로라제팜
Lorazepam
7-chloro-5-(2-chlorophenyl)-3-hydroxy-1,3-dihydro-2H-1,4-benzodiazepin-2-one
다른 이름: Ativan · Lorazepam Intensol · BRN-07599084 · CB-8133 · Ro-7-8408 · Wy-4036 · lorazapamum · anxiedin · azurogen · bonatranquan · delormetazepam · lorazin · lorazon · lorenin · norlormetazepam · novhepar · novolorazem · oChloroxazepam · sinestron · Lorazepamum
VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
동물 종별 용량
🌎 NA — North America🌍 EU — Europe
개
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Status epilepticus (alternative to diazepam) | 0.2 mg/kg IV, IM or intranasal once | IV/IM/intranasal | once | — | 🌎 NA |
| Status epilepticus | 0.2 mg/kg IV once, followed by a bolus IV loading dose of levetiracetam at 60 mg/kg | IV | once | — | 🌎 NA |
| Fears, anxieties, phobias | 0.02-0.1 mg/kg PO once daily to three times a day | PO | q8-24h | — | 🌎 NA |
| Anxiolytic | 0.05-0.25 mg/kg PO q12-24h | PO | q12-24h | — | 🌎 NA |
| Fears/anxiety | 0.02-0.5 mg/kg PO q8h | PO | q8h | — | 🌎 NA |
| Fears, anxieties, phobias, aversions | 0.02-0.1 mg/kg q8-24h | PO | q8-24h | — | 🌎 NA |
| Short-term management of anxiety disorders | 0.02-0.1 mg/kg | PO | q12-24h | Short-term | 🌍 EU |
- Fears, anxieties, phobias: May be used on an as needed basis
- Fears/anxiety: The lowest dose and frequency that alleviate the fear should be used
- Fears, anxieties, phobias, aversions: Minimally sedating, may require 4 weeks to peak effect
- Short-term management of anxiety disorders: Start at the lower end of the dose range and gradually increase as needed.
고양이
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Fears/anxiety | 0.03-0.08 mg/kg PO q12h | PO | q12h | — | 🌎 NA |
| Fears, anxieties, phobias | 0.125 mg-0.25 mg total dose (¼-½ of a 0.5 mg tablet) once to twice a day | PO | q12-24h | — | 🌎 NA |
| Anxiolytic | 0.05-0.25 mg/kg PO q12-24h | PO | q12-24h | — | 🌎 NA |
| Short-term management of anxiety disorders | 0.02-0.1 mg/kg | PO | q12-24h | Short-term | 🌍 EU |
- Fears/anxiety: The lowest dose and frequency that alleviate the fear should be used
- Fears, anxieties, phobias: May be used on an as needed basis
- Short-term management of anxiety disorders: Start at the lower end of the dose range and gradually increase. Monitor closely for signs of hepatotoxicity.
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
개요
로라제팜은 강력한 중간 작용형 벤조디아제핀계 약물로, 수의학에서는 주로 행동 장애를 위한 항불안제 및 간질 중첩증 치료 시 디아제팜의 대체제로 사용됩니다。
임상 요점: 디아제팜과 달리 로라제팜은 활성 중간 대사 산물을 형성하지 않고 직접 글루쿠론산 포합 과정을 거칩니다. 이는 노령, 비만 또는 간 기능이 저하된 환자에게 훨씬 안전한 선택이 됩니다.
- 다양한 투여 경로: 비강 내, 근육 내, 설하/볼 점막 등 다양한 경로로 투여할 수 있어 가정이나 병원에서의 응급 발작 관리에 매우 다용도로 활용됩니다.
- 작용 시간: 디아제팜만큼 효과적인 것으로 보이며, 항경련 작용 지속 시간이 더 길 수 있습니다(단, 개에서는 명확히 입증되지 않음).
작용 기전
Lorazepam acts as a positive allosteric modulator at the GABA-A receptor.
- It binds to the benzodiazepine site on the GABA-A receptor complex → enhances the affinity of the receptor for the inhibitory neurotransmitter gamma-aminobutyric acid (GABA).
- This increases the frequency of chloride channel openings → influx of chloride ions → hyperpolarization of the neuronal membrane → decreased neuronal excitability.
- This widespread CNS depression primarily affects the subcortical levels (limbic, thalamic, and hypothalamic), yielding anxiolytic, sedative, skeletal muscle relaxant, and anticonvulsant effects.
- Other postulated mechanisms include antagonism of serotonin and diminished release or turnover of acetylcholine in the CNS.
안전성·주의사항
금기사항
- Hypersensitivity to benzodiazepines
- Severe respiratory insufficiency (unless mechanically ventilated)
- Glaucoma
- Significant liver disease
- Significant kidney disease
- Pregnant animals
- Lactating animals
부작용
- Increased appetite
- Increased activity/excitement (paradoxical reaction)
- Vocalization
- Somnolence
- Lethargy
- Disinhibition (potential emergence of aggression)
- Drowsiness
- Mild transient incoordination (ataxia)
- Tremor and inappetence (associated with acute withdrawal)
주의
Withdrawal: When using for negative behaviors, withdraw the drug gradually to avoid a rebound effect. Physical dependency has been induced in dogs; long-term regular usage requires gradual weaning.
