Lorabex

Leaflet accompanying the packaging: patient information

Lorabex, 0.5 mg, tablets

Lorabex, 1 mg, tablets

Lorabex, 2.5 mg, tablets

Lorazepam

It is essential to carefully read the contents of the leaflet before taking the medication, as it contains important information for the patient.

• The leaflet should be kept in case it needs to be read again.
• In case of any doubts, the patient should consult a doctor or pharmacist.
• This medication has been prescribed for a specific person. It should not be given to others. The medication may harm another person, even if their symptoms are the same.
• If the patient experiences any side effects, including those not listed in this leaflet, they should inform their doctor or pharmacist. See section 4.

Table of contents of the leaflet

• 1. What is Lorabex and what is it used for
• 2. Important information before taking Lorabex
• 3. How to take Lorabex
• 4. Possible side effects
• 5. How to store Lorabex
• 6. Package contents and other information

1. What is Lorabex and what is it used for

Lorabex contains the active substance lorazepam. Lorazepam is a sedative and anxiolytic medication, belonging to the benzodiazepine group.
Lorabex is indicated:

• for the short-term symptomatic treatment of anxiety disorders and insomnia caused by anxiety, when the anxiety is severe, debilitating, or causes extreme suffering.
• for sedation before diagnostic procedures or surgical procedures.

2. Important information before taking Lorabex

When not to take Lorabex:

• if the patient is allergic to lorazepam, other benzodiazepines, or any of the other ingredients of this medication (listed in section 6);
• if the patient has severe respiratory problems or experiences chest pain, such as chronic obstructive pulmonary disease;
• if the patient has excessive muscle weakness (myasthenia gravis);
• if the patient has severe liver problems;
• if the patient has sleep apnea syndrome (breathing problems during sleep).

Warnings and precautions

Before starting treatment with Lorabex, the patient should discuss the following with their doctor or pharmacist:

• if the patient has a history of drug, alcohol, or substance abuse. In such cases, Lorabex should not be used, as the risk of dependence on lorazepam is increased;
• if the patient has personality disorders, as there is a higher risk of dependence on lorazepam;
• if the patient has kidney or liver problems;
• if the patient is elderly, as there is an increased risk of falls;
• if the patient has a history of depression, as lorazepam may cause a relapse of depression;
• if the patient has depression, lorazepam may increase the risk of suicidal thoughts;
• if the patient has coordination problems (ataxia);
• if the patient has breathing problems;
• if the patient has eye problems - glaucoma (high eye pressure);
• if the patient has low blood pressure.

In some patients, particularly those with depression, suicidal thoughts have occurred while taking lorazepam.
If the patient has depression, irrational fears, and obsessions, or has had suicidal thoughts or self-harm thoughts, they should immediately contact their doctor.
At the beginning of treatment, the doctor will monitor the patient's response to the medication to quickly detect potential overdose. Greater sensitivity to lorazepam may occur in children, elderly, or weakened patients. Therefore, in these groups, treatment with lorazepam should be carried out under closer medical supervision.
If the patient has kidney or liver dysfunction, heart failure, and/or low blood pressure (hypotension), they may be more sensitive to the effects of this medication; the same applies to elderly patients. In these patients, there is an increased risk of falls, especially when getting up at night.
During treatment with lorazepam, hepatic encephalopathy (brain disease caused by liver damage) may occur. Lorazepam should not be used in patients with severe liver dysfunction and/or hepatic encephalopathy.
Memory loss may occur during treatment with lorazepam.
When using lorazepam as a sleep aid, the patient should ensure they can have 7-8 hours of uninterrupted sleep. If the patient follows this recommendation, they can usually avoid post-awakening effects (e.g., fatigue, reaction disorders).
The patient should ask their doctor for detailed guidelines on daily life, taking into account their specific lifestyle (e.g., profession) during treatment with lorazepam.
Paradoxical reactions have been reported in patients taking benzodiazepines, such as anxiety, excitement, delusions, agitation, aggressive behavior, sleep disturbances, sexual stimulation, hallucinations, and psychoses (see section 4). The occurrence of these side effects is more likely in children or elderly patients. Treatment with lorazepam should be discontinued if paradoxical reactions occur.
The use of benzodiazepines, including lorazepam, can lead to life-threatening respiratory depression.
The risk of dependence increases with the dose and duration of treatment and is higher in patients addicted to alcohol and drugs. Lorabex should be used for the shortest possible time (see section 4).
If, after several weeks of treatment, the patient notices that the medication is not working as well as it did at the beginning of treatment, they should contact their doctor.
Lorazepam should be discontinued gradually to avoid withdrawal symptoms (see section 3).
Severe allergic reactions have been reported in patients taking benzodiazepines. In patients who have taken the first dose or subsequent doses of benzodiazepines, cases of skin and/or mucous membrane edema (angioedema) have been reported, including swelling of the tongue, throat, or vocal cords. In some patients, other side effects have occurred, such as shortness of breath, throat swelling, or nausea and vomiting.
Some patients may require hospitalization. If any of the above symptoms occur, the patient should immediately inform their doctor or go to the nearest hospital emergency department. Airway obstruction can be fatal.

