Talk:Lorazepam/Archive 1

Archive 1

Orphan

this article is an orphan. Kingturtle 07:32 May 14, 2003 (UTC)

Areas of Lorazepam article needing work:

Pharmacology: Basic mode of benzodiazepine action at receptor level, possibly with a diagram (may easily confuse rather than impart meaningful information).

Side effects: Question whether to paste in a complete list, as below, or just to leave readers to refer to official data sheets.

Dosages: may be wise to defer questions like this to official data sheets, but is there a bare minimum of representative examples?

Interactions: there is just the ethanol interaction at the moment. A discussion on metabolism and clearance, by enzymes, CYP2C19, etc. would help with drug interactions.

Lay readers: I discussed article with a layperson, who found it overwhelming. It is a pharmacology article, but anything that conveys the same information in clearer English... --Petlif 21:54, 22 August 2007 (UTC)

A diagram of the GABAa receptor (being a six subunit ion channel in the plasma membrane) might muddle things for the reader - if they are unfamiliar with that particular class of receptor. Regardless, there needs to be more information regarding the affinity of Lorazepam for the receptor, where it binds, what subunits it possesses, stuff like that. The interactions section needs to be expanded to include barbituates and other drugs/chemicals which modulate the affinity of GABA. Wisdom89 23:34, 22 August 2007 (UTC)

Unexplained Acronyms: Under "Recreational use" it is stated "pharmaceutical-related ED visits", but I cannot for the life of me find a previous definition of "ED". If I missed it, shame on me. If the author assumed I'd know, shame on her/him. Anyone writing to a general audience (and I would argue often to a speciality audience, too) should stop and consider the reader's context before using an acronym without first defining it--e.g., "I read the Wikipedia article (WA)". --70.166.13.6 (talk) 17:37, 30 May 2011 (UTC)

Interactions

Anyone going to kick off in the section on Lorazepam drug interactions?

It's a gaping hole in the article but quite important, cf. strong interaction with alcohol, etc.

Side Effects

not listed in the usual medication style, how come? they HAVE to be different than clonazepam and diazepam. please start a section for side effects and list the ones for lorazepam, here are the ones listed on Rxlist.com:

In a sample of about 3500 patients treated for anxiety, the most frequent adverse reaction to Ativan (lorazepam) was:

sedation (15.9%), dizziness (6.9%), weakness (4.2%), unsteadiness (3.4%). the incidence of sedation and unsteadiness increased with age.

Other adverse reactions are:

fatigue, drowsiness, amnesia, memory impairment, confusion, disorientation, depression, unmasking of depression, disinhibition, euphoria, suicidal ideation/attempt, ataxia, asthenia, extrapyramidal symptoms, convulsions/seizures tremor, vertigo, eye-function/visual disturbance (including diplopia and blurred vision), dysarthria/slurred speech, change in libido, impotence, decreased orgasm; headache, coma; respiratory depression, apnea, worsening of sleep apnea, worsening of obstructive pulmonary disease; gastrointestinal symptoms including nausea, change in appetite, constipation, jaundice, increase in bilirubin, increase in liver transaminases, increase in alkaline phosphatase; hypersensitivity reactions, anaphylactic/oid reactions; dermatological symptoms, allergic skin reactions, alopecia; SIADH, hyponatremia; thrombocytopenia, agranulocytosis, pancytopenia; hypothermia; and autonomic manifestations.

Paradoxical reactions, including anxiety, excitation, agitation, hostility, aggression, rage, sleep disturbances/insomnia, sexual arousal, and hallucinations may occur. Small decreases in blood pressure and hypotension may occur but are usually not clinically significant, probably being related to the relief of anxiety produced by Ativan (lorazepam).

I dont know why for GI symptoms they list nausea, as Lorazepam is commonly used as an antiemetic or an adjunct medication to stronger antiemetics like Compazine, Marinol or Zofran.

