[14] It is also used during surgery to interfere with memory formation, to sedate those who are being mechanically ventilated, and, along with other treatments, for acute coronary syndrome due to cocaine use.

[34] Lorazepam is more effective than diazepam and intravenous phenytoin in the treatment of status epilepticus and has a lower risk of continuing seizures that might require additional medication.

[36][37] Lorazepam's anticonvulsant properties and pharmacokinetic profile make intravenous use reliable for terminating acute seizures, but induce prolonged sedation.

Additionally, common seizure characteristics (e.g., hypersalivation, jaw-clenching, involuntary swallowing) pose some difficulties with regard to oral administration.

[38][39] Lorazepam's anticonvulsant and central nervous system (CNS) depressant properties are useful for the treatment and prevention of alcohol withdrawal syndrome.

[43] Its relative effectiveness in preventing new memory formation,[44] along with its ability to reduce agitation and anxiety, makes lorazepam useful as premedication.

In a group of around 3,500 people treated for anxiety, the most common side effects complained of from lorazepam were sedation (15.9%), dizziness (6.9%), weakness (4.2%), and unsteadiness (3.4%).

[72] Lorazepam should be avoided in people with: Dependence typified by a withdrawal syndrome occurs in about one-third of individuals who are treated for longer than four weeks with a benzodiazepine.

Potent benzodiazepines with a relatively short half-life, such as lorazepam, alprazolam, and triazolam, have the highest risk of causing dependence.

Lorazepam's relatively short serum half-life, its confinement mainly to blood, and its inactive metabolite can result in interdose withdrawal phenomena and next-dose cravings, that may reinforce psychological dependence.

The risk and severity of withdrawal are increased with long-term use, use of high doses, abrupt or over-rapid reduction, among other factors.

[citation needed] Withdrawal symptoms include headaches, anxiety, tension, depression, insomnia, restlessness, confusion, irritability, sweating, dysphoria, dizziness, derealization, depersonalization, numbness/tingling of extremities, hypersensitivity to light, sound, and smell, perceptual distortions, nausea, vomiting, diarrhea, appetite loss, hallucinations, delirium, seizures, tremor, stomach cramps, myalgia, agitation, palpitations, tachycardia, panic attacks, short-term memory loss, and hyperthermia.

[82] The ease of physical dependence to lorazepam, (Ativan brand was particularly cited), and its withdrawal were brought to the attention of the British public during the early 1980s in Esther Rantzen's BBC TV series That's Life!, in a feature on the drug over a number of episodes.

The combination also causes greater enhancement of the disinhibitory and amnesic effects of both drugs, with potentially embarrassing or criminal consequences.

Otherwise, management is by observation, including vital signs, support and, only if necessary, considering the hazards of doing so, giving intravenous flumazenil.

People are ideally nursed in a kind, frustration-free environment, since, when given or taken in high doses, benzodiazepines are more likely to cause paradoxical reactions.

Lorazepam may be quantitated in blood or plasma to confirm poisoning in hospitalized people, provide evidence of an impaired driving arrest or to assist in a medicolegal death investigation.

Blood or plasma concentrations are usually in a range of 10–300 μg/L in persons either receiving the drug therapeutically or in those arrested for impaired driving.

This is due to the fact that the majority of these screening tests are only able to detect benzodiazepines that undergo oxazepam glucuronide metabolism.

[92] It is a high-potency and an intermediate-acting[clarification needed] benzodiazepine, and its uniqueness,[93][94] advantages, and disadvantages are largely explained by its pharmacokinetic properties (poor water and lipid solubility, high protein binding and anoxidative metabolism to a pharmacologically inactive glucuronide form) and by its high relative potency (lorazepam 1 mg is equal in effect to diazepam 10 mg).

[22] Due to its poor lipid solubility, lorazepam is absorbed relatively slowly by mouth and is unsuitable for rectal administration.

However, its poor lipid solubility and a high degree of protein binding (85–90%[98]) mean that its volume of distribution is mainly the vascular compartment, causing relatively prolonged peak effects.

Clinical example: Diazepam has long been a drug of choice for status epilepticus; its high lipid solubility means it gets absorbed with equal speed whether given orally, or rectally (nonintravenous routes are convenient outside of hospital settings), but diazepam's high lipid solubility also means it does not remain in the vascular space, but soon redistributes into other body tissues.

So, it may be necessary to repeat diazepam doses to maintain peak anticonvulsant effects, resulting in excess body accumulation.

Lorazepam is a different case; its low lipid solubility makes it relatively slowly absorbed by any route other than intravenously, but once injected, it will not get significantly redistributed beyond the vascular space.

[100] The prolonged sedation from lorazepam may, however, be an acceptable trade-off for its reliable duration of effects, particularly if the person needs to be transferred to another facility.

Lorazepam-glucuronide is eventually excreted by the kidneys,[98] and, because of its tissue accumulation, it remains detectable, particularly in the urine, for substantially longer than lorazepam.

Relative to other benzodiazepines, lorazepam is thought to have a high affinity for GABA receptors,[107] which may also explain its marked amnesic effects.

Sustained repetitive firing seems to be limited by the benzodiazepine effect of slowing recovery of sodium channels from inactivation to deactivation in mouse spinal cord cell cultures, hence prolonging the refractory period.

[111] Intravenous injections should be given slowly and they should be closely monitored for side effects, such as respiratory depression, hypotension, or loss of airway control.