Lorazepam(lor a’ ze pam)
Apo-Lorazepam (CAN), Ativan, Lorazepam Intensol, PMS-Lorazepam (CAN)
PREGNANCY CATEGORY D
CONTROLLED SUBSTANCE C-IV
Drug Classes
Anxiolytic
Benzodiazepine
Sedative-hypnotic
Therapeutic Actions
Exact mechanisms are not understood; acts mainly at subcortical levels of the CNS, binding to benzodiazepine receptors on postsynaptic GABA neurons in the CNS, leaving the cortex relatively unaffected. Main sites of action may be the limbic system and reticular formation; benzodiazepines potentiate the effects of GABA, an inhibitory neurotransmitter; anxiolytic effects occur at doses well below those needed to cause sedation and ataxia.
Indications
Oral: Management of anxiety disorders or for short-term relief of symptoms of anxiety or anxiety associated with depression; insomnia due to anxiety or 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
Contraindications and Cautions
Contraindicated with hypersensitivity to benzodiazepines, propylene glycol, polyethylene glycol or benzyl alcohol (parenteral lorazepam); psychoses; acute narrow-angle glaucoma; shock; coma; acute alcoholic intoxication with depression of vital signs; pregnancy (crosses placenta; risk of congenital malformations and neonatal withdrawal syndrome); labor and delivery (“floppy infant” syndrome); lactation.
Use cautiously with impaired hepatic or renal function.
Available Forms
Injection—2, 4 mg/mL; oral solution—2 mg/mL; tablets—0.5, 1, 2 mg
Dosages
Adults
Oral
Usual dose is 2–6 mg/day PO; range, 1–10 mg/day in divided doses with largest dose at bedtime.
Insomnia due to transient stress: 2–4 mg PO at bedtime.
IM
0.05 mg/kg IM 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 IV, whichever is smaller. Do not exceed this dose in patients older than 50 yr. Doses as high as 0.05 mg/kg IV 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.
Status epilepticus: For patients older than 18 yr, 4 mg slowly IV at 2 mg/min. May give another 4 mg after 10–15 min if needed.
Pediatric patients
Drug should not be used in children younger than 12 yr.
Patients with renal or hepatic impairment
Initially, 1–2 mg/day PO in divided doses. Adjust as needed and tolerated.
Pharmacokinetics
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