LORAZEPAM

Short acting benzodiazepine

Dosage Forms

Solution for injection

4 mg/ml

Tablet

2.5 mg

Uses

  • Short-term use in anxiety or insomnia
  • Status epilepticus
  • Conscious sedation pre-operatively
  • Premedication before surgery or operation

Dose and Duration

Anxiety

Adult: by mouth, 1–4 mg daily in divided doses for 2–4 weeks

Elderly or debilitated: 0.5–2 mg as above

Insomnia associated with anxiety

Adult: by mouth, 1–2 mg at bedtime for 2–4 weeks

Acute panic attacks

Adult: by IM or slow IV injection (into a large vein), 0.025–0.03 mg/kg (usual range 1.5–2.5 mg), repeated every 6 hours if necessary

Premedication and conscious sedation

Adult and child over 12 years: by mouth, 2–3 mg the night before operation then 2–4 mg 1–2 hours before operation

By slow IV injection, 0.05 mg/kg 30–45 minutes before operation. Dilute with an equal volume of sodium chloride 0.9% or water for injection

By IM injection, diluted as above, 0.05 mg/kg 60–90 minutes before operation

Child 1 month–12 years: by mouth, 0.05–0.1 mg/kg (max 4 mg) as above. Same dose may be given the night before in addition to or as a replacement

By IV injection, 0.05–0.1 mg/kg (max 4 mg) 30–45 minutes before the procedure

Status epilepticus, febrile convulsions and convulsions caused by poisoning

Adult and child over 12 years: by IV injection, 4 mg as a single dose, repeated once after 10 minutes if necessary

Neonate and child up to 12 years: by IV injection, 0.1 mg/kg (max 4 mg) as a single dose, repeated once after 10 minutes if necessary

Contraindications

  • Acute pulmonary insufficiency
  • Obsessional states
  • Severe hepatic insufficiency
  • Myasthenia gravis
  • Sleep apnoea syndrome
  • Hypersensitivity to benzodiazepines

Side Effects

  • Daytime drowsiness, sedation, dizziness
  • Ataxia, muscle weakness
  • Asthenia (extreme tiredness), fatigue

Interactions

  • Clozapine ( increased risk of serious adverse events)
  • Olanzapine (increased risk of hypotension, bradycardia and respiratory depression when parenteral lorazepam is given with intramuscular olanzapine)
  • Sodium oxybate (enhanced effects of sodium oxybate)

Patient Instructions

  • Do not drink alcohol during and for 24–48 hours after treatment with lorazepam
  • Avoid driving or operating machinery while taking lorazepam

Pregnancy

  • Do not use in $1^{st}$ and $3^{rd}$ trimesters

Breast-feeding

  • Do not use

Storage

  • Store the solution for injection in a refrigerator at $2-8^{o}C$

⚠️ Caution

  • Only use the IM route when oral and IV routes are not possible. Do not give by the IM route for convulsions
  • Monitor patient for at least 8 hours and preferably overnight
  • Ensure availability of facilities for managing respiratory depression with mechanical ventilation
  • Reduce doses in mild to moderate hepatic impairment and in renal impairment