Lorazepam - instructions for use, analogues, indications

Nowadays, more and more people are stressed. A person with a strong nature manages not to succumb to depression and is able to keep his emotions in hand. But, unfortunately, such people are few. Many people experience stress and depression, which cause great damage to the entire body. If you experience insomnia or irritability, you must undergo a course of anti-depressant therapy. One of the popular and sought-after drugs for eliminating stress is the drug Lorazepam. Instructions for use describe how to use the drug correctly.

Action of the medicine

The drug belongs to the group of anti-anxiety drugs that are used to treat panic attacks, neurasthenia and other disorders caused by a stressful situation. The medicine is available in ampoules for intravenous and intramuscular administration, as well as in tablets. Medicines “Clonazepam”, “Lorafen”, “Rivotril” are analogues of the drug “Lorazepam” with identical active ingredients.

The active substance of the drug has a sedative, hypnotic, anticonvulsant and antiemetic effect on the body. The medicine refers to drugs that have a medium-lasting effect in the treatment of anxiety and panic attacks. The drug should be taken only as prescribed by a doctor and in a certain course to eliminate the possibility of addiction. Lorazepam has the same effect as Clonazepam. The instructions, composition, indications and contraindications for these products are almost identical.

Indications

Medicines should be taken strictly as prescribed. Indications include:

the need to normalize sleep during anxiety attacks and stressful situations;
use in combination with other groups of drugs for the treatment of epilepsy;
depressed states and various phobias;
increased arousal and emotionality;
migraine attacks;
states of anxiety, agitation, manic disorders in schizophrenia;
acute delirium due to alcohol poisoning;
panic attacks;
convulsive symptoms;
all kinds of neuroses.

Lorazepam should not be prescribed to children under 12 years of age. The instructions for use also describe other contraindications. Among them:

myasthenia gravis;
closed-type glaucoma;
alcohol intoxication;
hypersensitivity to the components of the drug;
bearing a fetus;
breast-feeding;

Also, with great caution, you need to prescribe medicine for:

porphyria;
epilepsy;
attacks of sleep apnea;
closed glaucoma;
shock states;
lung diseases;
severe depressive states;
coma

The drug Clonazepam has the same contraindications for the treatment of depression. The instructions are mandatory to study before starting treatment.

Contraindications

Absolute:

Acute intoxication with drugs that cause depression of the central nervous system (in particular, drugs with hypnotic effects, narcotic analgesics);
A state of acute alcohol intoxication with weakening of vital functions;
Myasthenia;
Shock;
Severe chronic obstructive pulmonary disease (in patients with progression of respiratory failure);
Coma;
Angle-closure glaucoma (during an acute attack or if there is a predisposition);
Severe depression (associated with the likelihood of developing suicidal tendencies);
Acute respiratory failure;
Age up to 18 years;
Pregnancy (especially during the first trimester), lactation period;
Individual intolerance to the components of the drug.

Relative (Nozepam is prescribed under medical supervision):

Liver/renal failure;
Compounded medical history of drug addiction;
Presence of a tendency to abuse psychoactive drugs;
Spinal/cerebral ataxias;
Hyperkinesis;
Psychosis (associated with the likelihood of paradoxical reactions);
Organic diseases of the brain;
Known/suspected sleep apnea;
Hypoproteinemia;
Elderly age.

Side effects

In general, the drug is well tolerated. In rare cases, the following side effects may develop:

increased fatigue;
amnesia;
headache;
dizziness;
nausea;
dry mouth;
diarrhea;
pain in the epigastric region.

The drug belongs to group B and is sold in pharmacies only by prescription, like Clonazepam. Instructions, analogues, composition of the medicine - all this can be found out from the article.

"Clonazepam"

An antiepileptic drug that belongs to the group of benzodiazepine derivatives. It has a calming, hypnotic, anti-anxiety and anti-emetic effect on humans. The main substance of the tablets binds to plasma almost 100%. It is excreted from the body in the form of metabolites. In humans, the drug Clonazepam suppresses paroxysmal activity of various types in a short time. Instructions for use, reviews from doctors - all this information is important. It is necessary to study it before starting treatment.

