Side effects of lorazepam
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Side Effects of Lorazepam: A Comprehensive Review
Common Side Effects of Lorazepam
Lorazepam, a benzodiazepine used for its sedative, anxiolytic, and hypnotic properties, is associated with several common side effects. These include sedation, dizziness, weakness, unsteadiness, and disorientation, which can significantly impair psychomotor performance and driving ability . Additionally, lorazepam can cause drowsiness, oversedation, and impaired coordination, which are dose-dependent and typically reversible upon dose reduction.
Cognitive and Memory Impairments
Lorazepam has been shown to cause cognitive impairments, including anterograde amnesia, confusion, and memory impairment. These effects are particularly pronounced during the initial days of administration but tend to diminish over time . In elderly patients, lorazepam can lead to oversedation, amnestic disorders, and confusion, sometimes resulting in drug-induced pseudodementia, which resolves upon discontinuation of the drug.
Rebound Phenomena
Withdrawal from lorazepam can lead to rebound phenomena, such as rebound insomnia and rebound anxiety. Studies have shown that after discontinuing lorazepam, total wake time and sleep latency can significantly increase, surpassing baseline levels . This rebound effect is also accompanied by increased daytime anxiety and tension.
Impact on Driving and Psychomotor Performance
Lorazepam significantly impairs driving ability and psychomotor performance. Studies have demonstrated that even at therapeutic doses, lorazepam can cause substantial impairment in car handling tasks and mental arithmetic, leading to increased risks of driving accidents . This impairment is independent of the concentration detected in the blood, indicating that even low doses can affect driving safety.
Side Effects in Specific Populations
Elderly Patients
In elderly patients, lorazepam is associated with a higher incidence of side effects, including oversedation, confusion, depression, and ataxia. These side effects often resolve upon withdrawal of the drug, but the risk of misdiagnosis, such as drug-induced pseudodementia, remains a concern.
AIDS Patients
In hospitalized AIDS patients, lorazepam has been found to be ineffective in treating delirium and is associated with treatment-limiting adverse effects. This has led to the early termination of lorazepam treatment in clinical trials due to concerns over its safety profile in this population.
Comparison with Other Benzodiazepines
When compared to other benzodiazepines like diazepam, lorazepam has a similar efficacy but a different side effect profile. Lorazepam is more likely to cause sedation and psychomotor impairment, whereas diazepam has a faster onset of action but a shorter duration of effect. In psychogeriatric inpatients, lorazepam, oxazepam, and temazepam were all effective in maintaining sleep, but lorazepam was associated with delayed but prolonged withdrawal insomnia.
Conclusion
Lorazepam is an effective sedative and anxiolytic agent, but its use is accompanied by several side effects, including sedation, cognitive impairments, and significant psychomotor impairment. These side effects are particularly concerning in elderly patients and those with specific medical conditions, such as AIDS. Rebound phenomena upon withdrawal further complicate its use. Therefore, careful consideration and monitoring are essential when prescribing lorazepam, especially in vulnerable populations.
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