Talk:Lorazepam

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Contents

[edit] Areas of Lorazepam article needing work:

Pharmacology: Basic mode of benzodiazepine action at receptor level, possibly with a diagram (may easily confuse rather than impart meaningful information).

Side effects: Question whether to paste in a complete list, as below, or just to leave readers to refer to official data sheets.

Dosages: may be wise to defer questions like this to official data sheets, but is there a bare minimum of representative examples?

Interactions: there is just the ethanol interaction at the moment.

Lay readers: I discussed article with a layperson, who found it overwhelming. It is a pharmacology article, but anything that conveys the same information in clearer English... --Petlif 21:54, 22 August 2007 (UTC)

A diagram of the GABAa receptor (being a six subunit ion channel in the plasma membrane) might muddle things for the reader - if they are unfamiliar with that particular class of receptor. Regardless, there needs to be more information regarding the affinity of Lorazepam for the receptor, where it binds, what subunits it possesses, stuff like that. The interactions section needs to be expanded to include barbituates and other drugs/chemicals which modulate the affinity of GABA. Wisdom89 23:34, 22 August 2007 (UTC)

[edit] Lorazepam in Popular Culture - Nuke it???

Anyone keen on deleting this section? It would NOT be found in a manufacturer's lorazepam data sheet, so perhaps "lowers the tone" of a pharmaceutical article. On the other hand a lot of work has gone into that section (by others than myself), something that would only have developed on Wikipedia, creating something unique. It does provide a certain non-scientific angle on the drug, in a proper context of "popular culture". I'm personally getting quite attached the idea of keeping this section, but then again am I being soft? Petlif 04:04, 9 August 2007 (UTC)

Perhaps I shouldn't have been so hasty in my actions - not usually my way, but, from my perspective the section is a glaring stigma for the article. I don't need to spout the typical argument about how trivia and popular culture sections (especially in the form of lists) are generally looked down upon, but for an article such as this I feel that it is totally unnecessary and unencyclopedic. Consensus, of course, should be reached before expunging it completely as I'm sure many editors will disagree. Wisdom89 13:56, 9 August 2007 (UTC)
I can only agree that, in current form, it "drags down" the otherwise scientific article tone (but with qualifier of it nevertheless providing that interesting non-scientific angle, something I have noted with interest to be growing while I've tinkered with the rest of the article over the last 6 months). I wonder if a better heading might help (no great suggestions forthcoming from my brain, maybe during the day some will pop up). The section could benefit from some purely editorial work, e.g. merging some of the list contributions in this section into something more prosaic? (for example, the two Movie instances where Ativan is the first line drug used for seizures. Other pop culture references have it in common that they deal with lorazepam's lifestyle drug aspects. Petlif 21:12, 10 August 2007 (UTC)
It's currently listy so writing it in a cohesive paragraph would be a great first step; the alternative view is that WP isn't a pharmacy journal either so lay- interest and pop culture comes in. I would keep it. I can try to write in a para. cheers, Casliber (talk · contribs) 21:18, 10 August 2007 (UTC)
OK there's a start. As soon as I or someone else finds out hwat the others are about they can be inserted too...cheers, Casliber (talk · contribs) 21:30, 10 August 2007 (UTC)

[edit] Interactions

Anyone going to kick off in the section on Lorazepam drug interactions?

It's a gaping hole in the article but quite important, cf. strong interaction with alcohol, etc.

[edit] Side Effects

not listed in the usual medication style, how come? they HAVE to be different than clonazepam and diazepam. please start a section for side effects and list the ones for lorazepam, here are the ones listed on Rxlist.com:

In a sample of about 3500 patients treated for anxiety, the most frequent adverse reaction to Ativan (lorazepam) was:

sedation (15.9%), dizziness (6.9%), weakness (4.2%), unsteadiness (3.4%). the incidence of sedation and unsteadiness increased with age.

