Please check your internet connection and try again.
# Lorazepam
## Overview
Lorazepam is a benzodiazepine with anxiolytic, sedative, hypnotic, amnestic, anticonvulsant, and muscle relaxant properties.
## Primary Indications
* Anxiety disorders
* Insomnia
* Status epilepticus
* Premedication for surgical procedures
* Management of agitation
## Adult Dosing
* **Anxiety:** 0.5 mg to 2 mg orally every 6 to 8 hours as needed. Maximum dose typically 6 mg/day, but may be higher in select patients.
* **Insomnia:** 2 mg to 4 mg orally at bedtime.
* **Status Epilepticus (IV/IM):** 0.1 mg/kg administered slowly (no faster than 2 mg/min) with a maximum dose of 4 mg per dose. May repeat in 10 to 15 minutes if needed, up to a maximum of 8 mg in 12 hours.
* **Premedication:** 2 mg to 4 mg orally or IM 2 hours before surgery.
## Pediatric Dosing
* **Status Epilepticus (IV/IM):** 0.1 mg/kg administered slowly (no faster than 2 mg/min) with a maximum dose of 4 mg per dose. May repeat in 10 to 15 minutes if needed. Dosing in younger children may require careful titration due to increased sensitivity. Specific recommendations for neonates and infants are variable and often based on expert consensus or local protocol.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution; may require lower doses.
* **Renal Impairment:** Use with caution; may require lower doses.
* **Elderly:** Initiate with lower doses (e.g., 0.5 mg twice daily) and titrate slowly.
## Contraindications
* Known hypersensitivity to lorazepam or other benzodiazepines.
* Acute narrow-angle glaucoma.
* Severe respiratory insufficiency.
* Severe hepatic insufficiency (relative contraindication).
## Adverse Effects
Common: Drowsiness, dizziness, weakness, unsteadiness, confusion.
Less common: Paradoxical excitation, amnesia, depression, hypotension.
Respiratory depression, particularly with IV administration or when combined with other CNS depressants.
## Key Drug Interactions
* **CNS Depressants (e.g., opioids, alcohol, barbiturates, other benzodiazepines, antihistamines):** Additive CNS depression, increased risk of sedation, respiratory depression, and coma. Use concomitantly with extreme caution and consider dose reduction of one or both agents.
* **Theophylline/Aminophylline:** May antagonize the sedative effects of lorazepam.
## Monitoring
* Level of sedation and respiratory rate, especially with IV administration or in combination with other sedatives.
* Mental status, gait, and coordination.
* Signs of dependence or withdrawal upon discontinuation.
* Liver and renal function, particularly with prolonged use or in patients with impairment.
## Clinical Pearls
* Lorazepam has an intermediate half-life.
* Intravenous administration should be slow to minimize the risk of respiratory depression and hypotension.
* Abrupt discontinuation can lead to withdrawal symptoms. Tapering is recommended.
* Long-term use can lead to physical and psychological dependence.
*Disclaimer: This information is intended for healthcare professionals. Always consult the official prescribing information and current guidelines for complete and up-to-date information before making clinical decisions.*
