Experiences with

Lorazepam

Lorazepam belongs to a group of medicines called benzodiazepines.

It's used to treat anxiety and sleeping problems that are related to anxiety.

It can also be taken to help you relax before an operation or other medical or dental treatment. This is known as a pre-med.

It's thought to work by increasing the levels of a calming chemical in your brain called gamma-aminobutyric acid (GABA).

Lorazepam is available on prescription only. It comes as tablets and as a liquid that you swallow.

It can also be given as an injection in hospital if you're having a seizure or fit.

Who can take lorazepam

Most adults can take lorazepam for anxiety or insomnia. Lorazepam can be used as a pre-med in people aged 5 years and older.

Who may not be able to take lorazepam

Lorazepam is not suitable for some people. To make sure it's safe for you, tell a doctor before starting to take lorazepam if you:

• have ever had an allergic reaction to lorazepam or any other medicine
• have liver or kidney problems
• have breathing or chest problems
• have myasthenia gravis, a condition that causes muscle weakness
• have sleep apnoea, a condition that causes breathing problems when you're asleep
• have ever had depression or thoughts of harming yourself
• have been diagnosed with a personality disorder
• have ever had problems with alcohol or drugs
• have arteriosclerosis, a condition that affects blood flow
• have balance problems or are at risk of falls
• are trying to get pregnant, are already pregnant or breastfeeding
• have glaucoma, a condition that causes high pressure in the eye
• are going to have a general anaesthetic for an operation or dental treatment

Dosage and strength

Lorazepam comes as 0.5mg, 1mg and 2.5mg tablets. The liquid contains 1mg of lorazepam in each 1ml.

The usual dose is:

• anxiety in adults – 1mg to 4mg each day. Your doctor will tell you how often you need to take it
• sleeping problems in adults – 1mg to 2mg before bedtime (lorazepam will start to work in around 20 to 30 minutes)
• a pre-med for adults – 2mg to 3mg the night before the procedure and then 2mg to 4mg about 1 to 2 hours before your procedure
• a pre-med for children aged 5 years to 11 years – the dose will depend on the child's weight
• a pre-med for children aged 12 to 17 years – 1mg to 4mg either the night before the procedure or at least 1 hour before the procedure, or both

For older people or people with liver or kidney problems, a doctor may recommend a lower dose.

Changes to your dose

Lorazepam is usually prescribed for a short time, from a few days to 4 weeks. Your dose may go up or down until your doctor is sure you're on the right dose.

Your doctor may gradually reduce your dose at the end of the course of treatment before you stop completely.

How to take it

Take lorazepam tablets with a drink of water. You can take them with or without food.

If you're taking lorazepam as a liquid, the medicine will come with a plastic syringe or spoon to help you measure out the right dose. If you do not have a syringe or spoon, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not measure the right amount.

How long to take it for

How long you take lorazepam for depends on why you're taking it.

For anxiety and sleep problems, it's usually only recommended for up to 4 weeks. Your dose may be reduced gradually to prevent withdrawal symptoms.

Before an operation or procedure, you'll usually only need a maximum of 2 doses.

If you're having a seizure or fit, you'll only be given a lorazepam injection while you're in hospital.

If a doctor prescribes lorazepam for more than 4 weeks, they'll tell you how long to take it for.

If you forget to take it

If you forget to take your lorazepam:

• for anxiety – if it's less than 3 hours since your missed dose, take it as soon as you remember. If more than 3 hours have passed, skip the missed dose and take your next dose at the usual time
• for sleeping problems – leave out the missed dose if you have not taken it by bedtime, and take your usual dose the next night
• before an operation or procedure (pre-med) – read any information the hospital has given you about your procedure, which may have advice about missed doses. If it does not, call the hospital to ask what to do next

Never take 2 doses to make up for a forgotten dose.

If you often forget doses, it may help to set an alarm to remind you. You could also ask a pharmacist for advice on other ways to remember to take your medicine.

If you take too much

If you take more than your prescribed dose of lorazepam you may get symptoms including:

• poor co-ordination or trouble speaking
• feeling sleepy
• a slow or irregular heartbeat
• uncontrolled eye movements
• muscle weakness
• feeling overexcited

The amount of lorazepam that can lead to an overdose varies from person to person.

