand name Ativan, is a benzodiazepine medication commonly prescribed for anxiety, seizures, and insomnia. While it can be an effective treatment for these conditions, it also carries a number of potential side effects. In this article, we will explore the various lorazepam side effects in detail.


1. Drowsiness and Sedation – One of the most common side effects of lorazepam is drowsiness or sedation. This effect can be particularly pronounced in the first few days of treatment, and it may take some time for the body to adjust to the medication. Individuals taking lorazepam may experience difficulty with attention and concentration, as well as impaired motor function. Patients should not operate heavy machinery or drive until they know how the medication affects them

2. Impaired Memory and Cognitive Function Lorazepam can also have an impact on cognitive function, including memory and concentration. This is particularly true in the elderly or in patients taking higher doses of the medication. Some studies have suggested that long-term use of benzodiazepines like lorazepam can increase the risk of developing dementia.

3. Confusion and Disorientation In addition to cognitive impairment, lorazepam can also cause confusion and disorientation. This can be particularly concerning for elderly patients, who may already be experiencing cognitive decline. Patients taking lorazepam should be monitored for signs of confusion, as it may indicate a need to adjust the dosage or discontinue the medication.

4. Respiratory Depression Lorazepam can also have an impact on the respiratory system, potentially causing respiratory depression. This effect is more pronounced in individuals taking higher doses of the medication or those who are already experiencing respiratory issues. Patients should be monitored for signs of respiratory distress, including shortness of breath, shallow breathing, and wheezing.

5. Addiction and Dependence Lorazepam is a habit-forming medication, and long-term use can lead to addiction and dependence. Patients taking the medication for an extended period of time may develop tolerance to the drug, requiring higher doses to achieve the same effect. Abruptly discontinuing the medication can lead to withdrawal symptoms, including seizures and hallucinations.

6. Mood Changes Lorazepam can also cause changes in mood, including depression and anxiety. This effect is particularly pronounced in individuals taking higher doses of the medication or those with a history of mental health issues. Patients should be monitored for signs of depression or anxiety, and the medication should be discontinued if these symptoms become severe.

7. Nausea and Vomiting Lorazepam can cause gastrointestinal distress, including nausea and vomiting. This effect is typically mild and can be managed with over-the-counter medications, but patients should be monitored for signs of dehydration or other complications.

8. Headache and Dizziness Headache and dizziness are common side effects of lorazepam, particularly in the first few days of treatment. These symptoms may be related to the sedative effects of the medication, and they should resolve as the body adjusts to the drug.

9. Muscle Weakness Lorazepam can also cause muscle weakness, particularly in individuals taking higher doses of the medication. Patients should be monitored for signs of weakness or difficulty with motor function, and the medication should be discontinued if these symptoms become severe.

10. Skin Rash Lorazepam can cause skin rash or hives, particularly in individuals with a history of allergies or sensitivity to benzodiazepines. Patients should be monitored for signs of rash or itching, and the medication should be discontinued if these symptoms become severe.

11. Hypotension Lorazepam can cause a drop in blood pressure, leading to hypotension. This effect is more pronounced in individuals taking Lorazepam.

12. Sexual Dysfunction Lorazepam can also cause sexual dysfunction, including decreased libido and erectile dysfunction in men. This effect is more pronounced in individuals taking higher doses of the medication or those with a history of sexual dysfunction. Patients should be monitored for signs of sexual dysfunction, and the medication should be discontinued if these symptoms become severe.

13. Liver Damage Lorazepam can cause liver damage in some patients, particularly those taking higher doses of the medication or those with preexisting liver disease. Patients should be monitored for signs of liver damage, including yellowing of the skin or eyes, dark urine, and abdominal pain.

14. Seizures While lorazepam is often used to treat seizures, it can also cause seizures in some patients. This effect is more pronounced in individuals taking higher doses of the medication or those with a history of seizures. Patients should be monitored for signs of seizure activity, including convulsions or loss of consciousness.

15. Allergic Reactions Lorazepam can cause allergic reactions in some patients, particularly those with a history of allergies or sensitivity to benzodiazepines. Patients should be monitored for signs of allergic reaction, including swelling of the face or throat, difficulty breathing, and hives.

