Lorazepam
Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.
| ID | DRUG-LORAZEPAM |
|---|---|
| Type | Drug |
| Aliases | AtivanTemestaЛоразепам |
| Status | reviewed 2026-04-27 | pending_clinical_signoff |
| Diseases | None declared |
| Sources | SRC-ESMO-DLBCL-2024 SRC-NCCN-BCELL-2025 |
Drug Facts
| Class | Intermediate-acting benzodiazepine (GABA-A positive allosteric modulator) |
|---|---|
| Mechanism | Binds the benzodiazepine site on GABA-A receptors, increasing the frequency of chloride channel opening upon GABA binding and producing hyperpolarization of neurons in cortical, limbic, and brainstem pathways. Therapeutic effects in oncology supportive care: anticipatory chemotherapy-induced nausea/vomiting (CINV) — where conditioned anxiety triggers nausea before chemo administration — and management of acute anxiety, insomnia, and agitation in hospitalized cancer patients. Also used as an anticonvulsant for seizure rescue (high-dose chemotherapy, ifosfamide encephalopathy, CNS metastases) and as an adjunct to multi-receptor antiemetic regimens for refractory CINV. Approved by FDA September 1977. |
| Typical dosing | Anticipatory CINV: 0.5-2 mg PO/SL the night before chemotherapy and again 1-2 hours before chemo on day 1; can repeat 0.5-1 mg q6-8h on day 1 if needed. Acute breakthrough anxiety / agitation: 0.5-2 mg PO / IV / IM, repeat q6-8h as needed. Status epilepticus / acute seizure rescue: 4 mg IV slow push (over 2-5 min), may repeat once in 5-10 min if no response. Geriatric / debilitated: start 0.5 mg. Renal: no major adjustment (non-renal clearance). Hepatic: caution in severe impairment but glucuronidation pathway preserved better than for diazepam (preferred BZD in liver dysfunction). Pediatric: 0.05 mg/kg/dose IV/PO (max 2 mg) for anxiety; 0.1 mg/kg IV (max 4 mg) for status. Limit duration to... |
| Ukraine registered | True |
| NSZU reimbursed | True |
| Ukraine last verified | 2026-04-27 |
Warnings
- Concomitant use with opioids may result in profound sedation, respiratory depression, coma, and death; reserve combination for patients in whom alternatives are inadequate; use lowest effective doses and shortest durations
- Risks from abuse, misuse, and addiction (Schedule IV controlled substance US; equivalent in EU/UA) — physical dependence within ~4 weeks of regular use; abrupt discontinuation can precipitate withdrawal seizures
Notes
Standard agent for anticipatory CINV (conditioned nausea triggered by sights/smells of chemotherapy unit prior to actual administration) — addresses anxiety component that pure 5-HT3 / NK1 antagonists do not. Also valuable as adjunct in refractory CINV regimens. Sublingual formulation onset ~15-30 min, useful for breakthrough anxiety and in patients unable to swallow. Glucuronidation metabolism (no active metabolites) makes lorazepam the preferred benzodiazepine in patients with hepatic impairment, elderly, or on multiple CYP- interacting medications. KEY SAFETY: opioid co-administration is boxed-warning (profound sedation, respiratory depression, death) — in cancer patients receiving both, monitor closely and use lowest effective doses; never bolus IV lorazepam in opioid-naive patients without airway management capability. Schedule IV controlled substance (US/UA equivalent психотропний контроль).
Used By
No reverse references found in the YAML corpus.