Management of anxiety disorders and short-term relief of anxiety or anxiety associated with depressive symptoms.
Preoperative Sedation, Anxiolysis, and Anterograde Amnesia
Preoperatively, to produce sedation, relieve anxiety, and provide anterograde amnesia.
Status Epilepticus
A drug of choice in the management of status epilepticus.
Sedation in Critical-care Settings
Sedation† of intubated and mechanically ventilated patients in a critical care setting. Other agents with more rapid onset (e.g., diazepam, midazolam) preferred for rapid sedation of acute agitated patients.
Schizophrenia
Has been used in management of schizophrenia; may be helpful for management of anxiety, agitation, and sleep disturbances that are often present during the acute phase of schizophrenia in patients receiving antipsychotic therapy.
May be helpful in patients experiencing akathisia† while receiving antipsychotic drugs (e.g., for management of schizophrenia).
Also has been used for treatment of acute catatonic reactions†, whether associated with schizophrenia or other conditions.
Cancer Chemotherapy-induced Nausea and Vomiting
Alone or as adjunctive therapy for the management of nausea and vomiting† associated with emetogenic cancer chemotherapy (including cisplatin).
Adjunct in the management of certain drug-induced cardiovascular emergencies† (e.g., drug-induced hemodynamically significant tachycardia†, hypertensive emergency†, acute coronary syndrome†, or acute anticholinergic syndrome†) when standard emergency cardiovascular care (ECC) guidelines may not be optimal or appropriate. Adjunct in the initial treatment of cocaine-induced acute coronary syndrome†.
Dosage and Administration
General
Use smallest effective dosage to avoid oversedation.
In patients who have received prolonged (e.g., for several months) therapy, avoid abrupt discontinuance, since manifestations of withdrawal can be precipitated; gradually taper dosage.
Administration
Administer orally, IM, or by IV injection or continuous infusion. Avoid intra-arterial injection (arteriospasm may cause gangrene, possibly requiring amputation).
Oral Administration
Dilute dose of oral concentrate solution in 30 mL or more of diluent (e.g., water, juice, carbonated or soda-like beverages) or mix with semi-solid foods (e.g., applesauce, pudding) just prior to administration.
IM Administration
Administer undiluted injection deeply into a large muscle mass. IM administration is not usually recommended, but may be used if IV access is not available.
IV Administration
For solution and drug compatibility see Compatibility under Stability.
Direct injection should be made with repeated aspiration to ensure that none of the drug is injected intra-arterially and that perivascular extravasation does not occur. If pain occurs during the injection, immediately stop the injection and determine whether intra-arterial injection or extravasation has occurred.
Equipment necessary to maintain a patent airway and to support respiration and ventilation should be immediately available prior to IV administration. Monitor vital signs during IV infusion of the drug.
Dilution
For administration as a direct injection, dilute 2-mg/mL injection with an equal volume of compatible diluent (e.g., sterile water for injection, 0.9% sodium chloride injection, or 5% dextrose injection) immediately prior to IV administration.
For administration as a continuous infusion, dilute the 2-mg/mL injection in a glass container to a concentration of ≤1 mg/mL with a compatible IV fluid. (See Solution Compatibility under Stability.)
Alternatively, 2-mg/mL injection may be administered undiluted as an infusion using a patient-controlled analgesia (PCA) device.
Rate of Administration
Administer by direct injection into a vein or the tubing of a free-flowing compatible IV infusion at a rate ≤2 mg/minute. (See Solution Compatibility under Stability.)
Dosage
Pediatric Patients
Status Epilepticus
IV
Initially, 0.05–0.1 mg/kg.†
Sedation in Critical-care Settings
IV
Children ≤12 years of age: Dosages of 0.025–0.05 mg/kg (up to 2 mg as initial dose) every 2–4 hours have been used. Alternatively, 0.025 mg/kg per hour (up to 2 mg/hour) as a continuous infusion; titrate infusion rate as necessary or supplement with rapid injections of the drug to provide the desired level of sedation. Children <2 months of age: Reduce initial dose by 50% because of wide interpatient variations in dosage requirements and low hepatic metabolic function.†
Children >12 years of age: 0.02–0.06 mg/kg given every 2–6 hours. Alternatively, 0.01–0.1 mg/kg per hour as a continuous infusion; titrate infusion rate to the lowest dosage that provides desired level of sedation.†
Adults
Anxiety
Oral
Initially, 2–3 mg daily divided in 2 or 3 doses. Maintenance dosage of 1–10 mg daily (usually 2–6 mg) in divided doses, with the largest dose administered at bedtime. Increase dosage gradually if higher dosage is indicated; increase the evening dose before the daytime doses.
For insomnia caused by anxiety, 2–4 mg as a single daily dose at bedtime.
Preoperative Sedation, Anxiolysis, and Anterograde Amnesia
IM
0.05 mg/kg (up to 4 mg) at least 2 hours prior to surgery.
IV
Initially, 0.044 mg/kg (up to 2 mg) 15–20 minutes prior to surgery; do not routinely exceed this dosage in patients >50 years of age. For amnesic effects, doses up to 0.05 mg/kg (maximum 4 mg) may be administered.
Status Epilepticus
IV
Initially, 4 mg. If seizures continue or recur after a 10- to 15-minute observation period, administer an additional 4-mg dose. Manufacturer states that experience with administration of additional doses is limited.
Sedation in Critical-care Settings
IV
0.02–0.06 mg/kg given every 2–6 hours.†
Alternatively, 0.01–0.1 mg/kg per hour as a continuous infusion; titrate infusion rate to the lowest dosage that provides desired level of sedation.†
Cancer Chemotherapy-induced Nausea and Vomiting
Oral
2.5 mg the evening before and just after initiation of chemotherapy.†
IV
1.5 mg/m2 (up to 3 mg) over 5 minutes, given 45 minutes before administration of chemotherapy.†
Delirium
IV
0.5–1 mg, immediately following 3 mg of haloperidol.†
Prescribing Limits
Adults
Preoperative Sedation, Anxiolysis, and Anterograde Amnesia
IM
4 mg.
IV
2 mg for sedation and relief of anxiety. For amnesic effects, 4 mg; 3 mg for management of chemotherapy-induced nausea and vomiting.
Special Populations
Hepatic Impairment
Dosage adjustments are not required for parenteral administration.
Adjust oral dosage carefully in patients with severe hepatic insufficiency because oral therapy may exacerbate hepatic encephalopathy; lower than recommended dosages may be sufficient in these patients.
Renal Impairment
Dosage adjustment is not required for single doses of lorazepam injection; however, exercise caution with administration of multiple doses over a short period of time.
Geriatric Patients
Cautious dosage selection recommended because of greater sensitivity and possible age-related decreases in hepatic or renal function; initiate therapy at the lower end of the usual range.
Anxiety Disorders
Oral
Initially, 1–2 mg daily divided in 2 or 3 doses.
Preoperative Sedation, Anxiolysis, and Anterograde Amnesia
IM or IV
Patients >50 years of age generally should not receive initial dose >2 mg unless enhanced suppression of recall is desired. Excessive and prolonged sedation may occur.
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