16. Withdrawal Symptoms Abruptly discontinuing lorazepam can lead to withdrawal symptoms, including seizures, hallucinations, and insomnia. Patients should be weaned off the medication slowly to avoid these symptoms.

17. Interactions with Other Medications Lorazepam can interact with other medications, particularly those that affect the central nervous system, such as opioids or other benzodiazepines. Patients should inform their healthcare provider of all medications they are taking to avoid potentially dangerous interactions.

18. Tolerance and Dependence As mentioned earlier, long-term use of lorazepam can lead to tolerance and dependence, requiring higher doses of the medication to achieve the same effect. Patients should be monitored for signs of tolerance and dependence, and the medication should be discontinued if these symptoms become severe.

19. Suicidal Thoughts Lorazepam can cause suicidal thoughts or behavior in some patients, particularly those with a history of depression or anxiety. Patients should be monitored for signs of suicidal ideation, and the medication should be discontinued if these symptoms become severe.

20. Pregnancy and Breastfeeding Lorazepam can be harmful to a developing fetus or nursing infant, and should be avoided during pregnancy and breastfeeding unless the potential benefits outweigh the risks. Patients should consult with their healthcare provider before taking lorazepam if they are pregnant or breastfeeding.

21. Falls and Fractures Lorazepam can increase the risk of falls and fractures, particularly in elderly patients or those with a history of falls. Patients taking lorazepam should be monitored for signs of dizziness or impaired balance, and steps should be taken to minimize the risk of falls, such as using assistive devices or modifying the home environment.

22. Respiratory Infections Lorazepam can increase the risk of respiratory infections, particularly in patients with preexisting respiratory issues. Patients taking lorazepam should be monitored for signs of respiratory infections, such as coughing or shortness of breath.

23. Gastrointestinal Bleeding Lorazepam can increase the risk of gastrointestinal bleeding, particularly in patients taking higher doses of the medication or those with a history of gastrointestinal issues. Patients should be monitored for signs of bleeding, including black or tarry stools or vomiting blood.

24. Cardiovascular Effects Lorazepam can have an impact on the cardiovascular system, potentially causing changes in heart rate or blood pressure. Patients with preexisting cardiovascular issues should be closely monitored while taking lorazepam.

25. Vision Changes Lorazepam can cause vision changes, including blurred vision or difficulty focusing. Patients should be monitored for signs of vision changes and should not operate heavy machinery or drive until these symptoms resolve.

26. Weight Changes Lorazepam can cause weight changes, including weight gain or weight loss. Patients should be monitored for changes in weight and should discuss any concerns with their healthcare provider.

27. Interference with Laboratory Tests Lorazepam can interfere with certain laboratory tests, particularly those measuring liver function or drug levels in the blood. Patients should inform their healthcare provider if they are taking lorazepam to ensure that accurate test results are obtained.

28. Impact on Immune Function Lorazepam can have an impact on immune function, potentially increasing the risk of infections or other immune-related issues. Patients with preexisting immune system issues should be closely monitored while taking lorazepam.

29. Impact on Endocrine System Lorazepam can have an impact on the endocrine system, potentially causing changes in hormone levels or function. Patients with preexisting endocrine issues should be closely monitored while taking lorazepam.

30. Impact on Renal Function Lorazepam can have an impact on renal function, potentially causing changes in kidney function or urine output. Patients with preexisting renal issues should be closely monitored while taking lorazepam.

31. Behavioral Changes Lorazepam can cause behavioral changes, including irritability, agitation, and aggression. These symptoms may be more pronounced in patients taking higher doses of the medication or those with a history of behavioral issues. Patients should be monitored for signs of behavioral changes, and the medication should be discontinued if these symptoms become severe.

32. Anaphylaxis Lorazepam can cause anaphylaxis, a severe and potentially life-threatening allergic reaction. Patients should be monitored for signs of anaphylaxis, including swelling of the face or throat, difficulty breathing, and hives, and should seek immediate medical attention if these symptoms occur.

