II. Class

  1. Medium Acting Benzodiazepine

III. Indications

  1. Anxiety Disorder
  2. Alcohol Withdrawal
  3. Preanesthetic medication (sedation, anxiolysis)
  4. Status Epilepticus
  5. Insomnia
    1. Short-term use only (other agents are preferred)

IV. Dosing: Adults

  1. Anxiety Disorder
    1. Start 0.5 to 1 mg orally 2 to 3 times daily
      1. Start at 0.5 mg if used in the elderly (typically avoid as per Beer's List, STOPP)
    2. May advance to 0.5 to 2 mg orally every 6 to 8 hours as needed
    3. Maximum Daily Dose: 10 mg orally/day in divided doses (2 mg/day divided in the elderly)
  2. Acute Agitation
    1. Give 1-2 mg PO/IV/IM as needed
  3. Anxiolysis or Sedation Prior to Procedure
    1. 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)
  4. Anxiolysis or Sedation in the ICU or Emergency Department
    1. Dose 0.02 to 0.06 mg/kg (typically 2 to 4 mg) IV every 2 to 6 hours as needed
  5. Status Epilepticus
    1. IV: 0.1 mg/kg IV (<2 mg/minute) up to 4 mg
    2. Rectal: 0.1 mg/kg up to 4 mg
    3. Avoid IM Lorazepam (unreliable in Status Epilepticus)
    4. May repeat once in 5-10 minutes
    5. Avoid more than 2 doses in children due to risk of respiratory depression
  6. Insomnia Related to Acute Emotional Stress
    1. Start 1 mg orally at bedtime (max dose 4 mg, limit to 1 mg in elderly)
  7. Alcohol Withdrawal
    1. See Alcohol Withdrawal for complete protocol (with expanded dosing)
    2. Give 1 to 2 mg PO/IM/IV every 2 to 4 hours as needed OR
    3. 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)

  1. Anxiolysis or Sedation
    1. Dose 0.05 mg/kg up to 2 mg IV/PO every 4 to 8 hours as needed
  2. Status Epilepticus
    1. Start 0.05 to 0.1 mg/kg IV up to 4 mg over 2 to 5 minutes
    2. May repeat 0.05 mg/kg IV up to 4 mg in 10 min if needed

VI. Dosing: Equivalent (for Benzodiazepine Withdrawal)

  1. Valium = Dose x5.0
  2. Phenobarbital = Dose x15.0

VII. Safety

  1. Pregnancy Category D
  2. Schedule IV Controlled Substance
  3. Avoid in Lactation if possible
    1. Benzodiazepines do cross into Breast Milk with risk of sedation in infants
    2. However, ACOG considers moderately safe
    3. Given Lorazepam's relatively short Half-Life, it is among the preferred Benzodiazepines

VIII. Pharmacokinetics

  1. Half Life: 10-20 hours
  2. Onset: 2-3 minutes with IV dosing
  3. Duration: 12-24 hours
  4. Glucuronidation to inactive metabolites, with no active metabolites

X. References

  1. (2019) Med Lett Drugs Ther 61(1578): 121-6
  2. (2020) Presc Lett, Resource #361206, Appropriate Use of Benzodiazepines
  3. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 55
  4. Hamilton (2020) Tarascon Pocket Pharmacopoeia

Images: Related links to external sites (from Bing)

Related Studies

Cost: Medications

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