Lorazepam: the BFFPharmacodynamics of the liverLorazepam or better known as Ativan belongs to the benzodiazepine family and produces inhibitory effects on the central nervous system. The therapeutic action of Lorazepam occurs through interaction at benzodiazepine binding sites. These binding sites are located on inotropic gamma-amino butyric acid-A (GABAA) receptors. The neurotransmitter used by Lorazepam is the inhibitory neurotransmitter GABA. Lorazepam and other benzodiazepines do not bind directly to the same receptor site as the endogenous neurotransmitter GABA. As you can see in Figure 1, they bind to benzodiazepine binding sites located between the alpha and gamma subunits of the GABAA receptors. Once the benzodiazepine locks into the GABAA receptor, it modifies it, so that the neurotransmitter GABA has a much higher affinity for it. Lorazepam does not mimic the effects of GABA, but rather enhances the affinity of GABA for the GABAA receptor. Lorazepam does not directly open the chloride gates. The neurotransmitter GABA is what opens the doors. With higher affinity, there is a pulsating movement of the door opening and closing, which causes more chloride to enter. When GABA normally binds to the GABAA receptor, it opens a chloride channel allowing chloride to rush into it. When lorazepam binds to benzodiazepine. site on the GABAA receptor, it increases the rate at which the chloride channel opens when GABA attaches to it. This helps increase the concentration of chloride ions in the cell. This effect causes the cell to hyperpolarize, making it very negative inside, which makes it less excitable. This reversal potential of chloride ions inhibits the initiation of any further powerful action...... middle of paper ......When the patient is suffering from anxiety or alcohol withdrawal, they receive the same dose. It is administered sublingually at a dose of 2 to 6 mg. If the patient is in status epilepticus, the recommended dose is 0.05 mg/kg up to a maximum of 4 mg by a slow intravenous push. This dose can be repeated once every 12 hours. (Wyeth & Ayerst) Local protocols may differ from these and medical directors may decide what dose of medication they prefer to receive. As you can see in Table 1, the recommended dose by Alberta Health Services is 1 mg sublingually and can be repeated once. More may be administered, but a consultation with an online medical check will need to be carried out. Lorazepam - Alcohol withdrawal and non-aggressive psychiatry Table 1: AHS protocols (https://www.ahsems.com/secure/protocols/1#view/5042/Notes)(Saari, Uusi-Oukari, Ahonen and Olkkola , 2011)