Indications:

status epilepticus;
West syndrome;
tonic and clonic convulsions;
epilepsy.

Contraindications:

diseases of the lungs and bronchi;
state of shock;
closed-type glaucoma;
pregnancy;
lactation;
intoxication due to alcohol and analgesic poisoning.

Dosage

The drug is prescribed individually, the daily dose depends on the severity of the disease. The initial dose of the medicine should not exceed 1 mg per day. For young children, the daily dosage of the drug is calculated based on years of life. It is recommended to divide the tablet intake into three times. In this case, half the dose should be taken in the morning and evening, and the rest should be taken before bed.

The course of treatment is one month. Adults are given 1 mg intravenously, and children 500 mg. Before starting therapy, you must read the instructions for use for Clonazepam. The form of release of the medicine matters. Intravenous injections are more effective.

Release form, composition and packaging

Dragee	1 dragee
lorazepam	1 mg

Excipients: potato starch, gelatin, talc, magnesium stearate, lactose.

Shell composition:

polyvinyl alcohol, maltodextrin, talc, titanium dioxide, sucrose.

25 pcs. — cellular contour packages (1) — cardboard packs.

Dragee	1 dragee
lorazepam	2.5 mg

Excipients: potato starch, gelatin, talc, magnesium stearate, lactose.

Shell composition:

polyvinyl alcohol, maltodextrin, talc, titanium dioxide, aluminum varnish, sucrose.

25 pcs. — cellular contour packages (1) — cardboard packs.

special instructions

The medicine is dispensed only with a doctor's prescription. Not recommended for patients with renal and hepatic insufficiency. If the profession is associated with increased attention and risk to life, the drug is prescribed with caution.

For older people and children under 12 years of age, it is better to administer the drug intramuscularly or intravenously. The medication Clonazepam should be stored away from children in a dry and dark place. Instructions for use, analogues - all information can be obtained from your doctor.

Contraindications

Absolute:

states of anxiety or mental stress caused by everyday problems;
severe respiratory failure of any origin;
sleep apnea syndrome;
psychoses;
severe liver and/or kidney failure;
glaucoma;
acute porphyria;
myasthenia gravis;
alcohol poisoning;
alcohol dependence (during and for three days after completion of treatment, you should not drink alcohol);
hereditary lactose or fructose intolerance, Lapp lactase or sucrase-isomaltase deficiency, glucose-galactose malabsorption syndrome;
breast-feeding;
age up to 12 years;
hypersensitivity to 1,4-benzodiazepine derivatives or components of the drug.

Lorafen should be taken with caution in case of mild to moderate severity of hepatic and/or renal failure, chronic respiratory failure, history of suicidal thoughts and attempts, depression, porphyria, cerebral and spinal ataxia, hyperkinesis, hypoproteinemia, organic pathologies of the brain, alcohol, drugs or a history of drug addiction, in old age, during pregnancy

"Lorafen"

The medicine belongs to the group of tranquilizers, benzodiazepine derivatives. It has the following effects on the body:

hypnotic;
antiemetic;
anti-anxiety;
anticonvulsant.

When taken orally, the bioavailability of the substance reaches 100%. Half of the drug is excreted within 12 hours through the kidneys. The drug "Lorafen" is identical in composition to the drug "Lorazepam". The instructions for use are also practically the same.

Indications:

anxiety states;
sleep disturbance associated with depression;
neuroses;
panic attacks;
epilepsy.

Contraindications:

myasthenia gravis;
closed-type glaucoma;
intoxication of the body associated with drug poisoning;
hypersensitivity to lorazepam;
pregnancy;
lactation.

General information about the drug

The drug is applicable for neuroses, anxiety conditions accompanied by somatic disorders, insomnia, and panic attacks.
It also has an anticonvulsant and muscle relaxant effect. The INN of the drug is Lorazepamum. It belongs to the pharmacological group of anxiolytics, that is, substances that have a sedative effect on the body, helping to suppress anxiety, fear, and relieve severe stress.

