Lorazepam vs. Diazepam

Instructor: Artem Cheprasov

Artem has a doctor of veterinary medicine degree.

This lesson compares and contrasts the many facets surrounding two medications known as lorazepam and diazepam. You'll learn the differences in what they're used for and their precautions, among other things.

Lorazepam vs. Diazepam

Caroline has epilepsy, or recurrent and unprovoked seizures. Caroline's friend, who also has epilepsy, recently told her that both lorazepam and diazepam have been used to help her with her seizures. But is this really true? Let's find out as we compare and contrast these two medications.

Names & Classification

Lorazepam and diazepam really don't ring a bell for Caroline. But her face does light up when she hears the names Valium and Ativan. She's seen ads for them before. Valium is just the brand name for diazepam and Ativan is the brand name for lorazepam.

Valium
Valium

Caroline is told by her doctor that both of these drugs are known as benzodiazepines. Benzodiazepines are chemical compounds that biochemically charge our brain cells in such a way that they are less likely to send erroneous signals to one another. This is really great for scenarios where our neurons are firing off inappropriately, as per seizures.

Uses

Since they both can treat seizures, they can also be classified as anticonvulsants as well. So, it seems that Caroline's friend was right, they can treat seizures. However, this is just the broad view of things. For example, lorazepam isn't used to treat any old seizure. Instead, it's used to help treat status epilepticus, a very prolonged and highly dangerous seizure. Diazepam can be used to help treat status epilepticus as well. However, diazepam can also be used help manage epilepsy patients who are having trouble controlling their epilepsy with other medications.

In other words, you wouldn't use either lorazepam or diazepam as the main drug to treat epilepsy or any old seizure. They are only used in very specific situations!

Lorazepam can also be used to treat anxiety and as a relaxing anesthesia premedication. Diazepam can similarly be used to help manage anxiety and preoperatively. Diazepam has other uses, however. It can be used to help manage muscle spasms and acute ethanol (alcohol) withdrawal symptoms like agitation.

Precautions

What should Caroline and her doctor take into consideration prior to Caroline being given any of these medications?

Well, neither medication should be used if a person has a known allergy to the medication or an ingredient in its dosage form. Both medications should be used with extreme caution if a person is also taking opioids, as this can lead to severe respiratory depression and sedation, coma, and death. Similarly, if a person has a known allergy to another benzodiazepine, both medications should be used with extreme caution or not at all.

Additionally, the following situations are contraindication to the use of both lorazepam and diazepam:

  • Acute narrow-angle glaucoma, where there is a sudden and severe increase in the pressure inside the eye
  • Severe respiratory insufficiency
  • Sleep apnea
  • Myasthenia gravis, a type of neuromuscular disorder. This is only a contraindication for lorazepam in Canada, not in the U.S. It is a contraindication for diazepam in both countries under most circumstances.

Additionally, diazepam shouldn't be used in people with acute alcohol intoxication, untreated open angle glaucoma, and in children less than 6 months of age. Lorazepam shouldn't be used intra-arterially and (as an injectable) in premature infants.

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