---

Lorazepam may cause nausea, but not in every patient - the larger study group, the more side-effects you will pick up. In reported-side-effects' lists such as the above, it is convention to have the commonest side effects listed first. Nausea, although a possibility, is way down the list above. People and their bodies are simply just different. In answer to why the list in the lorazepam article is different, it is about reading style. Wikipedia articles are not meant to replace manufacturers' official data sheets (turgid and unreadable as they are) and instead there are several links to such publications. I'll go and have a look at rxlist.com and see if I can find the reference to the large patient sample and add something to the lorazepam article. The longer side effect profiles often pertain to benzos in general - e.g. in the British National Formulary, readers are directed to the full side-effects list for Diazepam. This of course is not ideal, since the drugs have different profiles Petlif 02:13, 25 June 2007 (UTC)

---

That's it. Section on side-effects added.Petlif 06:59, 3 July 2007 (UTC)

---

I was recently prescribed lorazepam together with compazine for nausea resulting from cancer treatment. It seems to be a common use of the drug. I wonder why the main article does not mention this use of lorazepam as anti-nausea medication. Should the main article be edited to add this information? There are several places in the article where usages of the drug are listed where the antinausea property should be added to the list. 74.242.250.102 (talk) 12:20, 12 June 2010 (UTC)

It does mention this at the bottom of the indications section. :)--Literaturegeek | T@1k? 00:22, 15 June 2010 (UTC)

English - Help

Could a native english speaker who is good at writing please go through this article and improve the english so it flows better? Thanks. Petlif 06:01, 5 June 2007 (UTC)

Observation: Having reference numbers in superscript influences line spacing. This makes the article look very untidy, particularly if you print it out.Petlif 20:44, 29 May 2007 (UTC)

Can we possibly get some information on the recreational use of lorazepam? DryGrain 23:10, 6 Apr 2004 (UTC)

It is considered recreational. Check out www.erowid.org or www.bluelight.ru for a nice collection of users and stories. Debollweevil

Having been legit prescribed it, IME you'd have to take a hell of of a lot (possibly dangerously so) to experience any 'recreational' effects... Ride the Hurricane (talk) 10:50, 4 June 2015 (UTC)

Invalid word?

What is "cognital" deficits? As far as I can tell, cognital is not a real word. The author may have meant "cognitive" but I don't want to change it without being sure. Shadowin 19:43, 12 Oct 2005 (EST)

My mistake, I meant of course cognitive. Thanks for your feedback. I'll correct it right now. User:KlausFr, 12:21 (MEST), 16.10.2005

28 April 2006: This article is a good start. Question: can we also get a time frame of how long an indvidual would need to use Lorazepam? and typically what amounts and length of use puts one in the danger zone for addiction? thanks in advance.

Precise dosages -- how much is "higher"?

--Jamesrsheehan 19:50, 12 July 2006 (UTC)

"The action of lorazepam together with alcohol can be dangerous in higher amounts. . . ." This statement is muddled on two counts: 1. Higher amounts of alcohol, higher amounts of lorazepam, or higher amounts of both? 2. Higher than what? What is the reference point for higher? If it's alcohol, then it would seem appropriate to reference a blood alcohol content level; otherwise, this information may be less than precise. If it's lorazepam, apparently the "higher" dosage referred to is the upper extreme of 2.5mg/every 6 hours. If that's the case, then isn't that what should be stated?

I'm not sure lorazepam is in demand as a recreational drug. "Fighting" its sedative tendencies doesn't result in any noted euphoria or other recreational side effects, as is the reported case with Ambien. Of course, there are always a few zanies out there. . . .

I have tried both lorazepam and clonazepam recreationally in totally absurd doses. I had the assumption that it would cause "total relaxation" which appealed to me at the time. The result was actually quite the contrary. After dosing on say 15 tablets I felt completely "normal", which in retrorespect was not the case. It completely zapped my natural feeling of fear (a very useful emotion b.t.w.) which made me do some extremely stupid and dangerous things.

