Please check your internet connection and try again.
# Lorazepam
## Overview
Lorazepam is a benzodiazepine with anxiolytic, sedative, anticonvulsant, and muscle relaxant properties. It is a Schedule IV controlled substance.
## Primary Indications
* Anxiety disorders
* Insomnia
* Status epilepticus
* Sedation (pre-procedural or intensive care unit)
* Management of acute agitation
## Adult Dosing
* **Anxiety:** 0.5 mg to 2 mg orally every 8 hours as needed.
* **Insomnia:** 2 mg to 4 mg orally at bedtime.
* **Status Epilepticus:** 4 mg slow intravenous (IV) or IM injection. May repeat in 10-15 minutes if seizure persists. Maximum initial dose is 8 mg.
* **Pre-procedural Sedation:** 2 mg to 4 mg IM or IV 1-2 hours before procedure.
* **ICU Sedation:** 0.02 mg/kg to 0.04 mg/kg IV, not to exceed 2 mg per dose, for initial titration, followed by continuous infusion of 0.03 mg/kg/hour to 0.1 mg/kg/hour.
## Pediatric Dosing
Dosing in pediatrics is highly variable and depends on indication, age, and weight. Specific protocols are often used.
* **Status Epilepticus:** 0.1 mg/kg IV/IM, maximum 4 mg per dose. May repeat once after 5 minutes if needed.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution, may require dose reduction.
* **Renal Impairment:** No specific dose adjustment is typically recommended, but use with caution.
* **Elderly:** Lower doses generally recommended due to increased sensitivity and risk of adverse effects. Start with half the usual adult dose.
## Contraindications
* Known hypersensitivity to benzodiazepines.
* Acute narrow-angle glaucoma.
* Concurrent use with strong CYP3A4 inhibitors may increase lorazepam levels.
## Adverse Effects
Common adverse effects include drowsiness, dizziness, weakness, and unsteadiness. Less common include confusion, depression, amnesia, and paradoxical reactions (agitation, excitement). Respiratory depression can occur, especially with IV administration or when combined with other CNS depressants.
## Key Drug Interactions
* **CNS Depressants (opioids, alcohol, other sedatives, antihistamines):** Potentiated CNS depression, including respiratory depression and sedation.
* **CYP3A4 Inhibitors:** May increase lorazepam levels.
* **Theophylline and Aminophylline:** May reduce the sedative effects of lorazepam.
## Monitoring
* Level of consciousness, respiratory rate, and oxygen saturation, especially with IV administration or in combination with other sedatives.
* Signs of withdrawal upon discontinuation (anxiety, insomnia, seizures).
* Sedation score (e.g., RASS) in ICU settings.
## Clinical Pearls
* Lorazepam is available in oral, sublingual, and parenteral formulations.
* IV administration should be slow to minimize risk of respiratory depression and hypotension.
* Abrupt discontinuation can lead to withdrawal symptoms. Tapering is recommended for prolonged use.
* Due to its relatively short half-life compared to other benzodiazepines, it may be preferred for intermittent dosing.
***
*Please verify current prescribing information and local protocols for definitive guidance.*
