Lorazepam sublingual
| Lorazepam sublingual | |
| What is it? | Anxiolytic |
| Mechanism of action | Benzodiazepine |
| Starting dose | 0.5–1 mg |
| Time to maximal effect | 2.5 hours17 |
| Formulation | Tablet—can be halved |
| Indication | Anxiety, panic, agitation |
| Common adverse effects | ‘Apnoea; asthenia; coma; disinhibition; extrapyramidal symptoms; hypothermia; memory loss; speech slurred; suicide attempt’16 |
| Contraindications | Severe 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 |
| Licencing | Off license route of a licensed formulation |
| Benefits | Sublingual benzodiazepine, widely used in usual practice |
| Risks | Common misconception that the sublingual route is licensed due to widespread use |
| Cost | £3.29 for 28×1 mg tablets |