Therapeutic Use

Sources: "Lack of Relationship Between Long-Term Use of Benzodiazepines and Escalation to High Dosages" Soumerai SB et al., Psychiatr Serv 54:1006-1011, July 2003 (http://ps.psychiatryonline.org/cgi/content/full/54/7/1006)

"Benzodiazepines: Stable Long-Term Use" Journal Watch Women's Health, September 23, 2003; 2003(923): 10 - 10. (http://psychiatry.jwatch.org/cgi/content/citation/2003/1120/11) (This reference requiers subscription to online journal)

I remember seeing an article abstract on www.biopsychiatry.com (not primary, and I consider somewhat quetionable considering it's content associations with various other sites) which indicated that there appears to be a subpopulation which does not show the usual amnesiac and hypersomina responses to benzodiazepines, as well as do not show an escalation in use, or a definable "high" upon useage. I cannot find the article again. It was hypothesized in this article that in this subpopulation of patioents, bezodiazepines are safe for long-term use, and pose no risk of abuse. However, the above sources appear to support the same conclusion.

I personally hypothesize this could be due to a genetic imbalance betwee different GABA receptor types and/or subtypes, leading to the effect of benzodiazepine medications to be to correct an imbalance without creating a further imbalance leading to the classic side-effects and dose escalation behavior. I have not been able to find (nor have I looked) any primary studies supporting this conclusion though. Such primary sources may exist.

(Jim Witte)

"Chill"?

It's a very minor point, but I wonder if the term "chill" in the article should be replaced with slightly more formal language. ERobson 03:54, 10 January 2007 (UTC)

It's a valid, widely used term. I see no reason to change it TBH. Ride the Hurricane (talk) 10:52, 4 June 2015 (UTC)

Addiction

This article seems to be lacking in a section on the well-documented dangers of lorazepam addiction.

Diuretic?

Does lorazepam act as a diuretic (i.e., make you pee)? Myself I find that I pee a lot more than normal when I take it. A friend of mine also said the same thing about her and lorazepam. I usually only take lorazepam (2 mg) when I get really anxious (and thus am sweating). I suspect that it may be just that I perspire less due to the anxiolytic effect of lorazepam, and thus eliminate more water renally, not lorazepam acting as a diuretic per se. Please comment. --Seven of Nine (talk) 23:22, 19 March 2008 (UTC)

Hi, maybe lorazepam just makes you relax more and therefore more able to empty your bladder? e.g. ever found it hard to pee when using a public toilet urinal and you suddenly become aware someone is looking funny at you? Petlif (talk) 23:09, 13 June 2008 (UTC)

Hi, I got myself here by searching the same thing. Maybe it's a diuretic or maybe you drink more fluid on it as opposed to off. Also, possibly, since it may slow gut motility the contents in your intestines may have more time to sit and get the fluids absorbed. I also took a 500mg Tylenol earlier, but have been taking Tylenol for a long time and usually daily at 1000mg.. just stopped taking it every day a couple weeks ago. I hope this has helped others finding this in the future! — Preceding unsigned comment added by 98.176.61.49 (talk) 04:42, 4 August 2015 (UTC)

Please see link to "Disclaimers" at the bottom of every wiki page. Snowman (talk) 20:00, 28 March 2009 (UTC)

Please note that the wiki is not able to provide any medical advice. If necessary, please see your local health professional. Snowman (talk) 22:24, 28 March 2009 (UTC)

Generic or proprietary?

As with many Wikipedia pharmacology articles, this one uses the generic and proprietary names of the drug interchangeably. I feel that one or the other should be used consistently, and as this article is titled Lorazepam, the generic name is preferable. That said, I appreciate that I come from a part of the world where drugs are normally referred to by their generic names even in popular culture, whereas the opposite is the case in the USA. Lorazepam has been out of patent for about a century though (well, 25 years or so). --80.176.142.11 (talk) 20:29, 20 March 2008 (UTC)

Ativan and Temesta get their mentions at the beginning and the end of this article, so feel free to genericize other references. Petlif (talk) 23:11, 13 June 2008 (UTC)

I think that the generic name should be used, except perhaps when a particular brand is being referred to, Snowman (talk) 19:57, 28 March 2009 (UTC)

fetus vs unborn baby

OK folks, and IP with this edit, has given an explanation on my talk page. I will take this to WT:MED as it is an interesting conundrum. Casliber (talk · contribs) 19:36, 28 March 2009 (UTC)

