Lora Tablet, Injection, Oral Suspension

Lora is a short-acting tranquilizer of the benzodiazepine group. It is an agonist at benzodiazepine receptors in the CNS. It exerts a depressant action on the CNS, which may be mediated by potentiating the inhibitory actions of GABA (gamma amino butyric acid) in the CNS. This will result in diminution of the ascending activating systems, particularly the serotonergic and noradrenergic pathway from brain stem or the mid-brain to the cerebral cortex.

Uses

Lora is used for the treatment of anxiety states; including anxiety associated with phobic & obsessional states, psychosomatic, organic or psychotic illness, insomnia associated with anxiety, nervousness, restlessness, nausea and vomiting related to chemotherapy and anticonvulsants, and as a premedicant before dental or general surgery or prior to investigative procedures where there may be discomfort. Lora is not recommended in anxiety states in children but may be used as premedicant before surgery at a dose of 0.05 mg/Kg in children aged 5 to 13 years. The dosage of Lora tablet should be increased gradually when needed to avoid adverse effects. When higher dosage is used, the evening dose should be increased before the daytime.

Lora is also used to associated treatment for these conditions: Agitation, Alcohol Withdrawal Delirium, Alcohol Withdrawal Syndrome, Anxiety, Anxiety Disorders, Catatonia, Chemotherapy-Induced Nausea and Vomiting (CINV), Delirium, Insomnia, Muscle Spasms, Panic Disorder, Refractory seizure disorders, Preanesthetic medication therapy

Trade Name Lora
Generic Lorazepam
Other Names Loracepam, Lorazepam, o-Chlorooxazepam, o-Chloroxazepam
Weight 10mg, 5mg/5ml, 2mg,
Type Tablet, Injection, Oral Suspension
Formula C15H10Cl2N2O2
Weight Average: 321.158
Monoisotopic: 320.011932988
Protein binding

Reports indicate that 85% of lorazepam administered dose is protein bound.

Therapeutic Class Benzodiazepine hypnotics, Benzodiazepine sedatives
Manufacturer Abs Remedies, Yaher Pharma, Orchid Pharma, Opsonin Pharma Ltd
Available Country India, Bangladesh,
Last Updated: June 23, 2021 at 9:00 am

Dosage

Lora dosage

Oral-

Frequency of administration and duration of therapy should be individualized according to patient's response. The usual range is 2 to 6 mg/day given in divided doses, the largest dose being taken before bedtime, but the largest dosage may vary from 1 to 10 mg/day. For anxiety, most patients require an initial dose of 2 to 3 mg/day given b.i.d. or t.i.d. For elderly or debilitated patients, an initial dosage of 1 to 2 mg/day in divided doses is recommended, to be adjusted as needed and tolerated. For insomnia 1 to 2 mg before bedtime and as premedicant 1 to 2 mg the night before surgery and 1 to 2 hour before surgery.

Injection-

Acute anxiety:

  • Adult: IV/IM: 25-30 mcg/kg repeated 6 hrly if necessary. Give IV inj at a rate of not more than 2 mg/min into a large vein.
  • Child: <12 yr Not recommended.
  • Elderly: Half the usual adult dose or less.

Premedication in surgery:

  • Adult: 50 mcg/kg given pre-op over 30-45 min (IV) or 60-90 min (IM).
  • Child: <12 yr Not recommended.
  • Elderly: Half the usual adult dose or less.

Status epilepticus:

  • Adult: 4 mg as a single dose, into a large vein at a rate not more than 2 mg/min. May be repeated once after 10-15 min if seizures recur.
  • Child: 2 mg as single dose.
  • Elderly: Half the usual adult dose or less.

Injection: Dilute with an equal volume of compatible diluent (e.g. sterile water for inj, NaCl 0.9% inj, dextrose 5% inj). 

Oral concentrate solution: Dose should be added to 30 mL or more of diluent (e.g. water, juice, carbonated or soda-like beverage) or to semi-solid food (e.g. applesauce, pudding).

Side Effects

Adverse reactions are usually observed at the beginning of therapy and generally disappeared on continued medication or upon decreasing the dose. The most frequent adverse reactions of Lora are sedation followed by dizziness, weakness and unsteadiness. Less frequent adverse reactions are disorientation, depression, nausea, change in appetite, headache, sleep disturbance, agitation, dermatological symptoms, eye-function disturbance, together with various gastrointestinal symptoms and autonomic manifestations.

Precaution

In patients with depression accompanying anxiety, a possibility for suicide should be borne in mind. For elderly or debilitated patients, the initial daily dosage should not exceed 2 mg in order to avoid over sedation. The usual precautions for treating patients with impaired renal or hepatic function and with acute and chronic pulmonary insufficiency should be observed. Use of Lora for prolonged period and gastric patients requires caution and there should be frequent monitoring for symptoms of upper gastrointestinal disease. Machineries should be avoided during taking Lora.

Interaction

Lora may potentiate the central depressant effect when combined with other drugs with central depressant action. Such drugs include alcohol, general anesthetics, tricyclic antidepressants and monoamine oxidase inhibitors.

Food Interaction

  • Avoid alcohol.
  • Limit caffeine intake.
  • Take with food.

Volume of Distribution

The reported volume of distribution of lorazepam is 1.3 L/kg. It is important to mention that due to the lipophilicity of lorazepam, it does not redistribute as fast in the brain.

Half Life

When administered parentally, the registered half-life of lorazepam is of 14 hours.

Clearance

In vivo studies with lorazepam have shown a clearance rate of 5.8 ml.min/kg.

Pregnancy & Breastfeeding use

Safety of Lora in pregnancy has not been established. Because the use of this drug is rarely a matter of urgency, the use of Lora during this period should almost always be avoided.

It is not known whether oral Lora is excreted in human milk like other benzodiazepine tranquilizers. As a general rule, nursing should not be undertaken while a patient is on a drug since many drugs are excreted in human milk.

Contraindication

Lora should not be given to patients with a previous sensitivity to benzodiazepines or with acute narrow-angle glaucoma and myasthenia gravis.

Special Warning

Debilitated patient: Half the usual adult dose or less.

Renal Impairment: May require reduced doses.

Mild to Moderate Hepatic Impairment: May require reduced doses.

Severe Hepatic Impairment: Contraindicated.

Acute Overdose

Overdosage of Lora is usually manifested by varying degrees of central nervous system depression ranging from drowsiness to coma. In mild cases, symptoms include drowsiness, mental confusion and lethargy. In more serious cases and especially when other drugs or alcohol were ingested, symptoms may include ataxia, hypotonia, hypotension, hypnotic states (stages I to III), coma.

Storage Condition

Tablet: Store between 20-25°C. 

Injection or oral concentrate solution: Store between 2-8°C. Do not freeze. Protect from light.

Lora contains Lorazepam see full prescribing information from innovator Monograph