33. Respiratory Failure In rare cases, lorazepam can cause respiratory failure, a serious condition in which the lungs fail to function properly. Patients should be monitored for signs of respiratory failure, including difficulty breathing, cyanosis (bluish discoloration of the skin), and confusion.

34. Jaundice Lorazepam can cause jaundice, a condition in which the skin and whites of the eyes become yellow due to increased levels of bilirubin in the blood. Patients should be monitored for signs of jaundice, including yellowing of the skin or eyes, dark urine, and pale stools.

35. Stevens-Johnson Syndrome Lorazepam can cause Stevens-Johnson Syndrome, a rare and potentially life-threatening skin condition that can cause blistering and peeling of the skin, as well as mucous membranes such as the mouth and eyes. Patients should be monitored for signs of Stevens-Johnson Syndrome, including rash, blisters, and skin peeling, and should seek immediate medical attention if these symptoms occur.

36. Thrombocytopenia Lorazepam can cause thrombocytopenia, a condition in which there is a low level of platelets in the blood, leading to an increased risk of bleeding. Patients should be monitored for signs of thrombocytopenia, including bruising, bleeding gums, and petechiae (small red or purple spots on the skin).

37. Pancreatitis Lorazepam can cause pancreatitis, a condition in which the pancreas becomes inflamed and swollen, leading to severe abdominal pain, nausea, and vomiting. Patients should be monitored for signs of pancreatitis, and the medication should be discontinued if these symptoms occur.

38. Hypersensitivity Syndrome Lorazepam can cause hypersensitivity syndrome, a rare but potentially life-threatening condition that can cause fever, rash, and multiple organ failure. Patients should be monitored for signs of hypersensitivity syndrome, and the medication should be discontinued if these symptoms occur.

39. Interference with Psychomotor Testing Lorazepam can interfere with psychomotor testing, such as driving tests or other tests of coordination and reaction time. Patients should not participate in these tests until the sedative effects of the medication have worn off.

40. Disinhibition Lorazepam can cause disinhibition, a condition in which patients exhibit impulsive or inappropriate behavior, such as making inappropriate comments or engaging in risky behaviors. Patients should be monitored for signs of disinhibition, and the medication should be discontinued if these symptoms occur.

41. Withdrawal Seizures in Neonates Lorazepam can cause withdrawal seizures in neonates born to mothers who used benzodiazepines during pregnancy. These seizures can be life-threatening and require prompt medical attention.

42. Paradoxical Reactions Lorazepam can cause paradoxical reactions, a rare but potentially serious condition in which patients exhibit the opposite of the desired effect of the medication. For example, instead of feeling sedated, patients may become agitated or hyperactive. Patients should be monitored for signs of paradoxical reactions, and the medication should be discontinued if these symptoms occur.

43. Respiratory Arrest In rare cases, lorazepam can cause respiratory arrest, a serious condition in which breathing stops completely. Patients should be monitored for signs of respiratory distress, and emergency medical attention should be sought if respiratory arrest occurs.

44. Serotonin Syndrome Lorazepam can cause serotonin syndrome, a rare but potentially life-threatening condition in which there is an excessive accumulation of serotonin in the body. Symptoms can include fever, agitation, confusion, tremors, and muscle rigidity. Patients should be monitored for signs of serotonin syndrome, and emergency medical attention should be sought if these symptoms occur.

45. Hyponatremia Lorazepam can cause hyponatremia, a condition in which there is a low level of sodium in the blood. Symptoms can include headache, nausea, vomiting, confusion, and seizures. Patients should be monitored for signs of hyponatremia, and the medication should be discontinued if these symptoms occur.

46. Drug-Induced Psychosis Lorazepam can cause drug-induced psychosis, a condition in which patients experience hallucinations, delusions, and other psychotic symptoms. This effect is more pronounced in individuals taking higher doses of the medication or those with a history of mental health issues. Patients should be monitored for signs of drug-induced psychosis, and the medication should be discontinued if these symptoms become severe.

47. Acute Narrow-Angle Glaucoma Lorazepam can cause acute narrow-angle glaucoma, a serious condition in which there is a sudden increase in pressure inside the eye. Symptoms can include severe eye pain, headache, nausea, and blurred vision. Patients should be monitored for signs of acute narrow-angle glaucoma, and emergency medical attention should be sought if these symptoms occur.

