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## Lorazepam
### Overview
Lorazepam is a short-acting benzodiazepine with anxiolytic, sedative, hypnotic, amnestic, anticonvulsant, and muscle relaxant properties.
### Primary Indications
* Anxiety disorders
* Insomnia (short-term treatment)
* Status epilepticus (adjunctive treatment)
* Preoperative sedation
### Adult Dosing
* **Anxiety:** 0.5 mg to 2 mg three times daily. Maximum: 10 mg daily.
* **Insomnia:** 2 mg to 4 mg at bedtime.
* **Status Epilepticus:** 4 mg IV initially; may repeat 4 mg IV after 5-10 minutes if seizures persist. Maximum: 8 mg.
* **Preoperative Sedation:** 2 mg to 4 mg IM or IV given 2 hours before surgery.
### Pediatric Dosing
Dosing in pediatric patients is highly variable and often requires specialist guidance.
* **Anxiety:** Generally not recommended for routine use in children. Limited data for doses of 0.02 mg/kg to 0.1 mg/kg given every 6-8 hours.
* **Status Epilepticus:** 0.1 mg/kg IV/IM, not to exceed 4 mg per dose. May be repeated once after 15-30 minutes.
### Dose Adjustments
* **Hepatic Impairment:** Use with caution, may require dose reduction.
* **Renal Impairment:** No specific dose adjustments, but use with caution.
* **Elderly:** Start with lower doses and titrate slowly due to increased sensitivity.
### Contraindications
* Known hypersensitivity to benzodiazepines.
* Acute narrow-angle glaucoma.
* Severe respiratory insufficiency.
* Severe hepatic insufficiency.
* Myasthenia gravis.
* Sleep apnea.
### Adverse Effects
Common: Sedation, dizziness, weakness, unsteadiness.
Less common: Confusion, depression, amnesia, paradoxical excitation, respiratory depression (especially with IV administration or in combination with other CNS depressants).
### Key Drug Interactions
* **CNS Depressants (e.g., opioids, alcohol, other sedatives):** Increased risk of profound sedation, respiratory depression, coma, and death.
* **Theophylline, Aminophylline:** May reduce lorazepam's sedative effects.
* **Valproic acid:** May decrease lorazepam clearance and increase its plasma concentration.
### Monitoring
* Sedation and cognitive function.
* Respiratory rate and oxygen saturation (especially with IV administration or in combination with other depressants).
* Signs of dependence or withdrawal with prolonged use.
### Clinical Pearls
* Lorazepam has a relatively rapid onset of action, particularly with IV administration.
* IM absorption is reliable and can be faster than oral.
* Avoid abrupt discontinuation; taper dose gradually to prevent withdrawal symptoms.
* Use the lowest effective dose for the shortest duration necessary.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the official prescribing information and current clinical guidelines for the most up-to-date and comprehensive drug information.*
