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# Lorazepam
## Overview
Lorazepam is a benzodiazepine with anxiolytic, sedative, hypnotic, amnestic, anticonvulsant, and muscle relaxant properties. It acts by enhancing the inhibitory effects of gamma-aminobutyric acid (GABA) in the central nervous system.
## Primary Indications
* Anxiety disorders
* Insomnia characterized by difficulty sleeping
* Management of acute agitation or anxiety
* Status epilepticus (adjunct)
* Preoperative medication to induce sedation and reduce anxiety
## Adult Dosing
* **Anxiety:** 1-4 mg orally or IM every 4-6 hours as needed.
* **Insomnia:** 2-4 mg orally at bedtime.
* **Preoperative:** 2-4 mg IM administered 2 hours before surgery.
* **Status Epilepticus:** 4 mg IV/IM initially; may be repeated at 5-10 minute intervals up to a maximum of 8 mg. Further doses may require a different anticonvulsant.
* **Sedation (ICU):** Titrated based on patient response, typically 0.02-1 mg/kg/hr IV infusion, with boluses of 1-2 mg as needed.
## Pediatric Dosing
* **Anxiety:** Not well-established. Dosing is highly individualized. Oral dosing typically ranges from 0.02-0.06 mg/kg per dose every 4-6 hours. Maximum PO dose usually 0.07 mg/kg/day up to 4 mg/day.
* **Status Epilepticus:** 0.1 mg/kg IV/IM, not to exceed 4 mg per dose. May repeat once after 15-30 minutes.
* Consult specific pediatric guidelines for detailed dosing recommendations.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution; dose reduction may be necessary.
* **Renal Impairment:** No specific dose adjustment, but use with caution.
* **Elderly:** Start at the lower end of the dosage range. Increased sensitivity to CNS effects.
## Contraindications
* Known hypersensitivity to lorazepam or other benzodiazepines.
* Acute narrow-angle glaucoma.
* Severe respiratory insufficiency.
* Severe hepatic insufficiency.
* Sleep apnea.
## Adverse Effects
Common: Sedation, dizziness, weakness, unsteadiness, dry mouth, constipation.
Serious: Respiratory depression, paradoxical reactions (excitability, aggression), anterograde amnesia, dependence, withdrawal symptoms, suicidal ideation.
## Key Drug Interactions
* **CNS Depressants (e.g., alcohol, opioids, sedatives, anesthetics):** Additive CNS depression, potentially leading to profound sedation, respiratory depression, coma, and death.
* **Theophyllines/Aminophylline:** May decrease the sedative effects of lorazepam.
* **Valproic acid:** May increase serum concentrations of lorazepam.
## Monitoring
* Level of sedation and alertness.
* Respiratory rate and oxygen saturation, especially with IV administration or concomitant CNS depressants.
* Signs of paradoxical reactions.
* Signs of dependence and withdrawal if used long-term.
* Effectiveness for the intended indication.
## Clinical Pearls
* Lorazepam has a relatively intermediate half-life compared to other benzodiazepines.
* Intramuscular (IM) absorption can be variable and slower than intravenous (IV) or oral routes.
* Avoid abrupt discontinuation after prolonged use to prevent withdrawal symptoms. Tapering is typically recommended.
* Caution in patients with depression, suicidal tendencies, or a history of substance abuse.
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*This information is intended for clinical use by healthcare professionals. It is not a substitute for professional medical advice. Always consult the most current prescribing information and consider individual patient factors.*
