Lorazepam (Elderly — Short-Term Use)

How it works

It enhances the inhibitory action of GABA at the GABA-A receptor, increasing chloride conductance to produce anxiolytic, sedative and anticonvulsant effects.

Prescribing in practice

• In older people benzodiazepines markedly increase the risk of sedation, confusion, cognitive impairment and falls, so use the lowest effective dose for the shortest possible time and avoid routine or prolonged use.
• Tolerance and dependence develop with continued use, so plan a short course with a clear stopping strategy and gradual withdrawal if used beyond a brief period.
• Additive central nervous system depression occurs with opioids, alcohol and other sedatives, raising the risk of excessive sedation and respiratory depression.

Monitoring

Monitor sedation, cognition, mobility and falls risk, and review the ongoing need at each opportunity to keep the course short.

Counselling the patient

• This is intended only for short-term use to limit dependence and falls.
• It can cause drowsiness and unsteadiness; take care moving about and avoid alcohol.
• Do not stop abruptly after regular use, as withdrawal effects can occur.

Evidence & guidelines

Guidance on prescribing in older adults consistently identifies benzodiazepines as high-risk for falls and cognitive harm, supporting short-term use only with a planned withdrawal.