Children and adolescents

Lorabex should not be used in children and adolescents under 18 years of age, unless it is necessary for sedation before surgical or diagnostic procedures. For children under 6 years of age, lorazepam is contraindicated. More information - see section 3.

Lorabex and other medications

The patient should tell their doctor or pharmacist about all medications they are currently taking or have recently taken, as well as any medications they plan to take. This is especially important for medications such as:

• medications used to treat narcolepsy (e.g., sodium oxybate)
• medications used to treat HIV (e.g., zidovudine)
• medications used to treat delusions or hallucinations (e.g., chlorpromazine, loxapine, or clozapine)
• medications used to treat indigestion (e.g., antacids, cisapride, or omeprazole)
• medications used to treat nausea and vomiting caused by chemotherapy (nabilone)
• medications used to treat addictions (e.g., lofexidine and disulfiram)
• strong painkillers (e.g., methadone, tramadol, codeine, morphine)
• medications used to treat tuberculosis, such as isoniazid
• antibiotics, such as erythromycin
• medications used to treat high blood pressure (e.g., ACE inhibitors, alpha-blockers, angiotensin II receptor antagonists, calcium channel blockers, adrenergic neuron blockers, beta-adrenergic blockers, moxonidine, nitrates, hydralazine, minoxidil, sodium nitroprusside, and diuretics)
• medications used to treat asthma (e.g., theophylline)
• muscle relaxants (e.g., baclofen and tizanidine)
• other sedatives (e.g., barbiturates or antihistamines)
• other medications used to treat anxiety
• medications used to treat depression
• antihistamines for allergies
• medications used to treat Parkinson's disease (e.g., levodopa)
• medications used to treat epilepsy (e.g., phenobarbital or valproate)
• medications used to treat gout (e.g., probenecid)
• estrogen-containing contraceptives
• medications that affect liver enzymes (e.g., cimetidine, esomeprazole, rifampicin, ketoconazole, itraconazole).

If lorazepam is used at the same time as other medications that depress the central nervous system (e.g., psychotropic medications, sleep aids, sedatives, anesthetics, beta-adrenergic blockers, painkillers, sedative antihistamines, anticonvulsants), interactions may occur, resulting in additive effects on the central nervous system.
Concomitant use of lorazepam and opioids (e.g., strong painkillers, some antitussive medications, and replacement therapy medications) increases the risk of drowsiness, breathing difficulties (respiratory depression), coma, and may be fatal. Concomitant use should only be considered when other treatment options are not possible.
If the doctor prescribes lorazepam with opioids, they should limit the dose of lorazepam and the duration of treatment. The patient should inform their doctor about all opioid medications they are taking and strictly follow the doctor's dosage instructions. It may be helpful to inform relatives or friends about the above symptoms.
The patient should inform their doctor if any of the above symptoms occur.
The effects of muscle relaxants and painkillers may be enhanced.
If lorazepam is used with clozapine, significant sedation, excessive salivation, and coordination disorders may occur.
Concomitant use of lorazepam with valproate may increase the concentration of lorazepam in the blood. If valproate is used concomitantly, the dose of lorazepam should be reduced by about half.
Concomitant use of lorazepam with probenecid may accelerate the onset of action or prolong the effect of lorazepam. When probenecid is used concomitantly, the dose of lorazepam should be reduced by half.
Theophylline or aminophylline may weaken the sedative effect of lorazepam.

