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Due to tolerance and dependence, lorazepam is recommended for short-term use, 2–4 weeks only. If it is almost time for your next dose, skip the missed dose and take the medicine at your next regularly scheduled time. A clinically relevant lorazepam dose will normally be effective for 6 to 12 hours, making it unsuitable for regular once-daily administration, so it is usually prescribed as two to four daily doses when taken regularly. The above product is reacted with methylamine, as in the case of chlordiazepoxide, this leads to rearrangement and a ring expansion, forming 7-chloro-2-methylamino-5-(2′-chlorphenyl)-3H-1,4-benzodiazepin-4-oxide. Long-term effects of benzodiazepines include tolerance, dependence, a benzodiazepine withdrawal syndrome and cognitive impairments which may not completely reverse after cessation of treatment; however, for most patients, cognitive impairment is not severe. Additionally the elderly tend to take more drugs which may interact or enhance the effects of benzodiazepines. Other adverse effects include confusion, ataxia, anterograde amnesia and hangover effects. Lorazepam serum levels are proportional to the dose administered. * Sleep apnea – Sleep apnea may be worsened by lorazepam's central nervous system depressant effects. Oral lorazepam is given 90 to 120 minutes before procedures, and intravenous lorazepam as late as 10 minutes before procedures.