II. Class
- Medium Acting Benzodiazepine
III. Indications
- Anxiety Disorder
- Alcohol Withdrawal
- Preanesthetic medication (sedation, anxiolysis)
- Status Epilepticus
-
Insomnia
- Short-term use only (other agents are preferred)
IV. Dosing: Adults
-
Anxiety Disorder
- Start 0.5 to 1 mg orally 2 to 3 times daily
- Start at 0.5 mg if used in the elderly (typically avoid as per Beer's List, STOPP)
- May advance to 0.5 to 2 mg orally every 6 to 8 hours as needed
- Maximum Daily Dose: 10 mg orally/day in divided doses (2 mg/day divided in the elderly)
- Start 0.5 to 1 mg orally 2 to 3 times daily
- Acute Agitation
- Give 1-2 mg PO/IV/IM as needed
- Anxiolysis or Sedation Prior to Procedure
- IM/IV: 0.05 mg/kg up to 2 to 4 mg IV given 20 min prior to procedure (or IM given 2 hours prior)
- Anxiolysis or Sedation in the ICU or Emergency Department
- Dose 0.02 to 0.06 mg/kg (typically 2 to 4 mg) IV every 2 to 6 hours as needed
-
Status Epilepticus
- IV: 0.1 mg/kg IV (<2 mg/minute) up to 4 mg
- Rectal: 0.1 mg/kg up to 4 mg
- Avoid IM Lorazepam (unreliable in Status Epilepticus)
- May repeat once in 5-10 minutes
- Avoid more than 2 doses in children due to risk of respiratory depression
-
Insomnia Related to Acute Emotional Stress
- Start 1 mg orally at bedtime (max dose 4 mg, limit to 1 mg in elderly)
-
Alcohol Withdrawal
- See Alcohol Withdrawal for complete protocol (with expanded dosing)
- Give 1 to 2 mg PO/IM/IV every 2 to 4 hours as needed OR
- Give 2 mg PO/IM/IV every 6 hours for 24 hours, then 1 mg every 6 hours for 8 doses
V. Dosing: Children (not FDA approved)
- Anxiolysis or Sedation
- Dose 0.05 mg/kg up to 2 mg IV/PO every 4 to 8 hours as needed
-
Status Epilepticus
- Start 0.05 to 0.1 mg/kg IV up to 4 mg over 2 to 5 minutes
- May repeat 0.05 mg/kg IV up to 4 mg in 10 min if needed
VI. Dosing: Equivalent (for Benzodiazepine Withdrawal)
- Valium = Dose x5.0
- Phenobarbital = Dose x15.0
VII. Safety
- Pregnancy Category D
- Schedule IV Controlled Substance
- Avoid in Lactation if possible
- Benzodiazepines do cross into Breast Milk with risk of sedation in infants
- However, ACOG considers moderately safe
- Given Lorazepam's relatively short Half-Life, it is among the preferred Benzodiazepines
VIII. Pharmacokinetics
- Half Life: 10-20 hours
- Onset: 2-3 minutes IV (15-30 min IM, 30-60 min orally)
- Duration: 12-24 hours
- Glucuronidation to inactive metabolites (no active metabolites)
IX. Resources
- Lorazepam Tablet (DailyMed)
- Lorazepam Injection (DailyMed)
X. References
- (2019) Med Lett Drugs Ther 61(1578): 121-6
- (2020) Presc Lett, Resource #361206, Appropriate Use of Benzodiazepines
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 55
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
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Related Studies
lorazepam (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
LORAZEPAM 0.5 MG TABLET | Generic | $0.04 each |
LORAZEPAM 1 MG TABLET | Generic | $0.04 each |
LORAZEPAM 2 MG TABLET | Generic | $0.07 each |
LORAZEPAM 2 MG/ML ORAL CONCENT | Generic | $0.53 per ml |
LORAZEPAM INTENSOL 2 MG/ML | Generic | $0.53 per ml |
ativan (on 1/1/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
ATIVAN 0.5 MG TABLET | Generic | $0.04 each |
ATIVAN 1 MG TABLET | Generic | $0.04 each |
Ontology: Lorazepam (C0024002)
Definition (CHV) | a drug used to treat anxiety |
