Please check your internet connection and try again.
# Lorazepam
## Overview
Lorazepam is a benzodiazepine medication used for its anxiolytic, sedative, hypnotic, and anticonvulsant properties.
## Primary Indications
* Anxiety disorders
* Insomnia due to anxiety
* Status epilepticus
* Preoperative sedation
## Adult Dosing
* **Anxiety:** 1-4 mg orally every 6-8 hours. Maximum: 10 mg/day.
* **Insomnia:** 2-4 mg orally at bedtime.
* **Status Epilepticus (IV/IM):** 4 mg. May repeat in 5-10 minutes if needed. Maximum: 8 mg.
* **Preoperative Sedation (IV/IM):** 2-4 mg 2 hours before surgery.
## Pediatric Dosing
* **Anxiety:** 0.02-0.05 mg/kg orally every 4-6 hours. Maximum: 4 mg/day.
* **Status Epilepticus (IV/IM):** 0.1 mg/kg (max 4 mg) single dose. Dosing is highly variable and often guided by institutional protocols.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution; may require dose reduction.
* **Renal Impairment:** No specific dose adjustment, but monitor for accumulation.
* **Elderly:** Start with lower doses (e.g., 0.5-1 mg twice daily) and titrate slowly due to increased sensitivity and risk of side effects.
## Contraindications
* Known hypersensitivity to benzodiazepines or any component of the formulation.
* Acute narrow-angle glaucoma.
* Severe respiratory insufficiency (relative contraindication, especially in status epilepticus where benefits may outweigh risks).
## Adverse Effects
* **Common:** Drowsiness, dizziness, weakness, unsteadiness, ataxia.
* **Serious:** Respiratory depression, paradoxical excitation, anterograde amnesia, dependence and withdrawal symptoms.
## Key Drug Interactions
* **CNS Depressants (opioids, alcohol, other sedatives/hypnotics):** Additive CNS depression, increased risk of respiratory depression and profound sedation.
* **CYP450 Inhibitors/Inducers:** Lorazepam is primarily metabolized by glucuronidation, not significantly by CYP450 enzymes, thus fewer clinically significant CYP-mediated interactions compared to other benzodiazepines.
## Monitoring
* Mental status, sedation level, respiratory rate, and blood pressure, especially with IV administration.
* Signs of dependence and withdrawal upon discontinuation.
* Effectiveness for anxiety or insomnia.
## Clinical Pearls
* Lorazepam can be administered orally, intramuscularly, and intravenously. Intramuscular absorption can be less predictable than oral.
* Due to its long half-life and potential for accumulation, caution is advised in the elderly and those with hepatic impairment.
* Avoid abrupt discontinuation; taper dose gradually to minimize withdrawal symptoms.
* Use the lowest effective dose for the shortest duration necessary.
***
**Disclaimer:** This information is for educational purposes only and does not substitute for professional medical advice. Always consult current prescribing information and your healthcare provider for any health concerns or before making any decisions related to your health or treatment.
