Please check your internet connection and try again.
# Lorazepam
## Overview
Lorazepam is a benzodiazepine with anxiolytic, sedative, hypnotic, anticonvulsant, and muscle relaxant properties. It acts by enhancing the activity of the neurotransmitter gamma-aminobutyric acid (GABA) in the central nervous system.
## Primary Indications
* Anxiety disorders
* Insomnia due to anxiety or transient situational disturbances
* Status epilepticus and seizure disorders
* Preanesthetic medication to induce sedation and anxiolysis
## Adult Dosing
* **Anxiety Disorders:** 0.5 mg to 2 mg orally 2 to 3 times daily. Maximum daily dose is typically 10 mg, but may be higher under strict medical supervision.
* **Insomnia:** 2 mg to 4 mg orally at bedtime.
* **Status Epilepticus:** 2 mg to 4 mg intravenously (IV) or intramuscularly (IM). May repeat in 10 to 15 minutes. Maximum initial dose 4 mg. Subsequent doses may be given up to a total of 8 mg, with repeat doses not to exceed 4 mg every 15-30 minutes. Dosing for refractory status epilepticus may require higher doses and careful titration by a specialist.
* **Preanesthetic Medication:** 2 mg to 4 mg IM or IV given 2 hours before surgery.
## Pediatric Dosing
Dosing in pediatric patients is not well-established and should be individualized under specialist guidance.
* **Status Epilepticus:**
* **IM:** 0.1 mg/kg (maximum 4 mg) once.
* **IV:** 0.1 mg/kg (maximum 4 mg) once.
* For both routes, doses may be repeated every 5 to 10 minutes if seizures continue, up to a maximum of 0.1 mg/kg or 4 mg total.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution; dose reduction may be necessary.
* **Renal Impairment:** Use with caution; dose reduction may be necessary.
* **Elderly:** Start with lower doses (e.g., half the usual adult dose) and titrate slowly due to increased sensitivity and risk of CNS depression.
## Contraindications
* Known hypersensitivity to lorazepam, other benzodiazepines, or any component of the formulation.
* Acute narrow-angle glaucoma.
* Severe respiratory insufficiency.
* Severe hepatic insufficiency.
* Myasthenia gravis.
## Adverse Effects
Common: Drowsiness, dizziness, weakness, unsteadiness, fatigue.
Less common: Confusion, depression, ataxia, blurred vision, nausea, paradoxical reactions (agitation, excitement).
Serious: Respiratory depression, dependence, withdrawal symptoms, anterograde amnesia, potential for abuse.
## Key Drug Interactions
* **CNS Depressants (e.g., opioids, alcohol, other sedatives, antihistamines):** Additive CNS depression, potentially leading to severe sedation, respiratory depression, coma, and death. Use concurrently only when no other alternatives exist and with extreme caution, monitoring for signs of respiratory depression and sedation.
* **CYP450 Inhibitors/Inducers:** Lorazepam is primarily metabolized by glucuronidation and has minimal CYP450 involvement, so interactions are less common compared to other benzodiazepines.
* **Valproic acid:** May increase lorazepam levels.
## Monitoring
* Level of consciousness and sedation.
* Respiratory rate and oxygen saturation.
* Signs of dependence and withdrawal upon discontinuation.
* Effectiveness for the specific indication.
## Clinical Pearls
* Lorazepam has a moderate half-life, making it suitable for both acute and some chronic anxiety management.
* For IV administration, dilute with an equal volume of sterile water for injection, D5W, or NS. Do NOT mix with other medications in the same syringe.
* IM injections should be given deep into a large muscle.
* Avoid abrupt discontinuation, especially after prolonged use, to prevent withdrawal symptoms. Tapering is recommended.
* Use with caution in patients with a history of substance abuse.
***
*This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols before administering any medication.*