Definition (NCI_NCI-GLOSS) | A drug that is used to treat anxiety and certain seizure disorders (such as epilepsy), and to prevent nausea and vomiting caused by chemotherapy. It belongs to the families of drugs called antiemetics and benzodiazepines. |
Definition (NCI) | A benzodiazepine with anxiolytic, anti-anxiety, anticonvulsant, anti-emetic and sedative properties. Lorazepam enhances the effect of the inhibitory neurotransmitter gamma-aminobutyric acid on the GABA receptors by binding to a site that is distinct from the GABA binding site in the central nervous system. This leads to an increase in chloride channel opening events, a facilitation of chloride ion conductance, membrane hyperpolarization, and eventually inhibition of the transmission of nerve signals, thereby decreasing nervous excitation. |
Definition (CSP) | 7-chloro-5-(2-chlorophenyl)-1, 3-dihydro-3-hydroxy-1,4- benzodiazepin-2-one. |
Definition (MSH) | A benzodiazepine used as an anti-anxiety agent with few side effects. It also has hypnotic, anticonvulsant, and considerable sedative properties and has been proposed as a preanesthetic agent. |
Definition (PDQ) | A benzodiazepine with anxiolytic, anti-anxiety, anticonvulsant, anti-emetic and sedative properties. Lorazepam enhances the effect of the inhibitory neurotransmitter gamma-aminobutyric acid on the GABA receptors by binding to a site that is distinct from the GABA binding site in the central nervous system. This leads to an increase in chloride channel opening events, a facilitation of chloride ion conductance, membrane hyperpolarization, and eventually inhibition of the transmission of nerve signals, thereby decreasing nervous excitation. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39757&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39757&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C619" NCI Thesaurus) |
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | D008140 |
SnomedCT | 323084002, 334011000, 321293002, 19225000, 387106007 |
LNC | LP16176-7, MTHU003365 |
English | Lorazepam, 2H-1,4-Benzodiazepin-2-one, 7-chloro-5-(2-chlorophenyl)-1,3-dihydro-3-hydroxy-, Lorazepam [anxiolytic], Lorazepam [epilepsy], 7-Chloro-5-(2-chlorophenyl)-1, 3-Dihydro-3-Hydroxy-1,4- Benzodiazepin-2-one, lorazepam, Lorazepam [anaesthesia], Lorazepam [anesthesia], LORAZEPAM, lorazepam (medication), Lorazepam [Chemical/Ingredient], LORazepam, Lorazepam [epilepsy] (product), Lorazepam [anesthesia] (product), Lorazepam [anxiolytic] (product), Lorazepam (product), Lorazepam (substance), Lorazepam [anesthesia] (substance), Lorazepam [anxiolytic] (substance), Lorazepam [epilepsy] (substance) |
Swedish | Lorazepam |
Czech | lorazepam |
Finnish | Loratsepaami |
Russian | ATIVAN, TAVOR, LORAZEPAM, АТИВАН, ЛОРАЗЕПАМ, ТАВОР |
Japanese | ロラゼパム |
Croatian | LORAZEPAM |
Polish | Lorazepam |
Spanish | lorazepam [anestésico] (producto), lorazepam [epilepsia] (producto), lorazepam [epilepsia], lorazepam [anestésico], lorazepam [ansiolítico] (producto), lorazepam [ansiolítico], loracepam (producto), loracepam (sustancia), loracepam, lorazepam (sustancia), lorazepam, Lorazepam |
French | Lorazépam |
German | Lorazepam |
Italian | Lorazepam |
Portuguese | Lorazepam |
Ontology: Ativan (C0699194)
Definition (CHV) | brand name of lorazepam |
Definition (CHV) | brand name of lorazepam |
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | D008140 |
English | Ativan [brand name], Baxter Brand of Lorazepam, Lorazepam Baxter Brand, Lorazepam Wyeth Brand, Orfidal Wyeth, Wyeth Brand of Lorazepam, Wyeth, Orfidal, Ativan, Témesta |