Insomnia is generally defined as one’s inability to fall asleep or stay asleep throughout the night. This is not a condition per se but represents a symptom or sign of some underlying diseases, predominantly sleep, medical or psychiatric disorders. Sleep deprivation, especially if it lasts for a long period of time interferes with every day activities and triggers daytime sleepiness. What is more, lack of sleep further precipitates distress, agitation, anxiety and a whole variety of negative feelings. There are many patterns of insomnia and three basic types, transient insomnia, acute insomnia and chronic insomnia. All of these have specific approach which also depends on the underlying condition that have led to the problem in the first place.
Insomnia and Lorazepam
Most patients suffering from primary insomnia have to deal with daytime fatigue and stress. Still, most of the available treatments are rarely focused on these daytime symptoms. Instead they try to help patients have proper amount of sleep.
Today there is a number of medications which can improve sleep and help one overcome insomnia. Normally, we should not opt for medications if we experience occasional difficulty falling or staying asleep. The medications are strictly reserved for patients who are diagnosed to suffer from insomnia.
Lorazepam is one of the medications prescribed in this purpose. It belongs to benzodiazepinem together with other members such as diazepam, aprazolam etc. The drug is highly efficient against anxiety and may be equally good for patients suffering from certain psychological disorders.
The mechanism of activity of the drug is related to enhancement of the effects of GABA, a brain’s neurotransmitter. Once introduced into the body Lorazepam does not linger i.e. is removed much more easily compared to other members of benzodiazepines so it practically cannot be toxic to the body. Also, the drug has fewer interactions with other medications compared to other drugs from the group of benzodiazepines.
The medication is available in several forms including tablets, oral solution and injections. It should be used according to doctor’s orders and the prescribed dose should never be exceeded, missed or reduced. Most patients suffering from insomnia take 2-4mg of Lorazepam prior to going to bed.
The drug must never be taken together with alcohol, barbiturates, narcotics or tranquilizers since such combinations trigger depression of the central nervous system and may easily be lethal.
And finally, since both Lorazepam and other members of benzodiazepines have been connected with fetal damage (especially congenital malformations) it is strictly forbidden during pregnancy, the first trimester in particular.
Side Effects from Lorazepam
The most commonly reported adverse effect of Lorazepam is sedation. Then there are dizziness, weakness and unsteadiness. Several more nervous system side effects are fatigue, confusion, daytime anxiety, headaches, ataxia and impaired cognition. Rarely the drug may precipitate amnesia and asthenia while orofacial dyskinesia is extremely uncommon side effect of the drug. Amnesia is generally reported in individuals who consume large amounts of alcohol in the combination with Lorazepam.
As for respiratory side effects these are mostly reported when the drug is administered intravenously. Respiratory depression is one of the most severe adverse effects of the drug. Such patients require quick resuscitation in case the breathing completely stops.
Injectable form of Lorazepam is administered together with propylene glycol, a component that may easily trigger hyperlactatemia, interfere with the kidney function or precipitate respiratory acidosis. These side effects have been confirmed not to depend on the administered dose i.e. they are not dose-related.
What is more, some patients complain about local side effects associated with intramuscular injections of the drug. Namely, they may experience pain, burning sensation or local irritation at the site of injection. Even swelling may occur. Fortunately, these adverse effects affect approximately 8% of all patients. In rare instances unintentional injection of the drug into an artery instead of a vein may trigger damage to the blood vessel and potentially severe complications.
When it comes to hematologic side effects associated with Lorazepam, these include hemolytic anemia, a drop in the number of all blood cells (pancytopenia), neutropenia and aplastic anemia.
The drug is also connected with endocrine dysfunction. Namely, it may affect synthesis of ADH (antidiuretic hormone) and precipitate associated health problems.
Furthermore, myopathy and rhabdomyolysis are two musculoskeletal adverse effects connected to treatment with Lorazepam.
In the end, some patients may experience withdrawal symptoms once the treatment with the drug discontinues. Abrupt cessation of Lorazepam may easily lead to agitation, anxiety and restlessness. Insomnia usually reoccurs, there is tremor and some individuals additionally develop convulsions. Excessive perspiration, abdominal cramps and vomiting occur as well. In rare instances patients develop psychological disorders such as mania or delusional depression. Given all the mentioned the drug should be discontinued slowly, with gradually reduction in the dose.
All in all, in spite of potential side effects Lorazepam is powerful tool against insomnia and is definitely one the most commonly prescribed drugs in this purpose. With adequate dose and the form of the drug most side effects are successfully evaded.