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Lorazepam

    Brands

    DEA Class;  Rx

    Common Brand Names; Ativan, Loreev XR

    •  Antianxiety Agents; 
    • Anxiolytics, Benzodiazepines; 
    • Anticonvulsants, Benzodiazepine

    Oral and parenteral intermediate-acting benzodiazepine with no active metabolites
    Approved for anxiety, status epilepticus, perioperative sedation or amnesia induction, and the short-term treatment of insomnia in adults; several off-label uses
    Avoid coadministration with opioids if possible due to potential for profound sedation, respiratory depression, coma, and death

    Indicated for management of anxiety disorders or for the short-term relief of symptoms of anxiety or anxiety associated with depressive symptoms

    Anxiety or tension associated with stress of everyday life usually does not require treatment with an anxiolytic

    Indicated for anxiety disorders in adults who are receiving stable, evenly divided, TID dosing with lorazepam tablets

    Short-Term Treatment of Insomnia

    Documented hypersensitivity

    Acute narrow angle glaucoma

    Intra-arterial administration

    Severe respiratory depression

    Sleep apnea

    Use of injectable dosage form in premature infants (contains benzyl alcohol)

    • Sedation
    • Dizziness
    • Unsteadiness
    • Weakness
    • Fatigue
    • Drowsiness
    • Amnesia
    • Confusion
    • Disorientation
    • Depression
    • Suicidal ideation/attempt
    • Vertigo
    • Ataxia
    • Sleep apnea
    • Asthenia
    • Extrapyramidal symptoms
    • Respiratory depression
    • Tremor
    • Convulsions/seizures
    • Visual disturbances
    • Dysarthria
    • Hypotension
    • Blood dyscrasias
    • Change in libido
    • Impotence
    • Jaundice
    • Increased bilirubin
    • Increased liver transaminases
    • Increase in ALP
    • Hypersensitivity reactions
    • Nausea
    • Constipation
    • Change in appetite
    • Paradoxical reactions (anxiety, excitation, agitation, hostility, aggression, rage)

    Concomitant use of benzodiazepines, including lorazepam, and opioids may result in profound sedation, respiratory depression, coma, and death (see BBW)

    Advise both patients and caregivers about the risks of respiratory depression and sedation when lorazepam is used with opioids; advise patients not to drive or operate heavy machinery until the effects of concomitant use with the opioid have been determined

    Use of benzodiazepines, including lorazepam, both used alone and in combination with other CNS depressants, may lead to potentially fatal respiratory depression

    Not recommended for use in patients with primary depressive disorder or psychosis

    Injection contains benzyl alcohol associated with potentially fatal “gasping syndrome” in neonates and an increased incidence of kernicterus, particularly in small preterm infants; if patient requires more than recommended dosages or other medications containing this preservative, practitioner must consider daily metabolic load of benzyl alcohol from combined sources

    Prolonged use may lead to physical and psychological dependence especially in patients with history of alcohol or drug abuse; risk of dependence is decreased with short-term treatment (eg, 2-4 weeks); evaluate need for continued treatment prior to extending therapy duration

    Use of drug, particularly in patients at elevated risk, necessitates counseling about risks and proper use of drug along with monitoring for signs and symptoms of abuse, misuse, and addiction; do not exceed recommended dosing frequency

    Pregnancy category: D

    Lactation: Excreted in human breast milk; not recommended

    Adults

    10 mg/day PO; maximum IM and IV dose highly variable dependent upon indication.

    Geriatric

    10 mg/day PO; maximum IM and IV dose highly variable depending upon indication.

    Adolescents

    Up to 10 mg/day PO for anxiety disorders; 4 mg/day PO for insomnia. Safety and efficacy of extended-release capsules and parenteral lorazepam have not been established. Specific maximum dosage information not available; the dose required is dependent on route of administration, indication, and clinical response.

    Children

    12 years: Up to 10 mg/day PO for anxiety disorders; 4 mg/day PO for insomnia. Safety and efficacy of extended-release capsules and parenteral lorazepam have not been established. Specific maximum dosage information not available; the dose required is dependent on route of administration, indication, and clinical response.
    1 to 11 years: Safety and efficacy have not been established. Specific maximum dosage information not available; the dose required is dependent on route of administration, indication, and clinical response.

    Infants

    Safety and efficacy have not been established. Specific maximum dosage information not available; the dose required is dependent on route of administration, indication, and clinical response.

    Neonates

    Safety and efficacy have not been established. Specific maximum dosage information not available; the dose required is dependent on route of administration, indication, and clinical response.

    Lorazepam

    tablet: Schedule IV

    • 0.5mg

    • 1mg

    • 2mg

    capsule, extended-release: Schedule IV

    • 1mg

    • 2mg

    • 3mg

    oral concentrate: Schedule IV

    • 2mg/mL

    injectable solution: Schedule IV

    • 2mg/mL

    • 4mg/mL