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Lorazepam and liver metabolism

  Dear Doctor;
  Is Lorazepam metabolized in the liver or kidneys or both?
  Can 4mg per day damage the liver? No alchohol or any other
  drugs taken except Atenolol 75mg/day.
  What are the issues with taking Lorazepam in an individual
  with known liver disease?
  Any other short acting benzodiazepines that are metabolised only in the kidneys
  or very little in the liver?
  Would librium be more offensive to the liver?
  Thanks in advance for you help.
Dear Rob Muller:
Lorazepam is one of the drugs classified as a benzodiazepine.  These medications are completely metabolized in the liver and then conjugated to glucuronide before being excreted by the kidney.  In normal individuals the duration of a benzodiazepine effect is determined by the half-life of the active compounds and the half-life of the biologically-active breakdown products produced by liver metabolism.  In individuals with known liver disease, Lorazepam activity will be prolonged.
Currently, there are no benzodiazepines metabolized by kidney alone.  Liver damage with benzodiazepine use is a rare occurrence.  Remember, however, that liver damage in patients taking Lorazepam or Librium can produce behavioral changes.  
This information is presented for educational purposes only.  Always consult your personal physician for specific medical questions.
*keywords: liver disease, benzodiazepines

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