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Anxiolytic / Sedative  ·  Benzodiazepine

Lorazepam

Also known as: Ativan, Loraz, Temesta

A short-acting controlled medicine used mainly in acute psychiatric and emergency settings, preferred over diazepam by injection because of more predictable absorption.

ATC CodeN05BA06
Kenya EML 2023Listed
Level of UseLevel 4-6
This is health education, not medical advice. Never start, stop, or change a medication without speaking to a qualified healthcare professional first.
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Controlled Medicine

Controlled substance. The injectable form is used exclusively in clinical settings by trained staff.

What it treats

Which conditions is Lorazepam used for?

Acute AgitationEpilepsy / Status EpilepticusSevere Anxiety (short-term)Alcohol Withdrawal

Overview

What is Lorazepam?

Lorazepam is a benzodiazepine medicine used mainly in hospitals and emergency settings for managing severe acute agitation, seizures, and severe anxiety.

Its key clinical advantage over diazepam when given by injection is that its absorption into the muscle is more reliable and predictable. Unlike diazepam, it is broken down without going through the liver's main processing pathway, making it safer in people with liver disease.

Like all benzodiazepines, lorazepam is intended for short-term use only.

How it works

What does it do in the brain?

Lorazepam works by enhancing the activity of GABA at GABA-A receptors, producing widespread nervous system calming. Its lack of active breakdown products means its effect is more predictable and it does not accumulate in the body over time.

Formulations in Kenya

How is it available?

Tablet
0.5 mg, 1 mg, 2.5 mg
Taken by mouth
Available at Level 4 to 6
Injection
4 mg/mL
Given by a healthcare professional
Available at hospital level

Availability across Africa

Where is it available in Africa and what is it called?

Names and availability vary by country. Always confirm with a local pharmacist or healthcare provider.
CountryCommon Brand Name(s)Notes
UgandaAtivan, Lorazepam (generic)Available at Butabika Hospital and larger referral hospitals; used for acute psychiatric emergencies.
South AfricaAtivan, Lorazepam (generic)Available in public and private sectors; preferred for acute agitation management in emergency settings.
NigeriaAtivan, Lorazepam (generic)Available at teaching hospitals and private pharmacies in Lagos, Abuja, and other major cities.
GhanaLorazepam (generic)Available at Korle-Bu Teaching Hospital and Accra Psychiatric Hospital.
TanzaniaLorazepam (generic)Available at Muhimbili National Hospital.
EthiopiaLorazepam (generic)Available at Black Lion Hospital and Amanuel Hospital in Addis Ababa.

Side effects

What might you feel while taking it?

These are the most commonly reported effects. Not everyone experiences them, and many settle within the first few weeks.

  • Sedation and drowsiness
  • Dizziness and unsteadiness
  • Memory impairment around the time the medicine is working
  • Confusion, particularly in elderly patients
  • Dependence with regular use beyond a few weeks
Go to a doctor or emergency room straight away if you notice any of the following.
  • Breathing difficulty. The risk is highest with injected forms and when combined with other sedating medicines. Resuscitation equipment must be immediately available whenever the injection is used.
  • Dependence and withdrawal symptoms with prolonged use

Who should not take it

Important warnings before starting

Tell your doctor about all your medical conditions, allergies, and other medicines before starting Lorazepam.
  • Significant breathing problems
  • Myasthenia gravis
  • Sleep apnoea

Special care needed

Situations that need extra attention

  • The injectable form is only given in settings with resuscitation facilities
  • Do not drive or operate machinery while taking it
  • Elderly patients are particularly sensitive, lower doses and closer monitoring are needed
  • Tell your doctor about any history of substance use problems
Pregnancy
Avoid if possible. If it must be used, specialist guidance and close monitoring of the baby are required.
Breastfeeding
Not recommended during breastfeeding.

Other medicines

Medicines and substances that can interact with it

Always tell your doctor and pharmacist about every medicine, supplement, and herbal remedy you take, including those bought without a prescription.
  • Alcohol and opioid medicines: Severely amplifies sedation and respiratory depression. This combination is potentially life-threatening.
  • Other sedating medicines: All sedating medicines amplify each other.

Tests and follow-up

What your doctor will monitor

  • Breathing and level of consciousness with injectable use
  • Duration of treatment, oral lorazepam should be reviewed by two to four weeks
  • Signs of tolerance and dependence with ongoing use

Stopping this medicine

What happens if you stop taking it?

Do not stop lorazepam suddenly after regular use. Gradual reduction under medical supervision is needed to prevent withdrawal effects including rebound anxiety and, in severe cases, seizures.

In Kenya

What you should know about this medicine in Kenya

Lorazepam by injection is a valuable tool in Kenyan emergency psychiatric and general emergency settings, particularly because of its reliable muscular absorption.

In combination with haloperidol, lorazepam IM is a standard approach for managing severe acute agitation in Kenyan emergency psychiatric facilities.

As with diazepam, long-term prescribing of oral lorazepam for chronic anxiety is to be avoided.

Sources

References

  1. Ministry of Health, Kenya. (2023). Kenya Essential Medicines List 2023. Nairobi: Ministry of Health.
  2. Ministry of Health, Kenya. (2023). Kenya National Medicines Formulary, 1st Edition. Nairobi: Ministry of Health.
  3. World Health Organization. (2023). Model List of Essential Medicines, 23rd Edition. Geneva: WHO.