Lorazepam

Anxiolytics, benzodiazepine derivatives

ATC code: N05BA06

Brand names: Ativan, Temesta, Lorenin, Orfidal

Updated 24 Sep 2026 · Methodology

Indications

Generalized anxiety disorder

Second line

Lorazepam is second-line therapy for GAD, used short-term (2–4 weeks) for severe anxiety or panic attacks. Meta-analyses (Mitte 2005, Reinhold 2015) show efficacy comparable to other benzodiazepines. Lorazepam's advantage is absence of active metabolites and glucuronidation metabolism (not CYP) – convenient in older adults, hepatic impairment, and polypharmacy (no significant CYP interactions). CG113 and GAD guidelines list SSRIs/SNRIs and CBT as first-line; benzodiazepines short-term only. Dose 1–6 mg/day in 2–3 doses. In older adults, start at 0.5–1 mg/day.

Sources

AEMPS: Ficha técnica de Lorazepam (2024)

ICD-10: F41.1 · ICD-11: 6B00

Panic disorder

Second line

In panic disorder, lorazepam is used short-term for acute panic attack control. The Andrisano 2013 meta-analysis showed benzodiazepine efficacy in the acute phase. 2009 panic disorder guidelines list SSRIs/SNRIs and CBT as first-line; benzodiazepines are an option for inadequate response or short-term bridging at antidepressant initiation. Acute panic attack dose: 0.5–1 mg sublingually or orally.

Sources

AEMPS: Ficha técnica de Lorazepam (2024)

ICD-10: F41.0 · ICD-11: 6B01

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

Insomnia and sleep disorders

Not recommended

For insomnia, lorazepam is used off-label at 0.5–2 mg at bedtime. and ESRS guidelines list CBT-I as first-line for chronic insomnia; pharmacotherapy is second-line. Benzodiazepines (including lorazepam) are not first-line for insomnia due to tolerance, dependence, and risks in older adults. Z-drugs, sedating antidepressants (trazodone, mirtazapine), or melatonin are preferred.

Sources

ICD-10: G47.0 · ICD-11: 7A00

How to read tiers A–F

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit

Mechanism of action

Lorazepam is a medium-acting benzodiazepine. It potentiates GABA action at GABA-A receptors, increasing chloride channel opening frequency. Effects include anxiolytic, sedative, anticonvulsant, muscle-relaxant, and amnestic activity. Half-life 10–20 hours. Metabolized by direct glucuronidation without active metabolites or CYP involvement – important advantage in older adults, hepatic impairment, and polypharmacy. Frequently prescribed in Spain, UK, and US for anxiety and emergency conditions.

Safety

Contraindications

Myasthenia gravis
Acute alcohol, opioid, or barbiturate intoxication
Severe respiratory failure
Sleep apnea syndrome
Severe hepatic impairment
Narrow-angle glaucoma
Pregnancy and breastfeeding
Age under 18 (except emergency indications)

Serious adverse effects

Respiratory depression (especially with opioids)
Psychological and physical dependence
Withdrawal syndrome: anxiety, insomnia, tremor, in severe cases seizures and psychosis
Falls and fractures in older adults
Paradoxical reactions (agitation, aggression)

Common adverse effects

Drowsiness, sedation
Ataxia, impaired coordination
Dizziness
Anterograde amnesia
Cognitive impairment (especially in older adults)

Pregnancy: can you take Lorazepam?

AEMPS summary of product characteristics (section 4.6): lorazepam should not be used during pregnancy. If a patient plans a pregnancy or becomes pregnant during treatment, it is withdrawn. Benzodiazepines may increase the risk of congenital malformations after first-trimester exposure and cross the placenta. Use late in pregnancy or at high doses during labour can cause hypoactivity, hypothermia, hypotonia, apnoea, respiratory depression and feeding problems in the newborn; chronic use during pregnancy can lead to physical dependence and withdrawal in the baby after birth.

Breastfeeding: can you take Lorazepam?

Hale L3 · Probably compatible, limited data

Contraindicated: drug is excreted in breast milk.