Lorabex with food, drink, and alcohol

The patient should avoid drinking alcohol, as it may change and enhance the effect of lorazepam in an unpredictable way.

Pregnancy, breastfeeding, and fertility

If the patient is pregnant or breastfeeding, thinks they may be pregnant, or plans to have a child, they should consult their doctor or pharmacist before taking this medication.

Pregnancy

Lorazepam should not be taken during pregnancy. The doctor will decide whether to discontinue treatment.
If the patient takes lorazepam during late pregnancy or childbirth, the baby may be less active than other babies, may have low muscle tone, low body temperature (hypothermia), and/or low blood pressure (hypotension), respiratory depression, apnea, and feeding difficulties ("floppy infant syndrome"). After birth, the baby may experience withdrawal symptoms if the mother has taken lorazepam for a long time during late pregnancy.

Breastfeeding

Lorazepam passes into breast milk and may cause sedation and feeding problems in the baby. Lorazepam should not be taken during breastfeeding.

Fertility

There is no data on the effect of the medication on fertility in women. In men, benzodiazepines may cause ejaculation disorders and delayed orgasm.

Driving and operating machinery

Lorazepam used as directed may cause reaction disorders, especially in the first few days of treatment. In such cases, the patient may not be able to react quickly enough to unexpected and sudden events. The patient should not drive vehicles. The patient should not operate any hazardous electrical tools or machines. The patient should not work without secure foot support. In particular, remember that alcohol also impairs reaction ability.
The attending doctor will decide whether the patient can drive or operate machines, taking into account the individual response to treatment and the dose taken.

Lorabex contains lactose monohydrate

If the patient has been diagnosed with intolerance to some sugars, they should contact their doctor before taking this medication.

3. How to take Lorabex

This medication should always be taken as directed by the doctor. In case of doubts, the patient should consult their doctor or pharmacist.
The dosage and duration of treatment should be adjusted according to the individual response to treatment, the therapeutic indication (i.e., the disease for which the medication is prescribed), and the severity of the disease.
Essentially, the smallest effective dose should be used for the shortest possible time.

Adults

The patient should follow the doctor's instructions; otherwise, lorazepam may not work properly.
Lorazepam should be taken according to the following dosage schedule, unless the doctor advises otherwise:
Treatment of anxiety and insomnia caused by anxiety:
The daily dose for adults is usually 0.5 mg - 2.5 mg of lorazepam, in 2 - 3 divided doses or once before bedtime.
Sedation before diagnostic or surgical procedures:
For adults, 1 mg - 2.5 mg of lorazepam in the evening before the procedure and/or 2 mg - 4 mg of lorazepam about 1 - 2 hours before the procedure.

Use in elderly or weakened patients

In elderly or weakened patients, as well as in patients with organic brain damage, the initial total daily dose should be reduced by half. Patients should use the medication in the smallest effective dose. The doctor will decide on the best treatment schedule, tailored to the individual needs of the patient.

Use in patients with kidney dysfunction

Patients with kidney dysfunction may take lower doses. The initial dose is usually half the recommended dose for adults. The doctor will monitor the patient's response to the medication and adjust the dose if necessary.

Use in patients with liver dysfunction

Patients with moderate to mild liver dysfunction may receive lower doses. The initial dose is usually half the recommended dose for adults.
Lorazepam is contraindicated in patients with severe liver failure.

Use in children and adolescents

Lorazepam should not be used to treat anxiety or insomnia in children and adolescents under 18 years of age.

