Table 19

Lorazepam sublingual

Lorazepam sublingual
What is it?Anxiolytic
Mechanism of actionBenzodiazepine
Starting dose0.5–1 mg
Time to maximal effect2.5 hours17
FormulationTablet—can be halved
IndicationAnxiety, panic, agitation
Common adverse effects‘Apnoea; asthenia; coma; disinhibition; extrapyramidal symptoms; hypothermia; memory loss; speech slurred; suicide attempt’16
ContraindicationsSevere hepatic failure, untreated sleep apnoea, myasthenia gravis, severe respiratory failure16
Caution‘Avoid prolonged use (and abrupt withdrawal thereafter); debilitated patients (reduce dose) (in adults); elderly (reduce dose) (in adults); history of alcohol dependence or abuse; history of drug dependence or abuse; myasthenia gravis; personality disorder (within the fearful group—dependent, avoidant, obsessive-compulsive) may increase risk of dependence; respiratory disease’16
LicencingOff license route of a licensed formulation
BenefitsSublingual benzodiazepine, widely used in usual practice
RisksCommon misconception that the sublingual route is licensed due to widespread use
Cost£3.29 for 28×1 mg tablets