Lorazepam is available only in the form of white tablets, cylindrical in shape with stripes for separation on the sides. This drug is not available in Russia, so it is impossible to name the price of Lorazepam. Drug substitute – Lorafen. They do not differ either in composition or mechanism of action.

This analogue can be purchased in Russian pharmacies or on pharmacological websites (for this you will need a prescription from your doctor). The cost of Lorafen is in the range of 250 rubles. up to 300 rub. for 1 package. If necessary, you can purchase other medications that are analogues of Lorazepam in their effects and which can be found in Russian pharmacy chains.

Analogs

Lorazepam has a number of analogues that differ from this drug in the active substance, but have a similar mechanism and spectrum of effects on the patient’s body:

Anvifen. A nootropic whose active ingredient is aminophenylbutyric acid hydrochloride. Available in dosages from 25 mg to 250 mg.
The drug has a mechanism of action similar to Lorazepam; it can be prescribed to children to treat tics, stuttering, uncontrolled urination, and is used to prevent motion sickness in transport. Just like Lorazepam, Anvifen cannot be prescribed to pregnant women, but it can be used to treat children over 3 years of age.
Xanax. The main substance of the drug is alprazolam. Available in tablets with an extended duration of action. Used to relieve anxiety, irritability, treat insomnia and tremor. It is not used to treat children, and can be prescribed to pregnant women with great caution.
Atarax. Hydroxyzine-based tranquilizer. It is used as therapy for patients with chronic alcoholism, neurasthenia, various types of mental illnesses, relieving itching, and can also be used to prepare patients for operations. Can be prescribed to children from 1 year of age.

Compound

Lorazepam consists of an active substance with the same name Lorazepamum and additional components:

lactose monohydrate;
cellulose;
magnesium stearate;
potassium polacrilin.

One tablet can contain 1 mg and 2.5 mg of the active substance. By reducing the emotional reaction to external stimuli, this substance helps reduce the risk of diseases associated with increased stress on the psyche.

The pharmacological action of lorazepam is determined by its similarity to gamma-aminobutyric acid (GABA). Lorazepam belongs to the category of benzodiazepine derivatives and affects those structures of the central nervous system that are responsible for regulating emotional activity, and these are the limbic system and the hypothalamus. The drug ensures the entry of chlorine into the excited neuron, which in turn leads to the return of the neuron to a stable state.

Effect of the drug

Lorazepam affects the body as:

anxiolytic;
hypnotic;
anticonvulsant;
muscle relaxant.

The active substance is well absorbed from the digestive tract, reaching its maximum concentration in the patient’s blood after 2 hours. During the process of distribution throughout the body, it binds to proteins (85%), and also has the property of penetrating into breast milk. Metabolism of lorazepam occurs in the liver, and as a result of this process, lorazepam glucuronide is formed. The resulting substance is excreted from the body by the kidneys; the half-life process takes 12 hours.

During the study of the drug, it turned out that the elimination process depends on the patient’s age and concomitant diseases. When using the drug in the treatment of patients who suffer from kidney and liver diseases, it turned out that for them the half-life of lorazepam glucuronide is slightly longer than for other patients.

50 tablets in a dark glass jar; one can in a cardboard package.

Nozepam is a benzodiazepine anxiolytic. It is characterized by anxiolytic and sedative properties. Has a positive effect on the central nervous system (CNS), calms and relaxes. The drug also has slightly pronounced muscle relaxant effects and anticonvulsant activity.

In addition, it is often prescribed for withdrawal symptoms in people suffering from alcohol or drug addiction. Before taking it, you should consult a doctor and read the instructions. Since this drug is a tranquilizer, if taken for a long time, it can cause addiction or withdrawal syndrome (with abrupt cessation of use).

Nozepam belongs to the group of anxiolytic medications. It is a narcotic psychotropic drug and therefore subject to control. You can purchase the medicine only with a prescription from a doctor. MNN: Oxazepam.