• Children under 6 years of age Children under 6 years of age should not be treated with lorazepam.
• Children aged 6-12 years Before diagnostic or surgical procedures: the recommended dose is 0.5 mg - 1 mg, depending on the child's body weight (do not exceed 0.05 mg/kg body weight), taken at least 1 - 2 hours before the operation.
• Adolescents aged 13-18 years Before diagnostic or surgical procedures: the recommended dose is 1 mg - 4 mg, taken 1 - 2 hours before the operation.

Method of administration

Lorazepam is intended for oral administration.
Tablets should be swallowed whole, with a sufficient amount of liquid (e.g., ½ to 1 glass of water).
The score line on the tablet makes it easier to break the tablet in half, if the patient has difficulty swallowing the tablet whole.
Lorabex 1 mg and Lorabex 2.5 mg: tablets can be divided into equal doses.

Duration of treatment

The duration of treatment is determined by the doctor.
In acute conditions, the use of lorazepam should be limited to single doses or taken for a few days.
In chronic diseases, the duration of treatment depends on the severity of the disease. After 2 weeks of daily use, the doctor should gradually reduce the dose and decide whether treatment with lorazepam is still necessary.

Taking a higher dose of Lorabex than recommended

In case of overdose, the patient should immediately contact their doctor. The patient should call their doctor for first aid instructions and follow them. The patient should not induce vomiting unless the doctor advises otherwise. Symptoms of overdose are: drowsiness, confusion, lethargy, shallow breathing, coordination disorders, apathy, and in severe cases, loss of consciousness.

Missing a dose of Lorabex

If a dose is missed, the patient should take the next tablet at the usual time the next day. The patient should not take a double dose to make up for the missed dose.

Stopping treatment with Lorabex

Sudden discontinuation of Lorabex after prolonged use may lead to withdrawal symptoms (see section 4). To avoid this, the dose should be gradually reduced.
After a longer period of treatment (more than a week) and sudden discontinuation, sleep disorders, anxiety, and tension may temporarily return in an intensified form. The patient should not suddenly stop treatment but gradually reduce the dose.
If the patient has any further doubts about using this medication, they should consult their doctor or pharmacist.

4. Possible side effects

Like all medications, Lorabex can cause side effects, although not everyone will experience them.
The patient should expect side effects, especially at the beginning of treatment, if the dose is too high, and in the patient groups mentioned in "Warnings and precautions" (see section 2).

• 2.

Very common: may occur in more than 1 in 10 patients

• sedation, fatigue, drowsiness.

Common: may occur in less than 1 in 10 patients

• ataxia (coordination disorders).
• confusion, depression, onset of depression.
• dizziness.
• muscle weakness, feeling of weakness (fatigue).

Uncommon: may occur in less than 1 in 100 patients

• disturbed sexual desire, impotence, less intense orgasm.
• malaise.

Rare: may occur in less than 1 in 1,000 patients

• rash.
• concentration disorders.
• changes in salivation.

Very rare: may occur in less than 1 in 10,000 patients

• leukopenia.

Unknown(frequency cannot be estimated from available data):

• changes in blood morphology (thrombocytopenia, agranulocytosis, pancytopenia)
• prolonged reaction time
• impaired coordination (extrapyramidal symptoms)
• tremors
• vision disorders (double vision, blurred vision)
• speech disorders (dysarthria)
• headache
• seizures/epileptic fits
• amnesia
• disinhibition (psychic), euphoria
• coma
• suicidal thoughts/attempts
• attention/concentration disorders
• balance disorders
• dizziness
• paradoxical reactions, such as anxiety, excitement, agitation, aggressive behavior, sleep disturbances, sexual stimulation, hallucinations, and psychoses. If such side effects occur, treatment with lorazepam should be discontinued.
• low blood pressure (hypotension), slight decrease in blood pressure
• respiratory depression (dose-dependent), shortness of breath (apnea), worsening of sleep apnea (transient interruption of breathing during sleep)
• worsening of obstructive pulmonary disease (narrowing of airways)
• constipation
• increased bilirubin levels
• jaundice, increased liver enzyme activity (transaminases, alkaline phosphatase)
• allergic skin reactions
• hair loss
• hypersensitivity reactions and anaphylactic/anaphylactoid reactions, skin and/or mucous membrane edema (angioedema)
• syndrome of inappropriate antidiuretic hormone secretion (SIADH)
• low sodium levels in the blood (hyponatremia)
• decreased body temperature (hypothermia).