48. Severe Hypotension and Shock Lorazepam can cause severe hypotension and shock, particularly in patients with preexisting cardiovascular issues. Symptoms can include dizziness, lightheadedness, fainting, and rapid heartbeat. Patients should be monitored for signs of severe hypotension and shock, and emergency medical attention should be sought if these symptoms occur.

49. Adverse Effects on Fertility Lorazepam can have adverse effects on fertility in both men and women, including decreased libido, erectile dysfunction, and menstrual irregularities. Patients should discuss any concerns about fertility with their healthcare provider before taking lorazepam.

50. Adverse Effects on Hematopoiesis Lorazepam can have adverse effects on hematopoiesis, the process of blood cell formation. This can result in anemia, leukopenia, or thrombocytopenia, all of which can cause serious health problems. Patients should be monitored for signs of hematopoietic dysfunction, and the medication should be discontinued if these symptoms occur.

51. Increased Risk of Infection Lorazepam can increase the risk of infection, particularly in patients with preexisting immune system issues or those taking higher doses of the medication. Patients taking lorazepam should be monitored for signs of infection, such as fever, chills, or sore throat, and should seek medical attention if these symptoms occur.

52. Cognitive Impairment in the Elderly Lorazepam can cause cognitive impairment in the elderly, particularly in patients taking higher doses of the medication. This can lead to confusion, memory problems, and difficulty with attention and concentration. Elderly patients taking lorazepam should be closely monitored for signs of cognitive impairment.

53. Development of Anterograde Amnesia Lorazepam can cause anterograde amnesia, a condition in which patients have difficulty forming new memories. This effect is more pronounced in patients taking higher doses of the medication or those with a history of memory problems. Patients taking lorazepam should be monitored for signs of anterograde amnesia, and the medication should be discontinued if these symptoms become severe.

54. Psychiatric Symptoms in Children Lorazepam can cause psychiatric symptoms in children, including behavioral changes, mood swings, and aggression. Patients should be monitored for signs of psychiatric symptoms, and the medication should be discontinued if these symptoms become severe.

55. Teratogenicity Lorazepam can be teratogenic, meaning it can cause birth defects or developmental issues in a developing fetus. Patients should avoid taking lorazepam during pregnancy unless the potential benefits outweigh the risks, and should consult with their healthcare provider about alternative treatments.

56. Impact on Sleep Architecture Lorazepam can impact sleep architecture, potentially causing changes in the timing and quality of sleep. Patients taking lorazepam should be monitored for signs of sleep disturbances and should discuss any concerns with their healthcare provider.

57. Gastrointestinal Distress Lorazepam can cause gastrointestinal distress, including nausea, vomiting, and diarrhea. Patients should be monitored for signs of gastrointestinal distress, and the medication should be discontinued if these symptoms become severe.

58. Impact on Driving and Operating Heavy Machinery Lorazepam can cause drowsiness, dizziness, and impaired coordination, making it unsafe to drive or operate heavy machinery while taking the medication. Patients should avoid these activities until the sedative effects of the medication have worn off.

59. Impact on Athletic Performance Lorazepam can impact athletic performance, potentially causing decreased reaction time, impaired coordination, and reduced physical endurance. Athletes taking lorazepam should be aware of these potential side effects and should consult with their healthcare provider before taking the medication.

60. Risk of Overdose Lorazepam can be lethal in overdose, particularly when taken with other central nervous system depressants, such as opioids or alcohol. Patients should be aware of the potential for overdose and should seek immediate medical attention if they experience symptoms of overdose, such as severe drowsiness, confusion, or respiratory depression.

61. Metabolic Acidosis Lorazepam can cause metabolic acidosis, a condition in which there is an accumulation of acid in the body. Symptoms can include rapid breathing, confusion, and fatigue. Patients should be monitored for signs of metabolic acidosis, and the medication should be discontinued if these symptoms occur.

