What are the most common side effects of lorazepam

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Common Side Effects of Lorazepam

Lorazepam, a benzodiazepine commonly used for its anxiolytic and sedative properties, is associated with a range of side effects. This article synthesizes findings from multiple studies to highlight the most frequently reported adverse effects of lorazepam.

Sedation and Drowsiness

One of the most common side effects of lorazepam is sedation. Patients often report significant drowsiness upon awakening and increased sleepiness throughout the day, particularly in the mid-morning and mid-afternoon . This sedative effect can impair daily functioning and is a primary reason for caution in activities requiring alertness, such as driving .

Cognitive Impairment and Memory Issues

Lorazepam is known to cause cognitive impairments, including memory issues. Studies have documented episodes of memory impairment, confusion, and even amnestic disorders in patients using lorazepam Ancill1987Preston1992Pomara2014. These cognitive side effects are particularly concerning in elderly patients, where they can lead to misdiagnoses such as drug-induced pseudodementia .

Psychomotor Impairment

Impaired coordination and dizziness are also frequently reported side effects of lorazepam. These symptoms can significantly affect psychomotor performance, making tasks that require fine motor skills and coordination more challenging Cohn1984Clarkson2004Preston1992. This impairment is a critical factor in the increased risk of accidents and falls, especially in older adults.

Anxiety and Rebound Phenomena

While lorazepam is effective in reducing anxiety, its withdrawal can lead to rebound anxiety and insomnia. Studies have shown that after discontinuation, patients often experience increased anxiety and tension, along with a marked worsening of sleep quality, termed rebound insomnia Scharf1982Kales1986. These rebound effects can be more severe than the initial symptoms being treated.

Gastrointestinal Issues

Nausea is another common side effect associated with lorazepam use. This can be particularly problematic when lorazepam is used in combination with other medications, such as in the management of chemotherapy-induced nausea and vomiting Cohn1984Malik1995.

Other Side Effects

Additional side effects include lightheadedness, restlessness, and ataxia (lack of muscle coordination) Cohn1984Ancill1987. In some cases, patients have also reported experiencing depression and transient enuresis (involuntary urination) while sedated Ancill1987Kris1987.

Conclusion

Lorazepam is a potent benzodiazepine with a range of side effects that can impact cognitive, psychomotor, and gastrointestinal functions. While effective for its intended uses, the potential for sedation, memory impairment, and rebound anxiety necessitates careful monitoring and consideration, especially in vulnerable populations such as the elderly.

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Most relevant research papers on this topic

Double-blind crossover comparison of triazolam and lorazepam in the posthypnotic state.

Lorazepam has a higher incidence of common side effects, such as drowsiness, lightheadedness, restlessness, impaired coordination, dizziness, and nausea, compared to triazolam or placebo.

RCT

1984·

4citations

·J. Cohn

The Journal of clinical psychiatry

Lorazepam in the elderly—a retrospective study of the side-effects in 20 patients

Lorazepam is insufficiently data-recommended for elderly patients due to common side-effects and insufficient follow-up, and care should be exercised when prescribing in older patients.

1987·

9citations

·R. Ancill et al.

Journal of Psychopharmacology·

DOI

Lorazepam and driving impairment.

Lorazepam can significantly impair driving and psychomotor abilities, regardless of the concentration detected in the blood.

Observational Study

2004·

23citations

·Jayne E Clarkson et al.

Journal of analytical toxicology·

DOI

Clinical Efficacy of Lorazepam in Prophylaxis of Anticipatory, Acute, and Delayed Nausea and Vomiting Induced by High Doses of Cisplatin: A Prospective Randomized Trial

Lorazepam effectively increases the efficacy of metoclopramide in managing cisplatin-induced nausea and vomiting, offering a potential four-drug regimen for comparative trials against serotonin antagonists.

RCTHighly Cited

1995·

85citations

·I. Malik et al.

American Journal of Clinical Oncology·

DOI

Lorazepam—Efficacy, side effects, and rebound phenomena

4 mg lorazepam effectively induces and maintains sleep, but this dose induces significant side effects and rebound phenomena after withdrawal.

RCT

1982·

46citations

·M. Scharf et al.

Clinical Pharmacology & Therapeutics·

DOI

Antiemetic control and prevention of side effects of anti‐cancer therapy with lorazepam or diphenhydramine when used in combination with metoclopramide plus dexamethasone. A double‐blind, randomized trial

Lorazepam or diphenhydramine combined with metoclopramide and dexamethasone effectively prevents cisplatin-induced emesis and reduces treatment-related side effects, with less restlessness and anxiety observed in lorazepam-containing combinations.

RCTHighly Cited

1987·

141citations

·M. Kris et al.

Cancer·

DOI

Subjective and behavioral effects of diphenhydramine, lorazepam and methocarbamol: evaluation of abuse liability.

Diphenhydramine has fewer positive mood effects and more adverse effects than lorazepam and methocarbamol, with low abuse liability.

RCT

1992·

46citations

·K. Preston et al.

The Journal of pharmacology and experimental therapeutics·

DOI

Lorazepam: effects on sleep and withdrawal phenomena.

Lorazepam is moderately effective in inducing and maintaining sleep, but its withdrawal can cause rebound insomnia and increased tension and anxiety, with withdrawal symptoms being more severe than sleep improvement.

Non-RCT

1986·

26citations

·A. Kales et al.

Pharmacology·

DOI

Adverse performance effects of acute lorazepam administration in elderly long-term users: pharmacokinetic and clinical predictors

Acute lorazepam administration in elderly long-term users leads to reduced recall and psychomotor slowing, highlighting the importance of cognitive toxicity in benzodiazepine use.

RCT

2014·

27citations

·N. Pomara et al.

Progress in neuro-psychopharmacology & biological psychiatry·

DOI

A double-blind trial of haloperidol, chlorpromazine, and lorazepam in the treatment of delirium in hospitalized AIDS patients.

Low-dose neuroleptics (haloperidol or chlorpromazine) effectively treat delirium symptoms in medically hospitalized AIDS patients, while lorazepam alone is ineffective and associated with treatment-limiting adverse effects.

RCTHighly Cited

1996·

578citations

·W. Breitbart et al.

The American journal of psychiatry·

DOI

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