lorazepam

Drug Name

Generic Name : lorazepam

Brand Name: Apo-Lorazepam (CAN), Ativan, Novo-Lorazem (CAN), Nu-Loraz (CAN)

Classification: Benzodiazepine, Anxiolytic, Sedative-hypnotic

Pregnancy Category D
Controlled Substance C-IV 

Dosage & Route

Available forms : Injection—2, 4 mg/mL; oral solution—2 mg/mL; tablets—0.5, 1, 2 mg

ADULTS

Oral

  • Usual dose is 2–6 mg/day; range 1–10 mg/day given in divided doses with largest dose hs.
    • Insomnia due to transient stress: 2–4 mg given hs.

IM

  • 0.05 mg/kg up to a maximum of 4 mg administered at least 2 hr before operative procedure.

IV

  • Initial dose is 2 mg total or 0.044 mg/kg, whichever is smaller. Do not exceed this dose in patients older than 50 yr. Doses as high as 0.05 mg/kg up to a total of 4 mg may be given 15–20 min before the procedure to those benefited by a greater lack of recall. Continuous infusion 0.5–1 mg/hr titrated, based on patient response.
PEDIATRIC PATIENTS
  • Drug should not be used in children < 12 yr.
GERIATRIC PATIENTS OR PATIENTS WITH HEPATIC DISEASE
  • Initially, 1–2 mg/day in divided doses. Adjust as needed and tolerated.
Therapeutic actions
  • Lorazepam is a short acting benzodiazepine. Lorazepam enhances the inhibitory effect of GABA on neuronal excitability by modulating GABAA receptors.
Indications
  • Oral: Management of anxiety disorders or for short-term relief of symptoms of anxiety or anxiety associated with depression; insomnia due to anxiety of transient situational stress
  • Parenteral: Preanesthetic medication in adults to produce sedation, relieve anxiety, and decrease recall of events related to surgery; treatment of status epilepticus
  • Unlabeled parenteral use: Management of chemotherapy-induced nausea and vomiting, acute alcohol withdrawal
Adverse effects
  • Drowsiness, headache, dizziness, confusion; blurred vision; nausea; weakness; unsteadiness.
  • Potentially Fatal: Respiratory depression.
Contraindications
  • Severe hepatic impairment; respiratory depression; acute narrow-angle glaucoma; pregnancy and lactation.
Nursing considerations

CLINICAL ALERT! Name confusion has occurred between lorazepam and alprazolam; use caution.

Assessment
  • History: Hypersensitivity to benzodiazepines, propylene glycol, polyethylene glycol or benzyl alcohol; psychoses; acute narrow-angle glaucoma; shock; coma; acute alcoholic intoxication with depression of vital signs; pregnancy; lactation; impaired liver or renal function, debilitation
  • Physical: Skin color, lesions; T; orientation, reflexes, affect, ophthalmologic examination; P, BP; R, adventitious sounds; liver evaluation, abdominal examination, bowel sounds, normal output; CBC, LFTs, renal function tests
Interventions
  • Sublingual administration has more rapid absorption than PO, and bioavailability compares to IM use.
  • Do not administer intra-arterially; arteriospasm or gangrene may result.
  • Give IM injections of undiluted drug deep into muscle mass, monitor injection sites.
  • Do not use solutions that are discolored or contain a precipitate. Protect drug from light, and refrigerate oral solution.
  • Intensol is a concentrated solution; it is recommended it be mixed with water, juice, soda, applesauce, or pudding.
  • WARNING: Keep equipment to maintain a patent airway readily available when drug is given IV.
  • Refrigerate injection and oral solution (36° to 46° F).
  • Reduce dose of opioid analgesics by at least half in patients who have received parenteral lorazepam.
  • Keep patients who have received parenteral doses under close observation, preferably in bed, up to 3 hr. Do not permit ambulatory patients to drive following an injection.
  • WARNING: Taper dosage gradually after long-term therapy, especially in patients with epilepsy.
Teaching points
  • Take drug exactly as prescribed; do not stop taking drug (in long-term therapy) without consulting health care provider.
  • You may experience these side effects: Drowsiness, dizziness (may be transient; avoid driving or engaging in dangerous activities); GI upset (take drug with food); nocturnal sleep disturbances for several nights after discontinuing the drug if used as a sedative and hypnotic; depression, dreams, emotional upset, crying.
  • Report severe dizziness, weakness, drowsiness that persists, rash or skin lesions, palpitations, edema of the extremities; visual changes; difficulty voiding.