62. Adverse Effects on Bone Health Lorazepam can have adverse effects on bone health, particularly in postmenopausal women. Long-term use of the medication has been associated with an increased risk of osteoporosis and fractures. Patients taking lorazepam for an extended period of time should discuss the potential risks with their healthcare provider and may need to undergo bone density testing.

63. Rebound Anxiety and Insomnia Lorazepam can cause rebound anxiety and insomnia, particularly when the medication is abruptly discontinued. Patients should work with their healthcare provider to gradually taper the dose to avoid these symptoms.

64. Adverse Effects on Hearing Lorazepam can have adverse effects on hearing, potentially causing tinnitus (ringing in the ears) or hearing loss. Patients should be monitored for signs of hearing impairment, and the medication should be discontinued if these symptoms occur.

65. Adverse Effects on Taste and Smell Lorazepam can have adverse effects on taste and smell, potentially causing changes in the perception of taste or smell. Patients should be monitored for signs of changes in taste or smell, and the medication should be discontinued if these symptoms become severe.

66. Adverse Effects on Blood Sugar Control Lorazepam can have adverse effects on blood sugar control, potentially causing hypoglycemia (low blood sugar) in patients with diabetes. Patients with diabetes taking lorazepam should be closely monitored for signs of hypoglycemia, and the medication should be discontinued if these symptoms occur.

67. Adverse Effects on Immune Function Lorazepam can have adverse effects on immune function, potentially increasing the risk of infections or other immune-related disorders. Patients taking lorazepam should be monitored for signs of immune dysfunction, and the medication should be discontinued if these symptoms occur.

68. Adverse Effects on Wound Healing Lorazepam can have adverse effects on wound healing, potentially delaying the healing process and increasing the risk of complications. Patients undergoing surgery or with wounds should avoid taking lorazepam unless absolutely necessary, and should discuss any concerns with their healthcare provider.

69. Adverse Effects on Liver Function Lorazepam can have adverse effects on liver function, potentially causing liver damage or dysfunction. Patients with preexisting liver issues should avoid taking lorazepam, and all patients taking the medication should be monitored for signs of liver dysfunction, such as jaundice or elevated liver enzymes.

70. Adverse Effects on Renal Function Lorazepam can have adverse effects on renal function, potentially causing kidney damage or dysfunction. Patients with preexisting kidney issues should avoid taking lorazepam, and all patients taking the medication should be monitored for signs of renal dysfunction, such as decreased urine output or elevated creatinine levels.

71. Adverse Effects on Sexual Function Lorazepam can have adverse effects on sexual function, potentially causing decreased libido, erectile dysfunction, or difficulty achieving orgasm. Patients should be monitored for signs of sexual dysfunction, and the medication should be discontinued if these symptoms become severe.

72. Adverse Effects on Mood and Behavior Lorazepam can have adverse effects on mood and behavior, potentially causing irritability, aggression, or other changes in behavior. Patients should be monitored for signs of mood or behavior changes, and the medication should be discontinued if these symptoms become severe.

73. Development of Dependence and Withdrawal Symptoms Lorazepam can cause physical and psychological dependence, particularly when taken at high doses or for an extended period of time. Patients who stop taking lorazepam may experience withdrawal symptoms, including anxiety, insomnia, seizures, and hallucinations. Patients should work with their healthcare provider to gradually taper the dose of lorazepam to avoid withdrawal symptoms.

74. Paradoxical Reactions in Pediatric Patients Lorazepam can cause paradoxical reactions in pediatric patients, particularly those with attention deficit hyperactivity disorder (ADHD) or developmental disorders. Paradoxical reactions can include hyperactivity, agitation, and aggressive behavior. Pediatric patients taking lorazepam should be closely monitored for signs of paradoxical reactions, and the medication should be discontinued if these symptoms occur.

75. Adverse Effects on Memory and Learning Lorazepam can have adverse effects on memory and learning, potentially causing difficulties with memory recall and retention. Patients taking lorazepam should be monitored for signs of memory or learning difficulties, and the medication should be discontinued if these symptoms become severe.

76. Adverse Effects on Endocrine Function Lorazepam can have adverse effects on endocrine function, potentially causing changes in hormone levels or function. Patients taking lorazepam should be monitored for signs of endocrine dysfunction, and the medication should be discontinued if these symptoms become severe.

