Chronic Lorazepam Use Risks and Clinical Considerations

Introduction to Risks

• Chronic lorazepam use leads to tolerance, physical dependence, cognitive impairment, and increased risk of falls, particularly in older adults, and should be avoided for long-term management whenever possible, as recommended by the American Academy of Family Physicians and the Mayo Clinic 1, 2

Cognitive and Neurological Effects

• Regular use of lorazepam can lead to depression and cognitive impairment beyond the acute dosing effects, according to the American Academy of Family Physicians 3, 4

Risks in Older Adults

• Lorazepam poses particularly severe risks in elderly populations, including falls and injuries, motor skill impairment, habituation, and withdrawal syndromes, and should be tapered or avoided according to Beers Criteria, as recommended by the Mayo Clinic 1, 2
• Sedation, cognitive impairment, and unsafe mobility can lead to injurious falls in older adults taking lorazepam 2

Adverse Effects Profile

• Sedation is the most frequent adverse effect of chronic lorazepam use, with a 15.9% incidence 1
• Dizziness is a common adverse reaction with chronic use, with a 6.9% incidence 5
• Weakness is an adverse effect of chronic lorazepam use, with a 4.2% incidence 6
• Unsteadiness increases with age and is an adverse effect of chronic lorazepam use, with a 3.4% incidence 1
• Respiratory depression can worsen sleep apnea and obstructive pulmonary disease 7

Special Populations and Contraindications

• In patients with liver disease, lorazepam requires careful dose adjustment despite being an intermediate-acting benzodiazepine, as recommended by the European Association for the Study of the Liver 6

Appropriate Clinical Uses

• Lorazepam has limited appropriate indications, including short-term management of insomnia, anxiety, and agitation, as recommended by the American Academy of Family Physicians and the American Society of Clinical Oncology 3, 4, 5, 7
• Lorazepam is the treatment of choice for alcohol or benzodiazepine withdrawal, as recommended by the American Society of Clinical Oncology and the Clinical and Molecular Hepatology society 5, 7, 8

Deprescribing Recommendations

• The EMPOWER approach and Beers Criteria recommend tapering lorazepam whenever possible, with consideration of safer alternatives, as recommended by the Mayo Clinic and the American Geriatrics Society 1, 2
• Gradual taper technique should be implemented to avoid life-threatening withdrawal, and cognitive behavioral therapy should be considered as a safer alternative, as recommended by the Mayo Clinic 1, 2