Prescribed for sleep disorders, phobias, fears and anxiety. You can take the medicine with the permission of a specialist if there is a clearly expressed need.

The medication is available in tablet form. Tablets are packaged in blisters (10 pieces) or in a glass jar (50 pieces). The tablets come with detailed instructions for use.

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Since this medicine is a psychotropic narcotic drug, it is not freely available. You can check the price and availability in pharmacies in your city. The cost ranges from 82 to 315 rubles, depending on the manufacturing company.

Composition of Nozepam

The main active ingredient is oxazepam. It is a benzodiazepine anxiolytic. The white powder does not have a pronounced odor. It is poorly soluble in ether, ethanol and water. The powder can only be dissolved with dimethylformamide. Penetrating inside the body, it produces a sedative, hypnotic and anxiolytic effect. One tablet contains 10 mg of active substance.

The drug also includes a list of auxiliary components:

calcium stearate monohydrate (0.7 mg);
milk sugar (44.6 mg);
talc (0.7 mg);
potato starch (14 mg).

Additional substances provide better binding of the tablet components to each other.

Pharmaco-properties

The mechanism of action of the drug is determined by its main component. Under the influence of the drug, GABA processes in the brain are enhanced. The main effect of the drug is on the reticular activating formation of the brain. Emotional coloring is weakened, and there is a decrease in the impact of impulses from sensory receptors on the limbic system.

The sedative effect is due to the effect on the nonspecific nuclei of the thalamus and the reticular formation of the brain stem. As a result, there is a decrease in the symptoms of a neurotic disorder. Under the influence of drugs, the influence of vegetative, motor and emotional stimuli that disrupt the sleep pattern and structure decreases. By enhancing presynaptic inhibition, an anticonvulsant effect is achieved.

Action of anxiolytics

The process of absorption of the substance takes quite a long time. At the same time, it is absorbed in full. Approximately 97% binds to plasma proteins. The peak level of oxazepam concentration is recorded after 2-4 hours. It is worth considering that the substance can penetrate the placental barrier and into breast milk.

Transformation of components occurs in the liver. The half-life ranges from 5 to 15 hours. It is excreted from the body through the kidneys and with feces.

Dosage and side effects

Adults and children over 12 years of age should take the medicine in a dosage of 1 to 4 mg, dividing the daily dose into three doses. For intramuscular and intravenous use of the drug, the dose is 50 mg per kilogram of body weight. The course of treatment depends on the severity of the disease and the individual characteristics of the organism. The maximum permissible dosage of the drug in tablets is 10 mg per day, in the form of injections - 4 mg.

In general, Lorafen is well tolerated and does not cause side effects, just like Clonazepam. Instructions for use (tablets) describe a number of symptoms that may be observed at the beginning of therapy. These include:

migraine;
nausea;
diarrhea;
dizziness;
exacerbation of thrombophlebitis;
drowsiness.

Lorivan/Lorazepam. Instructions for use

Available in tablets.

One tablet contains:

Active substance: lorazepam 1 mg

20 pcs. – blisters (2) – cardboard packs.

Indications

- in conditions of a psychoreactive nature;

- in the treatment of extreme nervous emotional tension and anxiety, in case of psychosomatic disorders, to relieve a panic attack;

- during schizophrenic conditions;

- symptoms of VSD;

- in case of insomnia, which appears due to stress and increased anxiety;

- for the treatment of epileptic conditions (in these cases, the medicine is used as part of a complex treatment);

- during depressive states in which signs of anxiety are observed (used with extreme caution!);

- for headaches that are accompanied by increased muscle tension;

- to eliminate neurosis-like conditions and neuroses in which tension and feelings of anxiety are observed;

- to prevent nausea and vomiting that occurs during chemotherapy;

Dosage

Inside. The tablets are taken three times a day. The dosage at one time should be 1 mg.

For a hypnotic effect, the drug is used half an hour before bedtime, the dosage is 1-2 mg. During a state of increased anxiety and excitability, the medicine is taken 6 mg per day.

