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Lorazepam: Mechanism of Action & Chemical Structure

Instructor: Lori Haag

Lori has teaching experience in the health care setting. She has an associate's degree in Nursing and a bachelor's degree in Psychology.

In this lesson you will learn about lorazepam, how it works, what it's made of, common uses of the drug, and its potential benefits to patients in a multitude of settings.

The Magic Little Pill

Annie is at the grocery store doing her weekly shopping. Because she doesn't like to leave her house much, Annie tries to get everything she needs for the week in one trip. It's Saturday, and the grocery store is loud with all kinds of activity. They've moved things around, and she doesn't know where anything is. This makes Annie nervous. Her heart begins to race, and she is feeling light-headed. She is starting to have tunnel vision and feels she may need to sit down. She has a strong sense of impending doom and wants to leave the grocery store as fast as she can. Then Annie remembers her little magic pill. She digs into her purse and finds the small bottle. She takes out one of the little white pills and pops it into her mouth. Annie sighs with relief because she knows that soon she will begin to feel better.

Annie is having an anxiety attack, and her magic little pill is lorazepam, more commonly known by its brand name Ativan. Anxiety is just one of the indications for the use of lorazepam. Because of its sedative and anticonvulsant properties, lorazepam can be prescribed to help people fall asleep (insomnia) and in the treatment of seizures. Other uses for lorazepam include treatment of alcohol withdrawal, nausea in cancer patients, and irritable bowel syndrome.

Tablets Come in Different Strengths
Little White Pill

How It Acts

Lorazepam is a benzodiazepine. Benzodiazepines are drugs which reduce the nerve activity in the brain and spinal cord. Although their exact mechanism of action is not completely understood, it is believed that benzodiazepines, such as lorazepam, enhance the effects of gamma-aminobutyric acid by binding with its receptors in the brain. Gamma-aminobutyric acid, also known as GABA is a neurotransmitter (a chemical in the brain) which is responsible for decreasing stimulation in the brain, promoting relaxation, and preparing the body for sleep. Other examples of benzodiazepines are alprazolam (Xanax), clonazepam (Klonopin), and diazepam (Valium).

What It's Made Of

All benzodiazepines are similar in chemical structure in that they are all psychoactive drugs whose commonality is benzene and diazepine. The chemical formula of lorazepam in particular is:

chemical structure

Chemical Structure of Lorazepam
Chemical Structure of Lorazepam

Many Forms and Uses

Just as lorazepam worked its magic for Annie, it can be invaluable to patients in a multitude of settings. Lorazepam is extremely versatile in that it can be administered orally, intravenously, intramuscularly, and sublingually (under the tongue).

Oral forms of lorazepam include tablet and liquid suspension. Tablets are primarily utilized when a patient is able to administer the drug themselves, as was the case with Annie. Patients suffering from anxiety disorders and insomnia are generally prescribed the tablet form of the drug which is available in 0.5mg, 1mg, and 2mg strengths. Generic lorazepam is available from several manufacturing companies.

Intravenous administration of lorazepam is highly useful when oral administration is not achievable, as in the case of status epilepticus, a seizure disorder. Benzodiazepines such as lorazepam are a first-line treatment for seizures when IV (intravenous) access is available. Intravenous lorazepam is preferred over other intravenous benzodiazepines due to its proven efficacy in controlling seizures. Intramuscular lorazepam can be given in this situation if intravenous administration is not possible.

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