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 with IV dosing
- Duration: 12-24 hours
- Glucuronidation to inactive metabolites, with 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 |
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