RID, infant dose via milk: 2.6%
Maternal half-life: 12.0 h
Maternal peak time: 2 h
Peak milk concentration: 0.01 mg/L
Milk-to-plasma ratio: 0.22

Calculate RID Safe feeding window Full profile on NIH LactMed ↗

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

Practical notes

Russian practice note

In Russia, lorazepam is listed as a controlled psychotropic substance (Schedule III). Strict prescription on form 148–1/u-88. Cost of 30 tablets of 2.5 mg is 500–1000 ₽. In Spain, it is among the most popular benzodiazepines under the Orfidal brand (Pfizer). In older adults and hepatic impairment, lorazepam is preferred over diazepam and chlordiazepoxide due to absence of active metabolites and phase 2 metabolism (glucuronidation). Course should not exceed 4–12 weeks due to tolerance and dependence. Gradual taper: 25% dose reduction every 1–2 weeks.

Drug interactions

Additive CNS depression with alcohol, opioids, barbiturates, antipsychotics, first-generation antihistamines. black box warning on severe respiratory depression with opioid combination. Lorazepam's advantage is absence of CYP metabolism: no significant interactions with CYP inhibitors and inducers (unlike alprazolam, midazolam, diazepam).

Label mentions19 mentions

Verbatim lines from the interaction sections, in the language of the label

From this drug’s label

Majoropioidesclass named in the label
«Debido a estos riesgos, la prescripción conjunta de medicamentos sedantes, benzodiazepinas o medicamentos relacionados, como lorazepam con opioides, debe reservarse para aquellos pacientes para…»
AEMPS, section 4.4 · Open on CIMA
ModerateTheophylline
«Se deberá tener en cuenta que en la administración conjunta de benzodiazepinas incluida lorazepam y teofilina o aminofilina, se puede producir una disminución de los efectos sedantes de las…»
AEMPS, section 4.5 · Open on CIMA
antiepilépticosclass named in the label
«Se puede producir una potenciación del efecto depresor sobre el SNC, incluyendo depresión respiratoria coma y muerte, al administrar concomitantemente medicamentos sedantes como benzodiazepinas o…»
AEMPS, section 4.5 · Open on CIMA
antihistamínicosclass named in the label
«Se puede producir una potenciación del efecto depresor sobre el SNC, incluyendo depresión respiratoria coma y muerte, al administrar concomitantemente medicamentos sedantes como benzodiazepinas o…»
AEMPS, section 4.5 · Open on CIMA
antipsicóticosclass named in the label
«Se puede producir una potenciación del efecto depresor sobre el SNC, incluyendo depresión respiratoria coma y muerte, al administrar concomitantemente medicamentos sedantes como benzodiazepinas o…»
AEMPS, section 4.5 · Open on CIMA
barbitúricosclass named in the label
«Se puede producir una potenciación del efecto depresor sobre el SNC, incluyendo depresión respiratoria coma y muerte, al administrar concomitantemente medicamentos sedantes como benzodiazepinas o…»
AEMPS, section 4.5 · Open on CIMA
Clozapine
«El uso concomitante de lorazepam y clozapina puede producir un marcado estado de sedación, salivación excesiva y ataxia.»
AEMPS, section 4.5 · Open on CIMA

