Benzodiazepines produce a variety of effects by binding to the benzodiazepine receptor site and magnifying the efficiency and effects of the neurotransmitter gamma aminobutyric acid (GABA) by acting on its receptors. As this site is the most prolific inhibitory receptor set within the brain, its modulation results in the sedating (or calming effects) of lorazepam on the nervous system.
The anticonvulsant properties of benzodiazepines may be, in part or entirely, due to binding to voltage-dependent sodium channels rather than benzodiazepine receptors.
Lorazepam is thought to have a relatively high affinity for GABA receptors compared to other benzodiazepines, which may also explain its marked amnesic effects.
Lorazepam undergoes glucuronidation via Hepatic Pathways which produces lorazepam glucuronide as the main metabolite. The glucuronide attached increases the polarity of the molecule allowing a faster excretion through urine.
low toxicity relative to dose. However, it is lethal when mixed with depressants like alcohol or opioids]].
It is strongly recommended that one use harm reduction practices when using this substance.
-extremely physically and psychologically addictive.
Tolerance will develop to the sedative-within a couple of days of continuous use. After cessation,7 - 14 days. However, in certain cases this may take significantly longer in a manner which is proportional to the duration and intensity of one's long-term usage.
Withdrawal symptoms or rebound symptoms may occur after ceasing usage abruptly following a few weeks or longer of steady dosing, and may necessitate a gradual dose reduction. For more information on tapering from benzodiazepines in a controlled manner, please see this guide.
Benzodiazepine discontinuation is notoriously difficult; it is potentially life-threatening for individuals using regularly to discontinue use without tapering their dose over a period of weeks. There is an increased risk of hypertension, seizures, and death. Drugs which lower the seizure threshold such as tramadol should be avoided during withdrawal.
Lorazepam presents cross-tolerance with Cross-all benzodiazepines, meaning that after its consumption all benzodiazepines will have a reduced effect.
Benzodiazepine overdose may occur when a benzodiazepine is taken in extremely heavy quantities or concurrently with other depressants. This is particularly dangerous with other GABAergic depressants such as barbiturates and alcohol since they work in a similar fashion, but bind to distinct allosteric sites on the GABAA receptor, thus their effects potentiate one another. Benzodiazepines increase the frequency in which the chlorine ion pore opens on the GABAA receptor while barbiturates increase the duration in which they are open, meaning when both are consumed, the ion pore will open more frequently and stay open longer. Benzodiazepine overdose is a medical emergency that may lead to a coma, permanent brain injury or death if not treated promptly and properly.
Symptoms of a benzodiazepine overdose may include severe thought deceleration, slurred speech, confusion, delusions, respiratory depression, coma or death. Benzodiazepine overdoses may be treated effectively in a hospital environment, with generally favorable outcomes. Benzodiazepine overdoses are sometimes treated with flumazenil, a GABAA antagonist, however care is primarily supportive in nature.
Although many drugs are safe on their own, they can become dangerous and even life-threatening when combined with other substances. The list below contains some common potentially dangerous combinations, but may not include all of them. Certain combinations may be safe in low doses of each but still increase the potential risk of death. Independent research should always be done to ensure that a combination of two or more substances is safe before consumption.
- Depressants** (1,4-Butanediol, 2-methyl-2-butanol, alcohol, barbiturates, GHB/GBL, methaqualone, opioids) - This combination can result in dangerous or even fatal levels of respiratory depression. These substances potentiate the muscle relaxation, sedation and amnesia caused by one another and can lead to unexpected loss of consciousness at high doses. There is also an increased risk of vomiting during unconsciousness and death from the resulting suffocation. If this occurs, users should attempt to fall asleep in the recovery position or have a friend move them into it.
- Dissociatives** - This combination can result in an increased risk of vomiting during unconsciousness and death from the resulting suffocation. If this occurs, users should attempt to fall asleep in the recovery position or have a friend move them into it.
- Stimulants** - It is dangerous to combine benzodiazepines with stimulants due to the risk of excessive intoxication. Stimulants decrease the sedative effect of benzodiazepines, which is the main factor most people consider when determining their level of intoxication. Once the stimulant wears off, the effects of benzodiazepines will be significantly increased, leading to intensified disinhibition as well as other effects. If combined, one should strictly limit themselves to only dosing a certain amount of benzodiazepines per hour. This combination can also potentially result in severe dehydration if hydration is not monitored.
Internationally, lorazepam is a Schedule IV drug under the United Nations Convention on Psychotropic Substances.
Austria: Lorazepam is legal for medical use under the AMG (Arzneimittelgesetz Österreich) and illegal when sold or possessed without a prescription under the SMG (Suchtmittelgesetz Österreich).
Canada: Lorazepam is listed in Schedule IV of the Controlled Drugs and Substances Act in Canada.
China:** Lorazepam is a controlled Class II psychotropic substances. Prescriptions for psychotropic substances in Class II are generally limited to a 7-day supply.
Germany: Lorazepam is controlled under Anlage III BtMG (Narcotics Act, Schedule III) as of August 1, 1986. It can only be prescribed on a narcotic prescription form, except preparations which contain up to 2.5 mg lorazepam in each dosage form.
New Zealand: Lorazepam is a Class C Controlled drug under the Misuse of Drugs Act 1975.
Russia: Lorazepam is a Schedule III controlled substance since 2013.
Switzerland: Lorazepam is a controlled substance specifically named under Verzeichnis B. Medicinal use is permitted.
Turkey: Lorazepam is a 'green prescription' only substance and illegal when sold or possessed without a prescription.
United Kingdom: Lorazepam is classified as a controlled substance and is listed under Schedule IV, Part I (CD Benz POM) of the Misuse of Drugs Regulations 2001, allowing possession with a valid prescription. The Misuse of Drugs Act 1971 makes it illegal to possess it without a prescription and, for such purposes, it is classified as a Class C drug.
United States: Lorazepam is a Schedule IV drug under the Controlled Substances Act.
Poland: Lorazepam is controlled under act of psychotropic substances list IV-P Group of "low potential for abuse" (with other benzodiazepines in this group). It's legal for medical, scientific and manufacturing purposes.
Responsible use
Psychoactive substance index
Etizolam
Benzodiazepines
Depressants
Volumetric liquid dosing
Lorazepam (Wikipedia)
Lorazepam (Erowid Vault)
Lorazepam (Isomer Design)
Lorazepam (DrugBank)
Lorazepam (Drugs.com)
Lorazepam (Drugs-Forum)
Lorazepam can be administered via oral. The route of administration can influence both the onset and intensity of seizure.