Lorazepam

Indications
 Oral
Anxiety
Adult: Usual dose: 1-6 mg daily in 2 or 3 divided doses. Largest dose taken at night. Up to 10 mg daily has been used.
Elderly: Initial dose of 1-2 mg daily in 2 or 3 divided doses. Adjust as necessary.
Oral
Insomnia associated with anxiety
Adult: 1-4 mg as a single dose given at bedtime.
Elderly: 1-2 mg initially, adjust as needed.
Oral
Premedication in surgery
Adult: 2-3 mg given the night before the operation followed by a smaller dose if necessary, the next morning. Alternatively, 2-4 mg is given 1-2 hr before the operation.
Child: 1 mth-12 yr: 0.05-0.1 mg/kg (max: 4 mg) given at least 1 hr before surgery. Same dose may be given the night before either as an addition to or to replace the pre-operative dose.
Oral
Prophylaxis of nausea and vomiting associated with cytotoxic therapy
Adult: For moderately emetogenic chemotherapy: May add 1-2 mg to the antiemetic therapy with domperidone or metoclopramide.
Parenteral
Acute anxiety
Adult: 25-30 mcg/kg repeated every 6 hr if necessary. Dose may be given via IV or IM inj. Give IV inj at a rate of not >2 mg/minute into a large vein.
Child: Usual: 50 mcg/kg every 4-8 hr.
Intravenous
Status epilepticus
Adult: 4 mg injected slowly, may repeat once after 10 minutes if seizures recur. Dose should be given at a rate not >2 mg/minute into a large vein.
Child: Neonates and children up to 12 yr: 0.1 mg/kg (max: 4 mg) as a single dose, may repeat once after 10 minutes if needed.
Parenteral
Premedication in surgery
Adult: 50 mcg/kg, to be given 30-45 minutes before the operation if given via IV inj or 1-1.5 hr before operation if given via IM inj.
Intravenous
Sedation in critical care
Adult: 0.02-0.06 mg/kg every 2-6 hr as inj or 0.01-0.1 mg/kg/hr as continuous IV infusion.
Child: ≥2 mth: 0.025-0.05 mg/kg (max 2 mg) every 2-4 hr as intermittent IV infusion or 0.025 mg/kg/hr (to a max of 2 mg/hr) as continuous IV infusion.
Contraindications
 Severe hepatic impairment; respiratory depression; acute narrow-angle glaucoma; pregnancy and lactation.
Warnings / Precautions
 Hepatic and renal dysfunction; pulmonary insufficiency; myasthenia gravis; may impair ability to drive or operate machinery; elderly or debilitated patients.
Adverse Reactions
 Drowsiness, headache, dizziness, confusion; blurred vision; nausea; weakness; unsteadiness.
Potentially Fatal: Respiratory depression.
Overdose Reactions
 The main symptom of overdosage is excessive CNS depression. Treatment is generally supportive but flumazenil may also be used in hospitalised patients if the benefits are thought to outweigh the risk of seizure.
Drug Interactions
 Potentiation of CNS depression produced by alcohol; general anaesthetics; narcotic analgesics; TCAs; MAOIs; phenothiazines; antipsychotics; barbiturates; scopolamine.
See Below for More lorazepam Drug Interactions
Mechanism of Actions
 Lorazepam is a short acting benzodiazepine. Lorazepam enhances the inhibitory effect of GABA on neuronal excitability by modulating GABAA receptors.
Onset: Hypnosis: 20-30 min (IM); sedation: 5-20 min (IV); anticonvulsant: 5 min (IV), 30-60 min (oral).
Duration: 6-8 hr.
Absorption: Readily absorbed (oral, IM); peak plasma concentrations after 2 hr.
Distribution: Crosses the placenta and blood-brain barrier; enters breast milk. Protein-binding: 85%.
Metabolism: Hepatic; converted to inactive metabolites.
Excretion: Urine and faeces; 10-20 hr (elimination half-life).
Administration
 May be taken with or without food.
ATC Classification
 N05BA06 - lorazepam ; Belongs to the class of benzodiazepine derivatives anxiolytics. Used in the management of anxiety, agitation or tension.
Available As
  • Lorazepam 0.5 mg
  • Lorazepam 1 mg
  • Lorazepam 2 mg
  • Lorazepam 2.5 mg
  • Lorazepam 3 mg

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