Other adverse reactions are: fatigue, drowsiness, amnesia, memory impairment, confusion, disorientation, depression, unmasking of depression, disinhibition, euphoria, suicidal ideation/attempt, ataxia, asthenia, extrapyramidal symptoms, convulsions/seizures tremor, vertigo, eye-function/visual disturbance (including diplopia and blurred vision), dysarthria/slurred speech, change in libido, impotence, decreased orgasm; headache, coma; respiratory depression, apnea, worsening of sleep apnea, worsening of obstructive pulmonary disease; gastrointestinal symptoms including nausea, change in appetite, constipation, jaundice, increase in bilirubin, increase in liver transaminases, increase in alkaline phosphatase; hypersensitivity reactions, anaphylactic/oid reactions; dermatological symptoms, allergic skin reactions, alopecia; SIADH, hyponatremia; thrombocytopenia, agranulocytosis, pancytopenia; hypothermia; and autonomic manifestations. Paradoxical reactions, including anxiety, excitation, agitation, hostility, aggression, rage, sleep disturbances/insomnia, sexual arousal, and hallucinations may occur. Small decreases in blood pressure and hypotension may occur but are usually not clinically significant, probably being related to the relief of anxiety produced by Ativan (lorazepam).

I dont know why for GI symptoms they list nausea, as Lorazepam is commonly used as an antiemetic or an adjunct medication to stronger antiemetics like Compazine, Marinol or Zofran.

Lorazepam may cause nausea, but not in every patient - the larger study group, the more side-effects you will pick up. In reported-side-effects' lists such as the above, it is convention to have the commonest side effects listed first. Nausea, although a possibility, is way down the list above. People and their bodies are simply just different. In answer to why the list in the lorazepam article is different, it is about reading style. Wikipedia articles are not meant to replace manufacturers' official data sheets (turgid and unreadable as they are) and instead there are several links to such publications. I'll go and have a look at rxlist.com and see if I can find the reference to the large patient sample and add something to the lorazepam article. The longer side effect profiles often pertain to benzos in general - e.g. in the British National Formulary, readers are directed to the full side-effects list for Diazepam. This of course is not ideal, since the drugs have different profiles Petlif 02:13, 25 June 2007 (UTC)

That's it. Section on side-effects added.Petlif 06:59, 3 July 2007 (UTC)

[edit] English - Help

Could a native english speaker who is good at writing please go through this article and improve the english so it flows better? Thanks. Petlif 06:01, 5 June 2007 (UTC)

Observation: Having reference numbers in superscript influences line spacing. This makes the article look very untidy, particularly if you print it out.Petlif 20:44, 29 May 2007 (UTC)

Can we possibly get some information on the recreational use of lorazepam? DryGrain 23:10, 6 Apr 2004 (UTC)

It is considered recreational. Check out www.erowid.org or www.bluelight.ru for a nice collection of users and stories. Debollweevil

[edit] Invalid word?

What is "cognital" deficits? As far as I can tell, cognital is not a real word. The author may have meant "cognitive" but I don't want to change it without being sure. Shadowin 19:43, 12 Oct 2005 (EST)

My mistake, I meant of course cognitive. Thanks for your feedback. I'll correct it right now. User:KlausFr, 12:21 (MEST), 16.10.2005

28 April 2006: This article is a good start. Question: can we also get a time frame of how long an indvidual would need to use Lorazepam? and typically what amounts and length of use puts one in the danger zone for addiction? thanks in advance.


[edit] Precise dosages -- how much is "higher"?

--Jamesrsheehan 19:50, 12 July 2006 (UTC)

"The action of lorazepam together with alcohol can be dangerous in higher amounts. . . ."  This statement is muddled on two counts:  1.  Higher amounts of alcohol, higher amounts of lorazepam, or higher amounts of both?  2.  Higher than what?  What is the reference point for higher?  If it's alcohol, then it would seem appropriate to reference a blood alcohol content level; otherwise, this information may be less than precise.  If it's lorazepam, apparently the "higher" dosage referred to is the upper extreme of 2.5mg/every 6 hours.  If that's the case, then isn't that what should be stated?