Benzodiazepines cause dose-dependent depression of the central nervous system.
Dependence/abuse
Even after a few days of daily use of lorazepam, and after discontinuation, especially sudden, withdrawal symptoms may occur (e.g., sleep disorders, intense dreams). Anxiety, tension, and restlessness may worsen (rebound phenomena). Other symptoms reported after discontinuation of benzodiazepines include: headache, depression, confusion, irritability, sweating, mood disorders, loss of reality, behavioral disorders, numbness and tingling of limbs, hypersensitivity to light, sound, and touch, concentration disorders, involuntary movements, nausea, vomiting, diarrhea, loss of appetite, hallucinations/delirium, seizures/epileptic fits, tremors, muscle cramps, excitement, tachycardia, panic attacks, dizziness, hyperreflexia, loss of short-term memory, and increased body temperature. In the case of chronic use of lorazepam in patients with epilepsy or those taking other medications that lower the seizure threshold (e.g., antidepressants), sudden discontinuation of lorazepam may cause more frequent seizures. The risk of withdrawal symptoms increases with the duration of treatment and dose. This can usually be avoided by gradually reducing the dose.
Lorazepam has the potential for dependence. Patients who have abused drugs or alcohol in the past are at higher risk.
Procedure in case of side effects
Many of the above side effects will resolve as treatment continues or after the dose is reduced. If side effects persist, the patient should inform their doctor, who will decide whether to discontinue treatment. The patient should inform their doctor if a skin rash of unknown origin, discoloration, or skin swelling occurs.

Reporting side effects

If the patient experiences any side effects, including those not listed in this leaflet, they should inform their doctor or pharmacist. Side effects can be reported directly to the Department of Drug Safety, Office for Registration of Medicinal Products, Medical Devices, and Biocidal Products, Al. Jerozolimskie 181C, 02-222 Warsaw, Tel.: +48 22 49 21 301, Fax: +48 22 49 21 309, website: https://smz.ezdrowie.gov.pl. Side effects can also be reported to the marketing authorization holder. By reporting side effects, more information can be collected on the safety of the medication.

5. How to store Lorabex

Do not store above 25°C. Store in the original packaging to protect from light.
The medication should be stored out of sight and reach of children.
Do not use this medication after the expiration date stated on the packaging and blister after EXP.
The expiration date refers to the last day of the specified month.
The inscription on the packaging after the abbreviation EXP indicates the expiration date, and after the abbreviation Lot/LOT, it indicates the batch number.
Medications should not be disposed of in wastewater or household waste. The patient should ask their pharmacist how to dispose of unused medications. This will help protect the environment.

6. Package contents and other information

What Lorabex contains

• The active substance of the medication is lorazepam; each tablet contains 0.5 mg, 1 mg, or 2.5 mg of lorazepam.
• Other ingredients are: lactose monohydrate, povidone (K 30), crospovidone (type A), cornstarch, microcrystalline cellulose (E 460), sodium carboxymethylcellulose (type A), potassium polacrilin, magnesium stearate (E 572).

What Lorabex looks like and package contents

Lorabex 0.5 mg are white, round tablets with rounded edges.
Lorabex 1 mg are white, round, flat tablets with beveled edges, with the inscription "1.0" on one side.
Lorabex 2.5 mg are white, round, flat tablets with beveled edges.
The Lorabex 1 mg and 2.5 mg tablets can be divided into equal doses.
The packaging contains 25 tablets.

Marketing authorization holder

Zakłady Farmaceutyczne POLPHARMA SA, ul. Pelplińska 19, 83-200 Starogard Gdański, tel. +48 22 364 61 01

Manufacturer

Farmaceutisch Analytisch Laboratorium Duiven B.V., Dijkgraaf 30, 6921 RL Duiven, Netherlands, Zakłady Farmaceutyczne POLPHARMA SA, ul. Pelplińska 19, 83-200 Starogard Gdański

Date of last revision of the leaflet: