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## Lorazepam
### Overview
Lorazepam is a short-acting benzodiazepine with anxiolytic, sedative, hypnotic, amnesic, and anticonvulsant properties.
### Primary Indications
* Management of anxiety disorders
* Insomnia characterized by difficulty falling or staying asleep
* Status epilepticus and other acute seizures
* Preoperative sedation and anxiolysis
### Adult Dosing
* **Anxiety:** 0.5 mg to 2 mg orally 2 to 3 times daily. Maximum: 10 mg/day.
* **Insomnia:** 1 mg to 2 mg orally at bedtime.
* **Status Epilepticus:** 4 mg IV or IM, may repeat in 5 to 10 minutes. Maximum: 8 mg in a 24-hour period.
* **Preoperative Sedation:** 2 mg to 4 mg IM 2 hours before surgery.
### Pediatric Dosing
* **Anxiety:** Generally not recommended for routine use in children.
* **Status Epilepticus:** 0.05 mg/kg IV or IM (maximum 2 mg per dose), may repeat once after 5 to 10 minutes. Maximum cumulative dose should not exceed 0.1 mg/kg or 4 mg, whichever is less.
### Dose Adjustments
* **Hepatic Impairment:** Use with caution, may require dose reduction.
* **Renal Impairment:** No specific adjustment recommended, but use with caution.
* **Elderly:** Initiate at the lower end of the adult dose range and titrate slowly.
### Contraindications
* Known hypersensitivity to benzodiazepines
* Acute narrow-angle glaucoma
* Severe respiratory insufficiency
* Severe hepatic insufficiency
* Myasthenia gravis
### Adverse Effects
* **Common:** Sedation, dizziness, weakness, unsteadiness, confusion.
* **Serious:** Respiratory depression, paradoxical reactions (agitation, excitement), dependence, withdrawal symptoms.
### Key Drug Interactions
* **CNS Depressants (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 increase lorazepam levels.
### Monitoring
* Mental status, sedation level, respiratory rate, and blood pressure.
* Signs of withdrawal upon discontinuation.
* Efficacy for the specific indication.
### Clinical Pearls
* Lorazepam has a relatively rapid onset of action, particularly with IV/IM administration.
* Due to its short half-life, frequent dosing may be required for sustained anxiety relief.
* Abrupt discontinuation can lead to withdrawal symptoms, including rebound insomnia, anxiety, tremors, and seizures. Tapering is recommended.
* IV administration should be slow to minimize respiratory depression and hypotension.
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*Please verify current prescribing information before making clinical decisions.*
