Lorazepam: uses, side effects and dependence risks

Lorazepam belongs to the benzodiazepine group and increases a calming brain chemical called GABA. The NHS lists treatment of anxiety disorders, sleep problems linked to anxiety, and pre-medication before medical or dental procedures. The injectable form is given in hospital, for instance for seizures.

It can be used as a pre-med in people aged 5 and over.

It comes as tablets of 0.5 mg, 1 mg and 2.5 mg, and as a liquid at 1 mg per ml, measured with a plastic syringe or spoon. Take tablets with water, with or without food.

The NHS gives usual adult ranges: 1 to 4 mg daily for anxiety and 1 to 2 mg before bed for sleep problems. Older people and those with liver or kidney problems get lower doses. Your own dose will be specified by your prescriber.

Missed dose: for anxiety, take it within 3 hours, otherwise skip; for sleep, skip if it is already past bedtime. Never double up.

If you take too much, call NHS 111. Warning signs include poor coordination, drowsiness, irregular heartbeat and muscle weakness.

The NHS says lorazepam is usually only recommended for up to 4 weeks. The addiction risk is low if you take a low dose for 2 to 4 weeks, higher if you have had alcohol or drug problems. If you have taken it for longer, stopping suddenly can cause confusion, seizures, depression, irritability, sweating and diarrhoea, so the dose must be tapered. Do not stop without talking to a doctor.

Daytime drowsiness is the most common effect.

• Common: daytime sleepiness or fatigue (which should improve within a week), muscle weakness, and coordination or movement problems.

• Call NHS 111 for yellowing of the eyes or skin, hallucinations or delusions, repeated falls, unusual mood changes such as being overexcited or aggressive, or memory loss.

• Call 999 for difficulty breathing or very slow breathing, or signs of anaphylaxis.

Tell the prescriber about liver or kidney problems, breathing or chest problems, myasthenia gravis, sleep apnoea, depression or self-harm thoughts, a personality disorder, alcohol or drug misuse, arteriosclerosis, balance problems, glaucoma, pregnancy or breastfeeding, or planned general anaesthetic.

Avoid alcohol: it carries serious breathing risks. Cannabis, heroin and methadone increase drowsiness dangerously. The NHS lists antidepressants, antipsychotics, anticonvulsants, hypnotics, sedating antihistamines (chlorphenamine, promethazine), strong painkillers, HIV medicines, rifampicin, fluconazole, isoniazid, omeprazole and esomeprazole, baclofen, tizanidine, disulfiram and theophylline. Do not take valerian or passionflower remedies with it.

It can be taken in pregnancy, but long-term use close to delivery may cause drowsiness and withdrawal in the newborn, and babies may need observation. Small amounts pass into breast milk; do not share a bed with your baby.

The NHS says SSRIs such as sertraline, paroxetine and escitalopram are often preferred for anxiety, and talking therapies such as CBT are recommended. Suspected side effects can be reported to the MHRA Yellow Card scheme.