From other drugs’ labels

ModerateAripiprazole
«Drugs Having Clinically Important Interactions with Aripiprazole: Benzodiazepines (e.g., lorazepam) The intensity of sedation was greater with the combination of oral aripiprazole and lorazepam as…»
FDA, section 7 · Open on DailyMed
Bilastine
«Interacción con lorazepam : La administración concomitante de bilastina 20 mg y lorazepam 3 mg durante 8 días no potenció los efectos depresores del SNC causados por lorazepam.»
AEMPS, section 4.5 · Open on CIMA
Clarithromycin
«DRUG INTERACTIONS: Temazepam Nitrazepam Lorazepam No Dose Adjustment Temazepam, Nitrazepam, Lorazepam: For benzodiazepines which are not metabolized by CYP3A (e.g., temazepam, nitrazepam, lorazepam)…»
FDA, section 7 · Open on DailyMed
Duloxetine
«Lorazepam: Under steady-state conditions for duloxetine (60 mg Q 12 hours) and lorazepam (2 mg Q 12 hours), the pharmacokinetics of duloxetine were not affected by co-administration.»
FDA, section 7 · Open on DailyMed
Efavirenz
«Drugs Without Clinically Significant Interactions with Efavirenz: No dosage adjustment is recommended when efavirenz is given with the following: aluminum/magnesium hydroxide antacids, azithromycin…»
FDA, section 7 · Open on DailyMed
Granisetron
«En estudios en sujetos sanos, no se ha indicado evidencia de interacción alguna entre granisetrón y benzodiazepinas (lorazepam), neurolépticos (haloperidol) o medicamentos antiulcerosos (cimetidina)…»
AEMPS, section 4.5 · Open on CIMA
Lamotrigine
«Interacciones de lamotrigina con agentes psicoactivos: Los estudios in vitro indican que la formación del principal metabolito de lamotrigina, el 2-N-glucurónido, se vio mínimamente inhibida por la…»
AEMPS, section 4.5 · Open on CIMA
Pregabalin
«Estudios in vivo y análisis farmacocinético de la población: En consecuencia, en los estudios in vivo , no se observaron interacciones farmacocinéticas relevantes desde el punto de vista clínico…»
AEMPS, section 4.5 · Open on CIMA
Pregabalin
«DRUG INTERACTIONS: Multiple oral doses of pregabalin were co-administered with oxycodone, lorazepam, or ethanol. Although no pharmacokinetic interactions were seen, additive effects on cognitive and…»
FDA, section 7 · Open on DailyMed
Theophylline
«Drug Interactions:: Lorazepam Similar to diazepam. Similar to diazepam.»
FDA, section 7 · Open on DailyMed
Valproic acid
«Effects of Valproate on Other Drugs: Lorazepam Concomitant administration of valproate (500 mg BID) and lorazepam (1 mg BID) in normal male volunteers (n = 9) was accompanied by a 17% decrease in the…»
FDA, section 7 · Open on DailyMed
Ziprasidone
«Other Concomitant Drug Therapy: Population pharmacokinetic analysis of schizophrenic patients enrolled in controlled clinical trials has not revealed evidence of any clinically significant…»
FDA, section 7 · Open on DailyMed

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Frequently asked

What is Lorazepam used for?

Lorazepam is evaluated for the following indications with varying evidence strength: Panic disorder (evidence tier B), Generalized anxiety disorder (evidence tier B), Insomnia and sleep disorders (evidence tier C). See the full indication matrix with dosing and citations above on this page.

What are the side effects of Lorazepam?

Common side effects of Lorazepam (≥ 1 in 100): Drowsiness, sedation, Ataxia, impaired coordination, Dizziness, Anterograde amnesia, Cognitive impairment (especially in older adults). See the Safety section for uncommon and serious reactions.

Is Lorazepam safe during pregnancy?

Is Lorazepam compatible with breastfeeding?

Contraindicated: drug is excreted in breast milk.

Can you drink alcohol while taking Lorazepam?

Additive CNS depression with alcohol, opioids, barbiturates, antipsychotics, first-generation antihistamines.

Who should not take Lorazepam?

Lorazepam is contraindicated in: Myasthenia gravis; Acute alcohol, opioid, or barbiturate intoxication; Severe respiratory failure; Sleep apnea syndrome; Severe hepatic impairment. Full list in the Safety section.

Official sources

Direct links to regulator labels. Open in a new tab.

AEMPS / CIMALabel dated 02/12/2007
FDA / DailyMedLabel dated 07/10/2026

Other drugs in this group

Lormetazepam, Melatonin, Olanzapine, Paliperidone, Phenazepam, Selank (Thr-Lys-Pro-Arg-Pro-Gly-Pro), Aripiprazole, Diazepam