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## Lorazepam ### Overview Lorazepam is a short-acting benzodiazepine with anxiolytic, sedative, amnestic, anticonvulsant, and muscle relaxant properties. It is metabolized by glucuronidation, leading to a lower risk of drug-drug interactions compared to other benzodiazepines. ### Primary Indications * Anxiety disorders * Insomnia * Seizure disorders (status epilepticus) * Sedation (preoperative, intensive care unit) * Alcohol withdrawal symptoms ### Adult Dosing * **Anxiety:** 0.5-2 mg orally every 6-8 hours as needed. Doses may range from 1-6 mg daily. * **Insomnia:** 2-4 mg orally at bedtime. * **Status Epilepticus:** 4 mg intravenously (IV) or intramuscularly (IM). A second dose of 4 mg may be given after 5-10 minutes if seizures persist. * **Preoperative Sedation:** 2-4 mg IM 1-2 hours before surgery, or 2 mg orally 2 hours before surgery. * **ICU Sedation:** 0.02-0.1 mg/kg IV/IM, given in divided doses or as a continuous infusion. Titration is essential. ### Pediatric Dosing Dosing in children is highly variable and should be based on weight and specific indication. * **Status Epilepticus (IV/IM):** 0.1 mg/kg, not to exceed 4 mg per dose. * Dosing for other indications is less established and requires careful consideration of risks versus benefits. ### Dose Adjustments * **Hepatic Impairment:** Use with caution; dose reduction may be necessary due to reduced glucuronidation capacity. * **Renal Impairment:** Generally no dose adjustment needed as lorazepam is metabolized in the liver, but caution is advised in severe impairment. * **Elderly:** Initiate at lower doses (e.g., 0.5 mg orally twice daily) and tit