Please check your internet connection and try again.
# Lorazepam
## Overview
Lorazepam is a short-acting benzodiazepine with anxiolytic, sedative, hypnotic, anticonvulsant, and muscle relaxant properties.
## Primary Indications
* Management of anxiety disorders
* Insomnia due to anxiety or transient situational stress
* Status epilepticus (acute treatment)
* Premedication for surgery (sedation and anxiolysis)
## Adult Dosing
* **Anxiety:** 0.5 mg to 2 mg orally every 6 to 8 hours. Maximum daily dose typically 10 mg.
* **Insomnia:** 2 mg to 4 mg orally at bedtime.
* **Status Epilepticus:** 2 mg to 6 mg IV, may be repeated after 10 to 15 minutes to a maximum of 8 mg. (Intramuscular route may be used if IV access is not feasible, typically 0.1 mg/kg up to 4 mg per dose).
* **Premedication:** 2 mg to 4 mg orally or IM 2 hours before surgery or 1 mg to 2 mg IV 15 to 30 minutes before surgery.
Dosing for specific indications may vary based on institutional protocols.
## Pediatric Dosing
* **Anxiety/Sedation:** Dosing is highly variable and depends on age, weight, and clinical indication. A common starting dose for anxiety may be 0.02 mg/kg orally every 4 to 8 hours. Maximum dose should not exceed adult doses.
* **Status Epilepticus:** IV: 0.1 mg/kg per dose, maximum 4 mg per dose. May be repeated every 5 to 10 minutes.
* **Sedation (procedural):** IV: 0.044 mg/kg per dose (maximum 2 mg).
Pediatric dosing requires careful titration and monitoring; specific dosing should follow guidelines or institutional protocols.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution; dosage reduction may be necessary.
* **Renal Impairment:** No specific dose adjustment recommended, but use with caution.
* **Elderly:** Start with lower doses (e.g., half the adult dose) and titrate slowly due to increased sensitivity and potential for adverse effects like sedation and falls.
## Contraindications
* Known hypersensitivity to lorazepam or other benzodiazepines
* Acute narrow-angle glaucoma
* Severe respiratory insufficiency
* Severe hepatic insufficiency
* Myasthenia gravis (use with caution)
* Sleep apnea
## Adverse Effects
Common: Drowsiness, dizziness, sedation, weakness, unsteadiness, confusion, ataxia.
Serious: Respiratory depression, paradoxical reactions (agitation, excitement), anterograde amnesia, dependence, withdrawal symptoms.
## Key Drug Interactions
* **CNS Depressants (opioids, alcohol, barbiturates, other sedatives):** Increased risk of profound sedation, respiratory depression, coma, and death.
* **Theophylline, Aminophylline:** May reduce the sedative effects of lorazepam.
* **Valproic acid:** May increase lorazepam levels.
## Monitoring
* **For Anxiety/Insomnia:** Assess for therapeutic response (reduction in anxiety/improved sleep), sedation, cognitive impairment, and signs of dependence or withdrawal.
* **For Status Epilepticus:** Continuous EEG monitoring, vital signs, respiratory status.
* **For Premedication:** Level of sedation, vital signs, respiratory status.
## Clinical Pearls
* Lorazepam has a relatively short half-life, which can be beneficial for reducing daytime sedation but may lead to more frequent dosing or withdrawal symptoms with abrupt discontinuation.
* Intravenous administration should be slow to minimize adverse effects like hypotension and respiratory depression. Do not mix with other drugs in the same syringe.
* Avoid concurrent use with opioids when possible due to additive CNS depressant effects.
* Gradual tapering of the dose is essential when discontinuing lorazepam, especially after prolonged use, to prevent withdrawal symptoms.
***
**Disclaimer:** This information is intended for clinical decision support and does not replace independent judgment. Always consult the most current prescribing information, relevant clinical guidelines, and institutional protocols before making any treatment decisions.