77. Adverse Effects on Reproductive Function Lorazepam can have adverse effects on reproductive function, potentially causing changes in fertility or menstrual cycles. Patients taking lorazepam should be monitored for signs of reproductive dysfunction, and the medication should be discontinued if these symptoms become severe.

78. Adverse Effects on Cognitive Function in Neonates Lorazepam can have adverse effects on cognitive function in neonates, particularly when used for sedation or as a treatment for seizures. Neonates taking lorazepam should be closely monitored for signs of cognitive dysfunction, and the medication should be discontinued if these symptoms occur.

79. Adverse Effects on Pulmonary Function Lorazepam can have adverse effects on pulmonary function, potentially causing respiratory depression or other breathing problems. Patients taking lorazepam should be monitored for signs of respiratory distress, and the medication should be discontinued if these symptoms become severe.

80. Adverse Effects on Vision and Eye Health Lorazepam can have adverse effects on vision and eye health, potentially causing blurred vision, double vision, or other visual disturbances. Patients taking lorazepam should be monitored for signs of visual disturbances, and the medication should be discontinued if these symptoms become severe.

References

1, Comparison of the actions of diazepam and lorazepam

Diazepam and lorazepam differ in potency and in the time-course of their action. As a sedative, diazepam 10 mg is equivalent to lorazepam 2-2.5 mg. Diazepam is better absorbed after oral than after i.m. administrations but this does not apply to lorazepam. The clinical effect and amnesia begin more rapidly with diazepam, but last longer following lorazepam. Lorazepam is more effective than diazepam in blocking the emergence sequelae from ketamine. Lorazepam i.v. is followed by a lesser frequency of venous thrombosis.

2, The effects of benzodiazepines on cognition

Initially thought to be virtually free of negative effects, benzodiazepines are now known to carry risks of dependence, withdrawal, and negative side effects. Among the most controversial of these side effects are cognitive effects. Long-term treatment with benzodiazepines has been described as causing impairment in several cognitive domains, such as visuospatial ability, speed of processing, and verbal learning. Conversely, long-term benzodiazepine use has also been described as causing no chronic cognitive impairment, with any cognitive dysfunction in patients ascribed to sedation or inattention or considered temporary and associated with peak plasma levels. Complicating the issue are whether anxiety disorders themselves are associated with cognitive deficits and the extent to which patients are aware of their own cognitive problems. In an attempt to settle this debate, meta-analyses of peer-reviewed studies were conducted and found that cognitive dysfunction did in fact occur in patients treated long term with benzodiazepines, and although cognitive dysfunction improved after benzodiazepines were withdrawn, patients did not return to levels of functioning that matched benzodiazepine-free controls. Neuroimaging studies have found transient changes in the brain after benzodiazepine administration but no brain abnormalities in patients treated long term with benzodiazepines. Such findings suggest that patients should be advised of potential cognitive effects when treated long term with benzodiazepines, although they should also be informed that the impact of such effects may be insignificant in the daily functioning of most patients.

3, Lorazepam-efficacy, side effects, and rebound phenomena

Lorazepam, 4 mg, was evaluated in an 18-night sleep-laboratory study involving five insomniac subjects. Hypnotic effectiveness and effects on sleep stages and related parameters were assessed. Placebo was given on baseline nights 1 to 4, lorazepam on nights 5 to 11, and placebo was given again on withdrawal nights 12 to 18. Subjective and objective data clearly demonstrated that lorazepam was effective for both inducing and maintaining sleep. Sleep latency was reduced from a baseline value of 34.6 min to 17.9 min (P less than 0.01) and total wake time was reduced from 75.9 to 38.5 min (P less than 0.01). On the third and fifth nights of drug withdrawal total wake time rose above baseline levels (termed rebound insomnia) and sleep latency increased by 77% and 60% over baseline (P less than 0.01). Subjective estimates of daytime anxiety also increased above baseline (rebound anxiety) during the withdrawal period. All subjects experienced severe hangover and varying degrees of impaired functioning during the first 3 days on drug. Three subjects also experienced anterograde amnesia during the day after the first drug night. These side effects diminished in intensity over the course of the study. Our results suggest that while 4 mg lorazepam may be effective in inducing and maintaining sleep, this dose induces clinically significant side effects that are followed by consistent rebound phenomena after withdrawal.]

