The 3 differences between lorazepam and lormetazepam

Anxiety disorders are spreading like wildfire in the general population, as any person belonging to a globalized country will know firsthand the dizzying pace at which the society.

Therefore, it is not a coincidence that the use of anxiolytics and hypnotics has increased in almost everyone.

Despite being under prescription, the abuse of these drugs is a growing concern for public health organizations. Based on this reason, knowing exactly the differences between the drugs that try to address pathologies of a nervous nature becomes essential. Here we will focus on the differences between lorazepam and lormetazepam.

• Related article: "Benzodiazepines (psychoactive drug): uses, effects and risks"

Main differences between lorazepam and lormetazepam

Lorazepam, alprazolam, oxazepam, temazepam, lormetazepam, triazolam... Undoubtedly, the number of anxiolytics that end in "pam" can cause confusion even in the greatest of experts in the field. Therefore, here we will talk about the 3 differences between lorazepam and lormetazepam, two benzodiazepines widespread in the pharmaceutical world.

In the first place, we see of essential importance to frame the situation of anxiety and the disorders that it entails. Various studies show us data of great interest:

• In the United States, anxiety disorders occur in almost 13% of the population.
• Generalized anxiety disorder is seen in 5% of the world's population.
• The global prevalence of obsessive-compulsive disorder (OCD) is 2.1%.
• For these reasons, the global consumption of anxiolytics has increased by 4.5% in the last 8 years.

It may seem that a prevalence of generalized anxiety disorder of 5% is very low, but we have to keep one thing in mind: not all cases are diagnosed and we are facing a variant that requires permanence. Many people suffer from very strong episodes of anxiety, but if these do not persist over time, they are not considered a disorder as such. Thus, the numbers would surely inflate if we took into account all the possible meanings of the term "anxiety".

Before explaining the differences between lorazepam and lormetazepam, we have to take into account that both drugs are within the group of benzodiazepines. These are defined as central nervous system acting psychotropic medications with sedative, hypnotic, anxiolytic, anticonvulsant, amnesic, and muscle relaxant effects.

The Spanish Agency for Medicines and Health Products (AEMPS) published the use report of anxiolytics during the years 2000-2018 in Spain, which contains the most active ingredients consumed. At the top of the list we have lorazepam, as it accumulates a consumption of 39.47%. The rest of the news is not positive, because for the year 2011, the number of Defined Daily Dose (DDD) of this type of drug corresponded to 82.9 DDD per 1,000 inhabitants per day.

In recent years things have skyrocketed, as other sources indicate that from 2000 to 2012 the consumption of anxiolytics has increased by 57%. In addition, the figures in our country are some of the highest in Europe, surpassing Germany or the United Kingdom. Exposing these data is necessary, as you have to be careful with this type of drug and the dependence they generate.

Now let's see the differences between lorazepam and lormetazepam.

1. The key to the differences lies in their use

Although both belong to the group of benzodiazepines, lorazepam and lormetazepam are used for relatively different disorders.

First, lorazepam is an anxiolytic with sedative, muscle relaxant, anticonvulsant, and amnesic properties. It presents a high potency, since its bioavailability (the speed and efficiency with which it reaches the target tissue) is 90% and reaches its peak concentration two hours after an administration oral. According to the drug's own medical leaflet, lorazepam is used in the following cases:

• Short-term treatment of all anxiety states, associated or not with organic disorders, which acts without influencing the individual's activities.
• Sleep disorders.

On the other hand, lormetazepam is a short-acting benzodiazepine with hypnotic properties, anxiolytics, anticonvulsants, sedatives, amnesic and muscle relaxant (yes, almost the same as the lorazepam). The essential difference of this drug from lorazepam is in its hypnotic property. This means that it is used almost exclusively for the short-term treatment of insomnia.

This drug normalizes the time to fall asleep and the duration of the same, at the same time that it reduces the number of interruptions of rest during the night. For this reason, it can also be used to induce sleep in pre- and post-operative periods.

As we can see, the essential functional difference between both drugs is that lorazepam is used for a wide spectrum of situations to combat anxiety (since it does not severely affect the cognitive abilities of the individual), while lormetazepam seeks that the patient has a deep and uninterrupted sleep.

• You may be interested in: "Lorazepam: Uses and Side Effects of This Drug"

2. Two types of administration for two different drugs

Following again the medical leaflets of each of the drugs, we can discover even more differential properties between lorazepam and lormetazepam. The doses to be used are, without a doubt, a different element between both treatments.

First of all, the administration of lorazepam is recommended (as long as it has been prescribed by a professional) in anxiety pictures in a total concentration of 0.5 mg to 3 mg, divided into different doses during the day. This dose can be increased or decreased according to the age of the patient or his psychological needs. In general, the treatment should not exceed 8-12 weeks (always being as short as possible). For the treatment of insomnia, a single dose of 1 mg is recommended in the first instance, which can be increased to 4 mg, always before going to bed.

On the other hand, unlike lorazepam for anxiolytic use, the dose of lormetazepam is advised to be single and 1 mg 15 to 30 minutes before the patient lies down. As it has a unique hypnotic effect, its administration during the day in small doses is not contemplated. In addition, in this case, the dose can only be increased to 2 mg in either case. Still, as with all benzodiazepines, treatment should be as short as possible.

3. Differences in popularity

As we have already said previously, lorazepam (along with alprazolam) are the flagship benzodiazepines as far as general consumption is concerned. In Spain, for example, lorazepam leads consumption, with almost 40% of all prescription anxiolytics. They are followed by alprazolam (27.96%) and diazepam (16.46%). Between 2000 and 2011, a total of 20.5 Defined Daily Dose (DDD) of lorazepam was calculated per 1000 inhabitants per day. It was also recorded that their consumption increased by 75% in this interval.

In the previous paragraph we have not stopped moving in the field of anxiolytics, so it is normal that lorazepam is at the top of the mountain, but things change when we look at the hypnotics. Within its own land, lormetazepam is king, since between 2000 and 2011 a total of 18.3 DDD was calculated per 1000 inhabitants per day. Things get more interesting when we consider that this drug increased its consumption by 103% in the measured interval.

From all this conglomerate terminology, one thing is clear: the consumption of lorazepam is more more widespread than lormetazepam, but both are the dominant drugs within their own group of action.

Resume

As we have seen, the differences between lorazepam and lormetazepam are in the details: one focuses more on sleep therapy and another to generalized anxieties, they are administered in different ways and lorazepam is relatively more widespread in the population general. Nonetheless, being both benzodiazepines, they share many more characteristics than those that differentiate them.

Finally, it should be noted that all these drugs present various complications: they generate dependence, they can lead to a rebound effect and can endanger the lives of people with respiratory disorders and other pathologies (such as apnea dream). Therefore, its administration should only be contemplated under a medical prescription and during very strict periods of time.

Bibliographic references:

• Lorazepam accounts for 40% of the consumption of anxiolytics in Spain, redacciónmedica.com.
• Pharmacological treatment of mental disorders in primary health care (WHO). Collected on September 24 in https://www.who.int/mental_health/management/psychotropic_book_spanish.pdf
• Vicente Sánchez, M. P., Macías Saint-Gerons, D., González Bermejo, D., Montero Corominas, D., & Catalá-López, F. (2013). Evolution of the use of anxiolytic and hypnotic drugs in Spain during the period 2000-2011. Spanish Journal of Public Health, 87 (3), 247-255.