I'm not sure lorazepam is in demand as a recreational drug. "Fighting" its sedative tendencies doesn't result in any noted euphoria or other recreational side effects, as is the reported case with Ambien. Of course, there are always a few zanies out there. . . .

I have tried both lorazepam and clonazepam recreationally in totally absurd doses. I had the assumption that it would cause "total relaxation" which appealed to me at the time. The result was actually quite the contrary. After dosing on say 15 tablets I felt completely "normal", which in retrorespect was not the case. It completely zapped my natural feeling of fear (a very useful emotion b.t.w.) which made me do some extremely stupid and dangerous things.

[edit] Therapeutic Use

Sources: "Lack of Relationship Between Long-Term Use of Benzodiazepines and Escalation to High Dosages" Soumerai SB et al., Psychiatr Serv 54:1006-1011, July 2003 (http://ps.psychiatryonline.org/cgi/content/full/54/7/1006)

"Benzodiazepines: Stable Long-Term Use"

Journal Watch Women's Health, September 23, 2003; 2003(923): 10 - 10.

(http://psychiatry.jwatch.org/cgi/content/citation/2003/1120/11) (This reference requiers subscription to online journal)

I remember seeing an article abstract on www.biopsychiatry.com (not primary, and I consider somewhat quetionable considering it's content associations with various other sites) which indicated that there appears to be a subpopulation which does not show the usual amnesiac and hypersomina responses to benzodiazepines, as well as do not show an escalation in use, or a definable "high" upon useage. I cannot find the article again. It was hypothesized in this article that in this subpopulation of patioents, bezodiazepines are safe for long-term use, and pose no risk of abuse. However, the above sources appear to support the same conclusion.

I personally hypothesize this could be due to a genetic imbalance betwee different GABA receptor types and/or subtypes, leading to the effect of benzodiazepine medications to be to correct an imbalance without creating a further imbalance leading to the classic side-effects and dose escalation behavior. I have not been able to find (nor have I looked) any primary studies supporting this conclusion though. Such primary sources may exist.

(Jim Witte)

[edit] "Chill"?

It's a very minor point, but I wonder if the term "chill" in the article should be replaced with slightly more formal language. ERobson 03:54, 10 January 2007 (UTC)

[edit] Addiction

This article seems to be lacking in a section on the well-documented dangers of lorazepam addiction.

[edit] Diuretic?

Does lorazepam act as a diuretic (i.e., make you pee)? Myself I find that I pee a lot more than normal when I take it. A friend of mine also said the same thing about her and lorazepam. I usually only take lorazepam (2 mg) when I get really anxious (and thus am sweating). I suspect that it may be just that I perspire less due to the anxiolytic effect of lorazepam, and thus eliminate more water renally, not lorazepam acting as a diuretic per se. Please comment. --Seven of Nine (talk) 23:22, 19 March 2008 (UTC)

Hi, maybe lorazepam just makes you relax more and therefore more able to empty your bladder? e.g. ever found it hard to pee when using a public toilet urinal and you suddenly become aware someone is looking funny at you? Petlif (talk) 23:09, 13 June 2008 (UTC)

[edit] Generic or proprietary?

As with many Wikipedia pharmacology articles, this one uses the generic and proprietary names of the drug interchangeably. I feel that one or the other should be used consistently, and as this article is titled Lorazepam, the generic name is preferable. That said, I appreciate that I come from a part of the world where drugs are normally referred to by their generic names even in popular culture, whereas the opposite is the case in the USA. Lorazepam has been out of patent for about a century though (well, 25 years or so). --80.176.142.11 (talk) 20:29, 20 March 2008 (UTC)

Ativan and Temesta get their mentions at the beginning and the end of this article, so feel free to genericize other references. Petlif (talk) 23:11, 13 June 2008 (UTC)