4. Effects of lorazepam on prosaccades and saccadic adaptation

Background: Benzodiazepines have reliable adverse effects on saccadic eye movements, but the impact of sex as a potential modulator of these effects is less clear. A recent study reported stronger adverse effects on the spatial consistency of saccades in females, which may reflect sex differences in cerebellar mechanisms.

Aims: We aimed to further examine the role of sex as a potential modulator of benzodiazepine effects by employing the saccadic adaptation paradigm, which is known to be sensitive to cerebellar functioning.

Methods: A total of n=50 healthy adults performed a horizontal step prosaccade task and a saccadic adaptation task under 0.5 mg lorazepam, 1 mg lorazepam and placebo in a double-blind, within-subjects design.

Results: In the prosaccade task, lorazepam had adverse effects on measures of peak velocity, latency and spatial consistency. The administration of 0.5 mg lorazepam led to significant reductions in gain-decrease adaptation, while a dose of 1 mg did not impair adaptation learning. Gain-increase adaptation was generally less pronounced, and unaffected by the drug. There were no significant drug×sex interactions in either task.

Conclusions: We conclude that a low dose of lorazepam impairs gain-decrease adaptation independent of sex. At higher doses, however, increasing fatigue may facilitate adaptation and thus counteract the adverse effects observed at lower doses. With regards to prosaccades, our findings confirm peak velocity as well as latency and spatial measures as sensitive biomarkers of GABAergic effects.

5. Effects of Intramuscular Midazolam and Lorazepam on Acute Agitation in Non-Elderly Subjects – A Systematic Review

Benzodiazepines are commonly used for the treatment of acute agitation in a psychiatric setting.We searched MEDLINE, EMBASE, PsycINFO, and the Cochrane Central Register of Controlled Trials (CENTRAL) for relevant publications. Randomized trials evaluating intramuscular (IM) midazolam or lorazepam given as monotherapy or as add-on treatment, with more than 10 patients aged 18-65 years, conducted in a psychiatric setting, and published between January 1, 1980, and February 3, 2016, were included. 16 studies from a search result of 5 516 studies were included. In total, 577 patients were treated with lorazepam IM 2-4 mg, and 329 patients were treated with midazolam IM 5-15 mg. It is unclear whether lorazepam IM or midazolam IM is as efficacious as an antipsychotic IM. It is a bit more certain that the combination of benzodiazepines IM and a low dose antipsychotic IM is more efficacious than the benzodiazepine and the antipsychotic alone. However, there is no doubt that benzodiazepines are less likely to be associated with treatment emergent side effects, as compared to antipsychotics.

6. Lorazepam-induced diplopia

Diplopia – seeing double – is a symptom with many potential causes, both neurological and ophthalmological. Benzodiazepine induced ocular side-effects are rarely reported. Lorazepam is one of the commonly used benzodiazepine in psychiatric practice. Visual problems associated with administration of lorazepam are rarely reported and the frequency of occurrence is not established. We report a rare case of lorazepam-induced diplopia in a newly diagnosed case of obsessive compulsive disorder.

7. Acute lorazepam effects on neurocognitive performance

A double-blind, placebo-controlled, crossover design was employed to determine whether acute lorazepam (2 mg orally) cognitive side effects would emerge in a differential age-dependent fashion in 15 young (mean age=22 years) and 12 older (mean age=64 years) subjects. Acute use of lorazepam is frequently the initial treatment choice for convulsive status epilepticus or repetitive seizure clusters. Cognitive assessment was performed during drug and placebo conditions using a computerized battery of cognitive tests. With the exception of performance on the reasoning composite score, significant drug effects were present on all primary cognitive domain measures. However, the only significant drug-by-age interaction effect was seen for dual-task performance. The relationship between test performance and plasma lorazepam concentrations was generally modest and non-significant, suggesting that individual differences in pharmacokinetics are not a major factor contributing to the emergence of cognitive side effects. Despite robust lorazepam effects on multiple measures of neurocognitive function, differential age effects are largely restricted to dual-task performance. These results indicate that with the exception of dual-task performance, older individuals in the age range of this study do not appear to be at increased risk for the emergence of cognitive side effects following a single 2-mg dose of lorazepam.

