Lorazepam
Ativan
BenzodiazepineSchedule IVGeneric availableTDM data
Clinical Pharmacology Lorazepam is a benzodiazepine with anxiolytic, sedative, and anticonvulsant effects. Its action is mediated through enhancement of the activity of gamma aminobutyric acid (GABA), the major inhibitory neurotransmitter in the central nervous system, by binding to the benzodiazepine site on the GABA-A receptor.
Compare Lorazepam →FDA-Approved Indications
- anxiety disorders or for the short-term relief of the symptoms of anxiety or anxiety associated with depressive symptoms
Common Off-Label Uses
- Catatonia
- Alcohol withdrawal
- Chemotherapy-induced nausea
- Status epilepticus
- Acute agitation
What Sets This Drug Apart
- No CYP metabolism — directly glucuronidated (UGT pathway) with no active metabolites; safest benzo in hepatic impairment and polypharmacy
- First-line pharmacotherapy for catatonia: IV/IM lorazepam challenge (1-2 mg) is both diagnostic and therapeutic
- Reliable IM absorption (unlike diazepam IM) makes it the workhorse benzodiazepine for inpatient agitation management
- Intermediate half-life (~12h) without active metabolites — more predictable than long-acting benzos in elderly
- Available in oral, liquid, IM, and IV formulations; one of the 'LOT' benzos (Lorazepam, Oxazepam, Temazepam) preferred in liver disease
Boxed Warning
WARNING: RISKS FROM CONCOMITANT USE WITH OPIOIDS