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# Lorazepam
## Overview
Lorazepam is a short-acting benzodiazepine with anxiolytic, sedative, hypnotic, anticonvulsant, and muscle relaxant properties.
## Primary Indications
* Anxiety disorders
* Insomnia (short-term treatment)
* Status epilepticus
* Preoperative sedation
## Adult Dosing
* **Anxiety:** 0.5 mg to 2 mg orally every 8 hours as needed. Doses may be increased to 6 mg/day.
* **Insomnia:** 2 mg to 4 mg orally at bedtime.
* **Status Epilepticus:** 4 mg IV/IM, may repeat in 5-10 minutes if seizures persist. Maximum initial dose is 8 mg.
* **Preoperative Sedation:** 2 mg to 4 mg IM given 2 hours before surgery.
## Pediatric Dosing
* Dosing in pediatric patients is not well established and should be individualized.
* **Status Epilepticus:** 0.05 mg/kg IV/IM (maximum 2 mg per dose), may repeat once after 10-15 minutes.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution; dose reduction may be necessary.
* **Renal Impairment:** Use with caution; dose reduction may be necessary.
* **Elderly:** Lower doses are recommended due to increased sensitivity and risk of sedation and falls. Start with half the usual adult dose.
## Contraindications
* Known hypersensitivity to lorazepam or other benzodiazepines.
* Acute narrow-angle glaucoma.
* Severe respiratory insufficiency.
* Severe hepatic insufficiency.
## Adverse Effects
Common adverse effects include drowsiness, dizziness, ataxia, weakness, and confusion. Less common but serious effects include respiratory depression, paradoxical excitation, and dependence/withdrawal symptoms.
## Key Drug Interactions
* **CNS Depressants (e.g., opioids, alcohol, other sedatives):** Increased risk of profound sedation, respiratory depression, coma, and death. Use together with extreme caution, preferably avoided. If co-administration is necessary, reduce dose and duration of one or both agents.
* **Valproic acid:** May increase lorazepam plasma concentrations and prolong half-life.
## Monitoring
* Monitor for sedation, respiratory rate, blood pressure, and mental status.
* Assess for paradoxical reactions or signs of withdrawal.
* For chronic use, monitor for development of tolerance and dependence.
## Clinical Pearls
* Lorazepam can be administered intravenously, intramuscularly, or orally. IV administration provides rapid onset of action, particularly useful in acute settings like status epilepticus.
* When discontinuing chronic therapy, taper the dose gradually to minimize withdrawal symptoms.
*This information is intended as a quick reference. Always consult current prescribing information and relevant clinical guidelines for complete details.*