• you take more than your prescribed dose of lorazepam

Get help from 111 online or call 111. Call 111 if you need advice for a child under 5 years old

If you need to go to A&E, do not drive. Ask someone to drive you or call 999 and ask for an ambulance.

Bring the lorazepam packet or leaflet inside it, any remaining medicine, and any other medicines you take.

Common side effects

These common side effects of lorazepam happen to more than 1 in 100 people. There are things you can do to help cope with them:

Speak to a doctor or pharmacist if the advice on how to cope does not help and a side effect is still bothering you or does not go away.

Serious side effects

It happens rarely in less than 1 in 1,000 people, but some people have serious side effects when taking lorazepam.

Tell a doctor or call 111 straight away if:

• the whites of your eyes turn yellow, or your skin turns yellow although this may be less obvious on brown or black skin – this could be a sign of liver problems
• you see or hear things that are not there (hallucinations)
• you think things that are not true (delusions)
• you keep falling over
• you have unusual mood changes such as talking more than usual or feeling overexcited, agitated, restless, irritable or aggressive – these side effects are more likely in children or if you're over 65

Make an appointment to see your doctor if you have memory loss (amnesia).

• you have difficulty breathing or your breathing becomes very slow

In rare cases, lorazepam may cause a serious allergic reaction (anaphylaxis).

Lorazepam can cause withdrawal symptoms if you take it for a long time.

If you're prescribed lorazepam for more than 4 weeks, your dose may be reduced gradually when you stop taking it to prevent withdrawal symptoms.

Other side effects

These are not all the side effects of lorazepam. For a full list, see the leaflet inside your medicine packet.

Lorazepam and pregnancy

Lorazepam can be taken during pregnancy.

However, taking lorazepam for a long time, particularly towards the end of pregnancy, may make your baby drowsy after they're born and can cause withdrawal effects. The baby may need to be observed in hospital after they're born, so you may need to stay in hospital for longer than usual.

If you become pregnant while taking lorazepam, speak to your doctor. They can explain the risks and the benefits of taking it, and will help you choose the best treatment for you and your baby.

Lorazepam and breastfeeding

If your doctor, health visitor or midwife says your baby is healthy, you can usually take lorazepam if you're breastfeeding.

There's not much information about taking lorazepam while breastfeeding, but the information shows that it passes into breast milk in very small amounts.

If you take lorazepam for a longer time, in high doses, or with other medicines, your baby may be more likely to get side effects, although this is still rare. This can make your baby drowsy or tired and can make it difficult for them to feed.

Talk to your health visitor, midwife, doctor or pharmacist as soon as possible if you have any concerns, including if your baby:

• is not feeding as well as usual
• seems unusually sleepy
• has unusual breathing

It's important not to share a bed with your baby while you're taking lorazepam.

Lorazepam and fertility

There's no evidence that lorazepam will affect fertility in either men or women.

Cautions with other medicines

Some medicines affect the way lorazepam works and increase the chances of you having side effects.

Speak to a doctor or pharmacist before starting to take lorazepam if you take any of these medicines:

• antidepressants, used to treat depression
• antipsychotics, used to treat mental health problems
• anticonvulsants, used to treat seizures
• hypnotics, used to treat anxiety or sleep problems
• drowsy or sedating antihistamines, such as chlorphenamine or promethazine
• strong painkillers, such as codeine, methadone, morphine, oxycodone, pethidine or tramadol
• HIV medicines, such as ritonavir, atazanavir, efavirenz or saquinavir
• rifampicin, a medicine for bacterial infections
• antifungal medicines, such as fluconazole
• proton pump inhibitors (PPIs) – medicines for reducing stomach acid, such as omeprazole or esomeprazole
• muscle relaxants, such as baclofen or tizanidine
• disulfiram, a medicine for alcohol addiction
• isoniazid, a medicine for tuberculosis
• theophylline, a medicine for asthma and other breathing problems

Mixing lorazepam with herbal remedies or supplements

Do not take herbal remedies for anxiety or insomnia, such as valerian or passionflower, with lorazepam. They can increase the drowsy effects of lorazepam and may also have other side effects.

There's not enough information to say that other complementary medicines, herbal remedies and supplements are safe to take with lorazepam. They're not tested in the same way as pharmacy and prescription medicines. They're generally not tested for the effect they have on other medicines.

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