Lorazepam

Anxiety Disorder
1. Start 0.5 to 1 mg orally 2 to 3 times daily
  1. Start at 0.5 mg if used in the elderly (typically avoid as per Beer's List, STOPP)
2. May advance to 0.5 to 2 mg orally every 6 to 8 hours as needed
3. Maximum Daily Dose: 10 mg orally/day in divided doses (2 mg/day divided in the elderly)
Acute Agitation
1. Give 1-2 mg PO/IV/IM as needed
Anxiolysis or Sedation Prior to Procedure
1. IM/IV: 0.05 mg/kg up to 2 to 4 mg IV given 20 min prior to procedure (or IM given 2 hours prior)
Anxiolysis or Sedation in the ICU or Emergency Department
1. Dose 0.02 to 0.06 mg/kg (typically 2 to 4 mg) IV every 2 to 6 hours as needed
Status Epilepticus
1. IV: 0.1 mg/kg IV (<2 mg/minute) up to 4 mg
2. Rectal: 0.1 mg/kg up to 4 mg
3. Avoid IM Lorazepam (unreliable in Status Epilepticus)
4. May repeat once in 5-10 minutes
5. Avoid more than 2 doses in children due to risk of respiratory depression
Insomnia Related to Acute Emotional Stress
1. Start 1 mg orally at bedtime (max dose 4 mg, limit to 1 mg in elderly)
Alcohol Withdrawal
1. See Alcohol Withdrawal for complete protocol (with expanded dosing)
2. Give 1 to 2 mg PO/IM/IV every 2 to 4 hours as needed OR
3. Give 2 mg PO/IM/IV every 6 hours for 24 hours, then 1 mg every 6 hours for 8 doses

Anxiolysis or Sedation
1. Dose 0.05 mg/kg up to 2 mg IV/PO every 4 to 8 hours as needed
Status Epilepticus
1. Start 0.05 to 0.1 mg/kg IV up to 4 mg over 2 to 5 minutes
2. May repeat 0.05 mg/kg IV up to 4 mg in 10 min if needed

Pregnancy Category D
Schedule IV Controlled Substance
Avoid in Lactation if possible
1. Benzodiazepines do cross into Breast Milk with risk of sedation in infants
2. However, ACOG considers moderately safe
3. Given Lorazepam's relatively short Half-Life, it is among the preferred Benzodiazepines