During premedication, the medication is prescribed one hour before surgery. The dosage of the medicine should be 2.5-5 mg.

When used for seizures, withdrawal of the drug should be done slowly. The treatment period for this disorder is about a week.

Overdose

Symptoms: drowsiness, hypotension, confusion, depressed reflexes, coma.

Treatment: induction of vomiting, gastric lavage, intravenous administration of norepinephrine to increase blood pressure, symptomatic therapy, monitoring of vital functions. Administration of a specific antidote—the benzodiazepine receptor antagonist flumazenil (in a hospital setting).

Drug interactions

Lorazepam enhances the effect of central nervous system depressants, incl. phenothiazines, narcotic analgesics, barbiturates, antidepressants, hypnotics, anticonvulsants, antihistamines with a sedative effect.

Potentiates the effect of general and local anesthetics, enhances the effect of curare-like drugs.

When used simultaneously with alcohol, in addition to enhancing the inhibitory effect on the central nervous system, paradoxical reactions are possible (psychomotor agitation, aggressive behavior, state of pathological intoxication). Nicotine inhibits the activity of lorazepam (accelerates its metabolism).

Side effects

From the nervous system and sensory organs: lethargy, fatigue, drowsiness, disorientation, headache, dizziness, depression, ataxia, sleep disturbance, agitation, visual impairment, episodes of amnesia.

From the gastrointestinal tract: dry mouth, nausea, vomiting, diarrhea, change in appetite.

From the skin: erythema, urticaria.

Other: changes in blood composition (leukopenia), increased LDH activity.

The development of addiction, drug dependence, withdrawal syndrome, rebound syndrome is possible (see “Special Instructions”).

special instructions

Use with caution in patients with depression, given suicidal tendencies. In patients with drug and alcohol dependence, use under close medical supervision

Side effects are usually observed at the beginning of therapy. The possibility of a more frequent occurrence of side effects in elderly and debilitated patients should be taken into account.

During treatment and for 2 days after its completion, it is necessary to avoid drinking alcoholic beverages; Drivers of vehicles and people whose work requires quick mental and physical reactions, and is also associated with increased concentration, should not engage in professional activities during this period.

If treatment is abruptly stopped, withdrawal syndrome may occur (tremor, convulsions, abdominal or muscle spasms, vomiting, perspiration), and symptoms similar to those of the disease may also occur (anxiety, agitation, irritability, emotional tension, insomnia, convulsions).

With long-term use, it is necessary to periodically monitor the picture of peripheral blood, liver and kidney function.

Please note that anxiety or tension associated with everyday stress does not usually require treatment with anxiolytics.

"Rivotril"

Belongs to the group of antiepileptic drugs, benzodiazepine derivatives. It has a calming, anti-anxiety, antiemetic effect on the human body. The product helps get rid of neuroses associated with depression and stress. Psychotherapists often use this medicine in their practice.

Indications:

status epilepticus;
epilepsy;
tonic and clonic convulsions;
insomnia;
anxiety;
stress;
depressive states.

All these indications for use are identical to the drug Lorazepam. Instructions for use contain detailed information about the release form and properties of the medicine.

Contraindications:

severe diseases of the lungs and bronchi;
closed glaucoma;
severe depression;
intoxication associated with poisoning with drugs or alcohol.

Pharmacodynamics and pharmacokinetics

Pharmacodynamics

Benzodiazepine type tranquilizer. Has a sedative and anxiolytic effect. It also has muscle relaxant and anticonvulsant activity.

The effect of the drug is associated with an increase in GABA processes in the brain. It has an effect mainly on the retinal activating formation of the brain, reducing the influence of impulses from sensory type receptors on the limbic system and weakening emotional coloring.

Pharmacokinetics

Absorbed relatively slowly, but completely. Reaction with plasma proteins reaches 97%. The maximum concentration is reached on average after 2-3 hours. The drug is able to penetrate the placenta, the blood-brain barrier and be excreted in breast milk. Transformed in the liver to form inactive derivatives.

