Doctors use lorazepam partly because it stops you remembering the procedure
Most drugs list memory loss as a drawback. With lorazepam, sold as Ativan, it is sometimes the point: given before endoscopies or dental work, it calms patients and blocks memories of the procedure from forming. The same benzodiazepine is a first-line emergency treatment for prolonged seizures.
Lorazepam slows activity in the central nervous system, easing anxiety and inducing sleep. Patented in 1963 and sold in the United States from 1977, it is now a generic on the World Health Organization's list of essential medicines, and in 2023 it was the 100th most prescribed drug in America, with over 6 million prescriptions. It can be swallowed, injected into a vein or muscle, or applied to the skin; injected, it acts within one to thirty minutes and can last up to a day.
Its uses are broad but short-term: severe anxiety and panic, insomnia tied to anxiety, alcohol withdrawal, agitation, catatonia and nausea linked to chemotherapy. Intravenous lorazepam outperforms diazepam and phenytoin at halting status epilepticus, with less chance of seizures continuing. Because the liver does not need to oxidise it, it is regarded as the best-tolerated benzodiazepine in advanced liver disease. For patients on ventilators, though, propofol has proved more effective and cheaper, so lorazepam is now discouraged there.
Among benzodiazepines it hits memory especially hard, impairing both explicit and implicit recall, though regular users soon become tolerant to the amnesia. In one sleep study, three of five people given 4 mg at night later reported gaps in the following day. Sedation is the most reported side effect, and in about 3,500 people treated for anxiety it affected 15.9 percent. Some people react paradoxically with hostility or agitation, more often than with related drugs.
Dependence develops readily, and rebound anxiety or insomnia can appear after only seven days. The FDA advises against benzodiazepine use beyond four weeks, and in September 2020 it required stronger boxed warnings across the class about misuse, addiction and withdrawal. Older adults face greater risks, including falls and hip fractures, and injected solutions contain propylene glycol, which can build up to toxic levels during prolonged high-dose infusion.
Source: Lorazepam