8. Efficacy and side effects of lorazepam, oxazepam, and temazepam as sleeping aids in psychogeriatric inpatients

The efficacy and side effects of 2 mg of lorazepam, 30 mg of oxazepam, and 20 mg of temazepam as sleeping aids were investigated in 20 psychogeriatric inpatients. The drugs were administered in a random order, double-blind, for 7 night each. All of these short half-life benzodiazepines proved efficacious in maintaining sleep. None of them reduced initial sleep latency. Oxazepam and to a lesser degree temazepam induced withdrawal insomnia during the first night after the treatments. The withdrawal of lorazepam induced a delayed but prolonged insomnia in 3 patients. Both lorazepam and oxazepam had muscle relaxant side effects after awakening.

9. Effects of lorazepam on saccadic eye movements: the role of sex, task characteristics and baseline traits

Background: Saccadic eye movements are controlled by a network of parietal, frontal, striatal, cerebellar and brainstem regions. The saccadic peak velocity is an established biomarker of benzodiazepine effects, with benzodiazepines reliably reducing the peak velocity.

Aims: In this study, we aimed to replicate the effects of benzodiazepines on peak velocity and we investigated effects on previously less studied measures of saccades. We also explored the roles of sex, task characteristics and the baseline variables age, intelligence and trait anxiety in these effects.

Method: Healthy adults ( N = 34) performed a horizontal step prosaccade task under 1 mg lorazepam, 2 mg lorazepam and placebo in a double-blind, within-subjects design.

Results: We replicated the dose-dependent reduction in peak velocity with lorazepam and showed that this effect is stronger for saccades to targets at smaller eccentricities. We also demonstrated that this effect is independent of sex and other baseline variables. Lorazepam effects were widespread, however, occurring on mean and variability measures of most saccadic variables. Additionally, there were sex-dependent lorazepam effects on spatial consistency of saccades, indicating more adverse effects in females.

Conclusions: We conclude that saccadic peak velocity is a sensitive and robust biomarker of benzodiazepine effects. However, lorazepam has pronounced effects also on other parameters of horizontal saccades. Sex-dependent drug effects on spatial consistency may reflect cerebellar mechanisms, given the role of the cerebellum in saccadic spatial accuracy.

10. Subjective and behavioral effects of diphenhydramine, lorazepam and methocarbamol: evaluation of abuse liability

The effects of orally administered placebo, diphenhydramine, lorazepam, methocarbamol and placebo were studied in volunteers with histories of recreational substance abuse including sedative/hypnotics. Placebo, diphenhydramine (100, 200 and 400 mg), lorazepam (1 and 4 mg) and methocarbamol (2.25 and 9 g) were tested in a randomized, double-blind crossover study using 14 subjects. Psychomotor and cognitive performance and subject- and observer-rated responses were measured daily before and for 5.5 hr after drug administration. The results showed that each of the drugs exhibited a different profile of effects on the test battery. Lorazepam produced significant increases in subjects’ ratings of drug effect and liking, increases in measures of sedation and impairment of psychomotor performance. Methocarbamol also produced significant increases in subjects’ ratings of drug effect and liking and measures of sedation, but it produced only minor impairment of psychomotor and cognitive performance. Diphenhydramine increased subjects’ and observers’ ratings of drug effect and measures of sedation, but it produced less psychomotor performance impairment and liking than lorazepam. Diphenhydramine produced the most side effects. The present study clearly differentiated the behavioral and subjective profiles of diphenhydramine, lorazepam and methocarbamol. Consistent with its recognized low abuse liability, diphenhydramine produced fewer increases in measures of positive mood and more adverse effects. The considerable overlap in subjective effect measures of positive mood make further differentiation with respect to abuse liability difficult.