Dosage

The drug "Rivotril" at the beginning of treatment can be taken at a dosage of 1 mg per day. In the future, the daily rate can be from 4 to 8 mg per day. The maximum permissible dosage is 10 mg for tablets and 4 mg for solutions.

In most cases, Rivotril is well tolerated. As an exception, the following reactions may develop:

nausea;
vomit;
epigastric pain;
dizziness;
migraine;
drowsiness;
changes in peripheral blood parameters.

The drug Rivotril is used to treat stress and depression in adults and children over 12 years of age, as is the drug Clonazepam. Instructions for use (tablets) contain basic information about methods of administration and dosage.

Pharmacology

Interacts with specific benzodiazepine receptors of the GABA-benzodiazepine receptor complex, increases the sensitivity of GABA receptors to GABA. As a result, the frequency of opening of transmembrane channels for chlorine ions increases, the postsynaptic membrane of the neuron is hyperpolarized, neuronal activity is inhibited and interneuron transmission to the central nervous system is inhibited.

The effects are due to the influence on various parts of the central nervous system: the amygdala complex of the limbic system (anxiolytic), the reticular formation of the brain stem and the nonspecific nuclei of the thalamus, hypothalamus (sedative and hypnotic), spinal cord (muscle relaxant), hippocampus (anticonvulsant).

Suppresses anxiety, fear, reduces psychomotor agitation, emotional stress. It has an antipanic and amnestic (mainly when used parenterally) effect. Effective for insomnia caused by anxiety or short-term stressful situations: it facilitates the onset of sleep (shortens the period of falling asleep), reduces the number of night awakenings, and increases the duration of sleep. Inhibits polysynaptic spinal reflexes and reduces skeletal muscle tone.

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Lorazepam has low toxicity and a wide range of therapeutic effects.

An animal reproduction study showed that administration of lorazepam to rabbits in doses of 40 mg/kg orally and 4 mg/kg or higher intravenously led to fetal resorption and an increased incidence of fetal death. Causes developmental abnormalities in rabbits regardless of dose. In an 18-month study in rats, no carcinogenic activity was detected.

When taken orally, it is well but slowly absorbed from the gastrointestinal tract, bioavailability is 90%. Cmax is achieved within 2 hours and depends on the dose: at a dose of 2 mg, Cmax is 20 ng/ml. About 85% binds to plasma proteins. Equilibrium concentration in the blood is usually achieved after 2–3 days. Passes through the BBB and the placental barrier.

With intramuscular administration, Cmax is achieved within 60–90 minutes. T1/2 with parenteral administration is 16 hours. When used for 6 months, no accumulation phenomena are observed. The pharmacokinetic parameters of lorazepam do not change in the elderly.

Reviews

The drug "Lorazepam" and its analogues are popular among patients and doctors. In most cases, the drug is well tolerated, helps to normalize sleep in a short time, reduce epileptic seizures, get rid of stress and depression without harm to the body. If you adhere to the correct dosage, the product does not cause side effects.

Before starting treatment, you should carefully study the instructions for use, which will tell you in detail about the drug and its contraindications. The course of treatment should not exceed one month, otherwise an addiction syndrome may develop, which is fraught with serious complications. Experts note that treatment can be prescribed only after examination and diagnosis. It is not possible to purchase anti-depressant drugs without a prescription.

Negative statements about the described medications are also found. You can hear them most often from patients who neglect the doctor’s recommendations. Medicines must be taken in the dosage specified in the instructions. Do not suddenly stop taking the pills. Experts note that this can lead to a sharp deterioration in well-being. If everything is done correctly, side effects develop quite rarely. Some patients note that at the beginning of therapy, drowsiness, dizziness, and apathy may occur.

Lorazepam is an excellent remedy for fighting depression. The instructions for use describe in detail what the effect of therapy should be. But this is not a panacea. It is worth finding the cause of neuroses and trying to eliminate it. It would be a good idea to consult a psychotherapist. It is worth remembering that depression can lead to the development of serious abnormalities in the functioning of any body system.