Administration Warning: Injectable lorazepam must NOT be given intra-arterially; arteriospasm may occur resulting in necrosis.
Pregnancy: Designated FDA Category D in humans (evidence of fetal risk), but animal studies suggest relative safety at usual dosages. High doses just prior to delivery can cause 'floppy infant' syndrome.
약물 상호작용
Additive CNS effects
Decreased renal clearance of lorazepam
Increased CNS depression, irrational behavior
Decreased sedation from lorazepam
Increased lorazepam serum concentration
Inhibits the metabolism of lorazepam, potentially leading to increased plasma concentrations and prolonged sedation.
May inhibit the metabolism of lorazepam, increasing the risk of toxicity.
Additive CNS depression and sedation.
모니터링
- Clinical efficacy (seizure control or anxiety reduction)
- Adverse effects (CNS depression, paradoxical excitation, ataxia)
- Behavioral changes (watch for paradoxical aggression or extreme sedation)
- Liver enzymes (ALT, AST, ALP, Bilirubin), especially in cats
- Appetite and water intake
약동학
반감기
흡수
In humans, absolute bioavailability is ~90% orally. Rapidly and completely absorbed after IM dosing. Sublingual has similar bioavailability to oral, but peaks sooner. In dogs, intranasal administration reaches 30 ng/mL in 3-9 minutes.
분포
High affinity for benzodiazepine receptors in the CNS. Brain concentrations may persist longer than serum levels. Small amounts are distributed into milk.
대사
Converted into inactive glucuronide forms in the liver in most species. Lack of active metabolites makes it safer for patients with liver dysfunction.
배설
Dogs: Primary elimination route is via urine. Cats: Elimination is ~50% in urine (primarily as glucuronide) and 50% in feces.
과다투여
Overdoses of lorazepam are generally limited to CNS depression (confusion, lethargy, somnolence, decreased reflexes).
- Severe Toxicity: Very large overdoses can cause ataxia, hypotension, coma, and rarely death.
- Treatment: Standard protocols for removing/binding the drug in the gut (if orally ingested) and supportive systemic measures. Forced diuresis with IV fluids/electrolytes and mannitol may enhance excretion in patients with normal renal function.
- Antidote: Flumazenil may be considered for adjunctive treatment of serious overdoses, but it does not replace supportive therapy. Caution: Flumazenil is not recommended in patients with seizure disorders as it may induce seizures.
- Note: Analeptic agents (CNS stimulants like caffeine) are generally not recommended.
제품
제형
- Concentrated Oral Solution
- Injection
- 1 mg oral tablets
- 2 mg/ml oral suspension
- 4 mg/ml injectable solution
인용의약품
- Lorazepam Tablets: 0.5 mg, 1 mg, & 2 mg
- Lorazepam Concentrated Oral Solution: 2 mg/mL
- Lorazepam Injection: 2 mg/mL & 4 mg/mL
- Ativan 1 mg tablets
- Intensol 2 mg/ml oral suspension
- Lorazepam 4 mg/ml injectable solution
규제 현황
POM (Prescription Only Medicine). Subject to national controlled substance regulations.
POM-V / POM. Controlled Drug Schedule 4 Part 1.
규제 데이터 없음: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
보관·안정성
Tablets should be stored in well-closed containers at room temperature (20-25°C). Oral solution and injection should be stored refrigerated (2-8°C) and protected from light. Injection must be diluted just prior to IV use with an equal volume of D5W, normal saline, or sterile water. Do not use if discolored or if a precipitate forms.
보호자 정보
로라제팜은 반려동물의 발작을 조절하거나 심각한 불안 및 공포증을 관리하는 데 사용되는 약물입니다.
- 식욕 변화: 이 약물은 반려동물의 식욕을 증가시킬 수 있습니다. 원치 않는 체중 증가를 방지하기 위해 철저한 식사 제한이 필요할 수 있습니다.
- 행동 변화: 활동 수준의 변화를 관찰하십시오. 졸음/무기력을 유발할 수도 있고, 반대로 활동 증가, 흥분, 짖음 증가를 유발할 수도 있습니다.
- 갑작스러운 중단 금지: 수의사의 지시 없이 갑자기 치료를 중단하지 마십시오. 이 약물을 장기간 정기적으로 복용한 동물은 적절히 '점진적 감량'을 하지 않으면 금단 증상이 나타날 수 있습니다.
- 간 건강: 로라제팜을 복용하는 동물에서 간 독성이 보고된 바는 없지만, 유사한 약물(디아제팜)이 고양이에서 드물게 간 독성을 일으킨 적이 있습니다. 구토, 식욕 부진, 또는 흰자위나 잇몸이 노랗게 변하는 증상(황달)이 관찰되면 즉시 수의사에게 연락하십시오.
- 투약 팁: 알약은 비교적 맛이 없고 침에 쉽게 녹습니다. 알약을 먹이기 어렵다면 환자의 볼 안쪽에 알약을 넣고 1분 정도 후에 작은 간식을 주어 삼키도록 유도하십시오.
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