This issue arose in the page on Lorazepam and was with reference to a foetus in the first trimester of pregnancy. I think that most people would recognise the word foetus as being appropriate in lay or other usage to refer to a foetus during this stage of development. Snowman (talk) 19:48, 28 March 2009 (UTC)

It's not appropriate because it's not correct. The fetal stage does not begin until quite late in the first trimester. WhatamIdoing (talk) 21:44, 28 March 2009 (UTC)

Please note that there is extra discussion at WP:MED; see above. I have changed it to "developing baby", which seems to me to be a more appropriate. Snowman (talk) 22:27, 28 March 2009 (UTC)

Just noting my agreement with the above in case anyone misses teh discussion at WT:MED. Casliber (talk · contribs) 22:47, 28 March 2009 (UTC)

The outcome of the discussion on Wikipedia talk:WikiProject Medicine was to use "developing baby" in place of "unborn baby". The word "fetus" - USA (or "foetus" - UK) was not thought satisfactory as a single-word replacement for "unborn baby", because during the first trimester (the first 13 wks of gestation) the conceptus goes through several stages including an embryo for about 8 weeks and then a foetus. Snowman (talk) 12:34, 29 March 2009 (UTC)

i have taken ativan and if u really dont want to sleep u probably cant, it is a 2 way street, no point increasing the dosage and u get addicted and it will add up to cost and a change in your personality live a healthy life and make do. —Preceding unsigned comment added by 210.24.73.13 (talk) 14:41, 19 April 2009 (UTC)

POV issues

All of the benzo articles are unduly emphasizing the adverse effects and paradoxical reactions of these drugs. These need to be kept in a single section, (e.g., "Adverse reactions and side-effects") as opposed to having a winded mention in the opening, as well as nearly every other section of the article itself. I can't even get through a few sentences of the article without redundantly being told how terrible and addictive benzos are. 70.153.101.208 (talk) 18:23, 26 February 2011 (UTC)

Amen to the comment above starting, "All of the benzo articles are unduly emphasizing the adverse effects and paradoxical reactions of these drugs"-yes, like all psychoactive medications, there are risks involved with benzodiazepines, but the risks pale compared to the alternatives, namely, some SSRI's, TCA's, dual-receptor antidepressants, MAO inhibitors, anti-convulsants, atypical antipsychotics, etc. The only significant issue with benzos is dependence with a certain subpopulation of users-which requires tapering the drug, not unlike the tapering required for many drugs. Other side effects and issues are rare among those suffering an anxiety disorder. The reality of the situation is that despite recommendations to the contrary, benzos are the most prescribed class of drug for anxiety because unlike the other classes of drugs mentioned, they are effective, fast-acting, tolerated well, seldom have side effects, and are very safe-even in overdose. Benzos are, unfortunately, also a drug that is abused-but it is not at all clear that should be an issue discussed at any length in the current article which (I presume) has as its major purpose the discussion of the therapeutic use of lorazepam-just as it would be inappropriate to constantly remind the reader of an article on "house paint" that, in fact, many people abuse house paint by inhalation of paint solvent fumes. Dehughes (talk) 14:51, 5 June 2011 (UTC)

Evidence for this would be needed. Doc James (talk · contribs · email) 23:20, 5 June 2011 (UTC)

Recreational/Other uses

I'm confused as to why alcohol is mentioned as the most common date-rape drug. I don't want to seem callous but this has no place in the article, as the two drugs are completely different. Equating the two, in any sense, may be dangerous for both victim and criminal alike. — Preceding unsigned comment added by 50.30.147.91 (talk) 03:39, 24 April 2013 (UTC)

Agreed. Both can be used in that manner - but so can many other substances. I don't see any reason for its inclusion here. Ride the Hurricane (talk) 10:46, 4 June 2015 (UTC)

intrinsic effects

Lorazepam appears to go from having 6 to 5 "intrinsic benzodiazepine effects" from the intro to the adverse effects section. What happened to antiemetic?

God Of Djinns (talk) 20:11, 11 May 2013 (UTC)

Criminality?

"Criminals may take them to deliberately seek disinhibition before committing crimes[13] (which increases their potential for violence)."

Is there a legit reference for this? I was prescribed lorazepam (legitimately, clinically) and experienced nothing of the sort...

The stated link (13), by the way, is defunct.

Ride the Hurricane (talk) 10:43, 4 June 2015 (UTC)

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Sedation

The section on sedation has only a single mention directly pertaining to sedation. The rest is a mishmash of information, all well-sourced, but ultimately unrelated to sedation. I've no idea how to fix this. Anastrophe (talk) 18:51, 17 September 2017 (UTC)

Drug testing

Doc James, there is definitely a common belief, especially, but not exclusively, amongst laymen, that lorazepam will test positive for benzodiazepine in urine drug screenings.

See for example:

https://www.drugs.com/answers/will-ativan-show-up-on-a-home-drug-test-as-181219.html

and https://www.quora.com/Does-Ativan-show-up-the-same-on-drug-screens

and https://deserthopetreatment.com/ativan-addiction/stay-in-system/ (Quote: "Most drug tests determine that short-acting benzodiazepines like lorazepam can be detected in a window of about 24 hours")

and https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&contentid=benzodiazepine_urine (It lists lorazepam with the implicit assumption that it will test positive)

There are countless other examples which can easily be found with google. There are few, if any, examples of evidence that it is common knowledge that lorazepam will not show up in a urine drug screening. The only mentions that seem to exist to the fact that it won't be detected are in journal articles or other resources targeted towards doctors or researchers, and even then I wasn't able to find anything on pubmed about it, which is why I used the reference that I originally used. (Thank you for finding better references, by the way.) It's definitely a common misconception, thus I think it is appropriate and preferable to add the clause "contrary to common belief" to the sentence "Lorazepam may not be detected by commonly-used urine drug screenings for benzodiazepines." Remember that the target audience of Wikipedia is absolutely anyone on earth. Wikipedia is not just for experts in a subject who already know what is being stated. Vontheri (talk) 19:31, 30 January 2019 (UTC)

User:Vontheri we currently state "Lorazepam may not be detected by commonly-used urine drug screenings for benzodiazepines." based on two textbooks.

Neither source discussing how commonly this misunderstand is known or not. Q and A user generated content are not reliable references. And Quora appears to be incorrect. Doc James (talk · contribs · email) 19:38, 30 January 2019 (UTC)

Doc James I know that the links I provided in this discussion are obviously not reliable sources to be referenced in an article. I was posting them as anecdotal evidence for this discussion only, not as potential references to add to an actual article. The last two links I gave were not Q and A, by the way.

The original reference that I used when I first added the information about drug testing to the article stated: "[M]ost physicians think the screening tests will detect newer benzodiazepines such as lorazepam, which is a commonly prescribed benzodiazepine. And it’s not going to be detected.” Do you have an objection to me re-adding that reference, in the format: "Contrary to common belief [new reference that contains the quote I just pasted], Lorazepam may not be detected by commonly-used urine drug screenings for benzodiazepines.[the two references you gave]"?

Thanks. Vontheri (talk) 19:50, 30 January 2019 (UTC)

This is not a particular good source.[1]

Not pubmed indexed. Just one person's opinion. Not convinced that how commonly this is fact known is really notable.

Most ER physicians know that urine tox screens are really poor. And that the only reason to really get them is to appease psychiatrists. Doc James (talk · contribs · email) 19:59, 30 January 2019 (UTC)

I believe you that it is common knowledge among ER doctors; I have no reason to not believe you. But you are aware that the majority of people reading this article are not ER physicians, and that there are countless other reasons that drug tests are performed other than in an ER setting, right? I wasn't claiming that it's a common misconception among ER physicians, but that it is definitely a common misconception among people in general, and among plenty of other types of doctors who aren't ER physicians, especially those who aren't regularly involved in drug testing. People hear "benzodiazepine drug test" and they assume that it means it is testing for ALL benzodiazepines.

https://academic.oup.com/painmedicine/article/13/7/868/1891231 This journal article says "In fact, a common misconception is that an opiate screen (via immunoassay) will include all opiates and opioids. However, in general, opiate immunoassay screens will not reliably detect oxycodone, oxymorphone, meperidine, and fentanyl." Obviously it is talking about opioids and not benzodiazepines, but it does reference the same concept as being a "common misconception". The article also mentions the issue with lorazepam not showing up as a benzodiazepine in urine tests. There is plenty of evidence that it is a common misconception, but I can find no evidence that it is not a common misconception. It's notable because of how pervasive it is. But, if you still don't want to include it, then okay. I have spent half a day on this, and I really don't have time to keep doing it. Vontheri (talk) 22:25, 30 January 2019 (UTC)

Potent Benzodiazipines

@DocJames: I had changed "Potent benzodiazepines, such as lorazepam, alprazolam, and triazolam, have the highest risk of causing a dependence" to "Potent benzodiazepines, such as lorazepam, alprazolam, and triazolam, appear to have the highest risk of causing a dependence", to make the claim that was actually made in the reference. The relevant sentence in the reference is "Potent BZDs with relatively short t1/2 (e.g. triazolam, alprazolam and lorazepam) appear to carry the highest risk of dependence". The reference does not definitivey say that they do have the highest risk, it says that they appear to have the highest risk. Should we say what the reference being used actually says, or make a stronger statement than what the reference says? (Also, I'm going to add "with a relatively short half life" after "potent benzodiazepines", since that is also what the reference says. I won't add back "appear to have" for now.) Vontheri (talk) 18:31, 19 April 2019 (UTC)

Flunitrazepam Inclusion/Facilitation of Criminal Activity

Under society and culture > recreational use, a paragraph is dedicated to discussing flunitrazepam's potential usage in facilitating criminal activity, especially date rape and robbery; however, flunitrazepam and the issue in general is not mentioned on any other pages dedicated to specific benzodiazepines, and there's little evidence that most common benzodiazpeines see appreciable usage in the above mentioned criminal activity, likely due to the fact that unlike flunitrazepam, other benzodiazepines generally possesses relatively minor polar solubility and thus will not dissolve readily in most common beverages, making it far more difficult to administer the drug without a subject's knowledge.

In essence I feel the section is out of place and potentially confusing/misleading, but as someone not especially familiar with the dos and don'ts of wiki editing I don't feel comfortable just deleting it based purely on personal judgement, so I figured I'd at least bring it up here. 100.19.116.119 (talk) 17:57, 17 August 2019 (UTC)

Respiratory Depression

DocJames and I seem to be having multiple disputes on various pages. I am a physician-pharmacologist who has been teaching at one of the largest research medical schools in the US for 26 years, but I don't get to editing Wikipedia often. When I do, it's to correct something just too absurd or troublesome to let go. The issue here is whether any benzodiazepine causes respiratory depression, and DocJames cites a Cochrane review focusing on a different subject in support of this relationship. This is not support because neither respiratory depression nor benzodiazepines was the focus of the review, and it is - indeed just a review of published work, not data in its own right. Actual primary data says something quite different, for example: G. E. Carraro, E. W. Russi, S. Buechi, and K. E. Bloch. Does oral alprazolam affect ventilation? A randomised, double-blind, placebo-controlled trial. Journal of Psychopharmacology 23 (3):322-327, 2009. Papers like this, done with modern methods, strongly deny a respiratory depressant effect of benzos, and can explain why earlier investigations were misinterpreted.

This isn't an idle discussion. The opioid overdose epidemic and its "association" with benzos is a very big deal in the US right now, with an immense amount of litigation surrounding it. In the midst of flaring accusations and repetitively-quoted misleading concepts, it is more important than ever to read the PRIMARY literature (not merely side issues mentioned in review literature). Verytas (talk) 17:04, 20 October 2019 (UTC)

The problem is reading primary research in isolation, which is why we prefer review articles, per WP:MEDRS. But anyway, your above study had the following methodology: “20 healthy men ingested 1 mg of alprazolam“. Your source then goes on to emphasise (“Oral alprazolam in a mildly sedative dose has no clinically relevant effect on ventilation in healthy, awake men.”) that the dose used is mild (I wouldn’t call 1 mg mild but the point is much higher doses are used in certain medical settings). Twenty is a very small number and since many, perhaps most, people sedated by benzodiazepines are far from “healthy” and also in medical settings, especially surgical and intensive care very high doses of benzodiazepines are more often used it means this source proves little. So really, your source is narrow and weak evidence. Your arguments really appear to be based on WP:SYN and I suggest you find reliable secondary sources, the more recently published the better, to support your position.--Literaturegeek | T@1k? 20:00, 20 October 2019 (UTC)

Yes, reading literature in isolation has pitfalls, however, I offered that as only one example of far better methodology that prior efforts. I have personally and professionally reviewed the entire world literature on this specific subject without a personal agenda or financial COI, only a high-level mandate to present the best evidence-based medical/scientific information to our students, residents, and faculty. The literature is deficient in definitive well-conducted studies, but the best evidence that is available does not support the idea that benzos cause respiratory depression. The prevailing view among those of us professionally considering the question of benzos + {opioids or alcohol} and death by respiratory depression is that either (a) benzos are implicated solely because they tend to be abused by people who are also abusing opioids or alcohol, or (b) they reduce the anxiety someone may have that would otherwise prevent them from ingesting excessive opioids or alcohol.

As for your preference for "review articles", that has far greater pitfalls than reading primary literature. The Cochrane review being bandied about has barely a handful of sentences in a 156-page document that was focused on something else entirely, and the authors actually made no attempt to review the literature on respiratory depression. Regardless of your (admittedly valid) criticisms of the Carraro study, it was a randomised, double-blind, placebo-controlled trial, well written, published prominently, peer-reviewed, and it thoughtfully considered the world literature to date in its discussion. That is vastly better evidence to those of us who are actively prescribing benzos and opioids for people, and teaching others about it, than a handful of remarks in a 156 Cochrane review about another issue entirely.Verytas (talk) 22:07, 20 October 2019 (UTC)

It is not my preference but the consensus of the Wikipedia community to use secondary sources, per WP:MEDRS and WP:V. You literally would need to convert the thinking of 98% of the community to your line of thinking on primary sources for building an encyclopedia and then have the relevant policies and guidelines overhauled. If you reviewed all of the ‘entire world literature’ on the subject matter at hand then you will most likely have published a review article somewhere, surely. You could then cite that here in the article with consensus of other editors of course. I can’t imagine you took on such an enormous research effort for the fun of it. Do you know of a better review article or meta-analysis than the Cochrane source? Benzos are indeed relatively safe in overdose alone for healthy adults, but the literature does find that a synergistic effect occurs in combination with opioids or alcohol.--Literaturegeek | T@1k? 23:18, 20 October 2019 (UTC)

This ref is clear https://www.drugs.com/monograph/lorazepam.html that it is associated with respiratory depression especially when used together with opioids.

But it also occurs when given alone in enough quantities or when given to someone with ETOH on board. Doc James (talk · contribs · email) 02:57, 21 October 2019 (UTC)

No, literaturegeek, I am not opposed to secondary sources, but your secondary source is not appropriate to the question in this case.

Also, I most certainly did not do my review for the fun of it: https://glossipvgross.files.wordpress.com/2015/02/14-7955-ac_sixteen-professors-supporting-neither-party.pdf I was not among the amici curiae for this brief, merely consulted to review and verify facts prior to filing, but I certainly concur with the opinion. As for synergy, there is simply no evidence for it, no matter how many times a poorly written secondary source may suggest it.

All this so sorely reminds me about why I have not become more involved with editing Wikipedia, it's such an utter waste of time when someone's interpretation of a largely irrelevant review overrides genuine expertise with the primary literature. Verytas (talk) 06:16, 21 October 2019 (UTC)

Well the secondary source match my professional experience of 20 years. I have seen "parenteral therapy for the management of status epilepticus" result in "hypotension, somnolence, respiratory failure"[2]

Doc James (talk · contribs · email) 12:32, 21 October 2019 (UTC)

With respect to the primary source you have provided. Sure I agree "In ... 20 healthy men ... 1 mg of alprazolam" by mouth will not likely affect respiratory function... That does NOT show that benzos never cause respiratory depression or even that they do not commonly do so.

Finding primary sources that support concern[3][4][5] is easy. Doc James (talk · contribs · email) 12:36, 21 October 2019 (UTC)

Doc James - In my professional experience, I have seen hypotension, somnolence, respiratory failure in persons after prolonged seizures before any benzo therapy. Your experience may suffer from a logical fallacy: post hoc ergo propter hoc.

My offerings: a well-written, prominently published, randomised, double-blind, placebo-controlled trial, and a US Supreme Court brief filed by 16 exceedingly well qualified and rigorously vetted pharmacologists that was extensively fact checked by many other exceptionally well-qualified persons before filing.

Your offerings: (1) an uncontrolled very small series of case reports written 17 yrs ago, (2) a small uncontrolled study of a respiratory volume monitor in which the authors had obvious conflicts of interest to develop and sell their device, and (3) a retrospective database study in which the only evidence that persons had taken benzos was that at one time they had filled a prescription for them somewhere in Taiwan.

It seems that the person who wins these "edit wars" is the person with the most time on their hands, not the person with the most scientific evidence or expertise. You win! Verytas (talk) 15:23, 21 October 2019 (UTC)

Verytas I was not suggesting that we use any of the primary sources in Wikipedia (neither the ones you provided nor the ones I provided). I was just showing how easy ones that support the opposite conclusion are to pull up. We should be using high quality secondary sources (which we do in this article and which supports the content in this article).

The American Society of Health-System Pharmacists has a review of the topic of lorazepam and discusses the concerns around respiratory depression. Why we would go looking at legal documents I am not sure.

If you refuse to follow Wikipedia's guidelines so be it. Neither your nor my claims of expertise advance the discussion. Best Doc James (talk · contribs · email) 01:56, 22 October 2019 (UTC)

Agreed. Flyer22 Reborn (talk) 03:28, 22 October 2019 (UTC)

Verytas, you may be correct and you may be incorrect but please try to understand that Wikipedia is not about an editor’s version of the WP:TRUTH, it is about what reliable sources say, per WP:MEDRS. Drugs.com is a reliable source and disagrees with you. Perhaps one day reliable secondary sources will agree with your viewpoint.--Literaturegeek | T@1k? 20:29, 22 October 2019 (UTC)

This drug mentioned in "The Departed" movie.

In Martin Scorsese's recent film, The Departed, Billy Costigan--an edgy, bitter, intelligent undercover cop for the Massachusetts State Police--suffers from frequent anxiety, claims to have panic attacks, and is prescribed lorazepam by a police psychologist. Source Ram nareshji (talk) 06:03, 28 May 2020 (UTC)

The website which you claimed to be a source is a wiki, so not acceptable as a reliable source, see WP:USERGENERATED. --David Biddulph (talk) 07:01, 28 May 2020 (UTC)

Also: so what? —Tamfang (talk) 03:18, 3 June 2020 (UTC)

Lorazepam is also prescribed for anxiety without an anxiety disorder

In regard to the recent reversion by the editor who seems certain it is only prescribed for anxiety disorders (in the context of anxiety), I've been in medical contexts as well as personally know people who have been prescribed Lorazepam, and I know that Lorazepam has been acceptably prescribed for temporary bouts of significant anxiety (e.g. a few days or weeks at most such as due to temporary health scares), without diagnosed anxiety disorders, and the heightened anxiety clearing after the triggering event resolves. An "anxiety disorder" entails a chronic condition. Lorazepam is without a doubt also prescribed for temporary heightened anxiety, with or without an anxiety disorder. 72.69.150.212 (talk) 04:37, 2 October 2023 (UTC)