Med of the Month: Lorazepam

Lorazepam has quietly stepped into the pop-culture spotlight. After appearing in the latest season of The White Lotus, Google searches for lorazepam surged. A reminder that medications we think of as routine can suddenly become very visible, very fast, and very relevant to patients.

Now layer in the holidays. End-of-year stress, travel anxiety, disrupted sleep, and family dynamics all tend to push benzodiazepines like lorazepam back into the conversation. For dental providers, that matters. This is a medication many patients are already taking, sometimes more frequently this time of year, and sometimes without fully understanding the risks.

With that in mind, we thought this was the right moment to spotlight lorazepam. Below, we break down key prescribing precautions to keep in mind, along with practical, dental-specific tidbits that can help you anticipate interactions, recognize red flags, and have better chairside conversations with your patients during one of the busiest and most stressful times of the year.

Generic Name: Lorazepam

Brand Name(s): Ativan, Loreev XR, Lorazepam Intensol

Pronunciation: lor A ze pam

About this drug:

• Lorazepam is a benzodiazepine used to treat anxiety disorders.

• It can also be used for short-term symptoms of anxiety caused by depression.

Dentistry-related tidbits:

• The Beers Criteria recommend avoiding benzodiazepines, including lorazepam, in elderly patients aged 65 years and older.

• Lorazepam may worsen sleep apnea.

• Lorazepam has been associated with thrombocytopenia.

• Lidocaine, including topical formulations such as Xylocaine, when used in combination with lorazepam, may decrease seizure threshold and alter seizure control, particularly in patients with epilepsy.

• If prescribing lorazepam, keep in mind that:

  • Lorazepam can be habit-forming. It should be prescribed at the lowest effective dose and for the shortest duration possible.

  • Prior to discharge, ensure the patient is able to ambulate and respond appropriately to verbal questions.

  • Avoid prescribing lorazepam in combination with narcotics, muscle relaxants, fluconazole, anticonvulsants such as gabapentin, pregabalin, or carbamazepine, or other sedating medications including over-the-counter products, due to the increased risk of CNS and respiratory depression and potential fatal outcomes.

  • Patients should be advised that combining lorazepam with alcohol, antihistamines, or other sedating medications, including over-the-counter products, may increase the risk of severe CNS and respiratory depression and impair psychomotor function.

• The most common side effects of lorazepam are dose-related and include drowsiness, lethargy, ataxia, dysarthria, and dizziness.

• Lorazepam, like all oral benzodiazepines, carries a boxed warning highlighting the risks of severe sedation and potentially fatal respiratory depression when combined with opioids, the risk of abuse, misuse, and addiction with prolonged use, and the risk of dependence and severe, potentially life-threatening withdrawal if abruptly discontinued.

• Staying safe: It’s important to use a tool like the MedAssent DDS Rx Check to practice safe prescribing. It includes sample dentistry-specific dosing guidance for over 90+ common drugs, including lorazepam.

Fun facts:

• Lorazepam takes a simpler path through the liver. It’s metabolized by direct glucuronidation rather than the cytochrome P450 system, and its glucuronide metabolite is inactive. Because of this, it tends to have more predictable effects and can be used in patients with liver dysfunction with minimal changes in how the drug behaves.

• Not all benzodiazepines are created equal. Compared to alprazolam (Xanax), lorazepam has a slower onset but a longer duration of action, lasting around 8 hours versus Xanax’s 4 to 6 hours. Xanax may feel stronger sooner, but its effects also wear off more quickly, while lorazepam tends to linger.

Get more dental-specific drug information with the Digital Drug Handbook (web) or BrushUp Rx (mobile app).