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
- 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.
- 0.05 mg/kg up to a maximum of 4 mg administered at least 2 hr before operative procedure.
- 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.
- 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.
- Lorazepam is a short acting benzodiazepine. Lorazepam enhances the inhibitory effect of GABA on neuronal excitability by modulating GABAA receptors.
- 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
- Drowsiness, headache, dizziness, confusion; blurred vision; nausea; weakness; unsteadiness.
- Potentially Fatal: Respiratory depression.
- Severe hepatic impairment; respiratory depression; acute narrow-angle glaucoma; pregnancy and lactation.
CLINICAL ALERT! Name confusion has occurred between lorazepam and alprazolam; use caution.
- 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
- 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.
- 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.