LORAZEPAM

Indications & Dose:

Short-term use in anxiety 

• BY MOUTH

Adult: 1–4 mg daily in divided doses, for debilitated patients, use elderly dose

Elderly: 0.5–2 mg daily in divided doses

Short-term use in insomnia associated with anxiety

•  BY MOUTH

Adult: 1–2 mg daily, to be taken at bedtime

Acute panic attacks

•   BY INTRAMUSCULAR INJECTION, OR BY SLOW INTRAVENOUS INJECTION

Adult: 25–30 micrograms/kg every 6 hours if required; usual dose 1.5–2.5 mg every 6 hours if required, intravenous injection to be administered into a large vein, only use intramuscular route when oral and intravenous routes not possible

Conscious sedation for procedures

• BY MOUTH

Adult: 2–3 mg, to be taken the night before operation; 2–4 mg, to be taken 1–2 hours before operation

•   BY SLOW INTRAVENOUS INJECTION

Adult: 50 micrograms/kg, to be administered 30– 45 minutes before operation

•   BY INTRAMUSCULAR INJECTION

Adult: 50 micrograms/kg, to be administered 60– 90 minutes before operation

Premedication

•   BY MOUTH

Adult: 2–3 mg, to be taken the night before operation; 2–4 mg, to be taken 1–2 hours before operation

•   BY SLOW INTRAVENOUS INJECTION

Adult: 50 micrograms/kg, to be administered 30– 45 minutes before operation

•   BY INTRAMUSCULAR INJECTION

Adult: 50 micrograms/kg, to be administered 60– 90 minutes before operation

Status epilepticus

Febrile convulsions

Convulsions caused by poisoning

•  BY SLOW INTRAVENOUS INJECTION

Child 1 month–11years: 100 micrograms/ kg (max. per dose 4 mg) for 1 dose, then 100 micrograms/kg after 10 minutes (max. per dose 4 mg) if required for 1 dose, to be administered into a large vein Child 12–17years: 4 mg for 1 dose, then 4 mg after 10 minutes if required for 1 dose, to be administered into a large vein

• Adult: 4 mg for 1 dose, then 4 mg after 10 minutes if required for 1 dose, to be administered into a large vein

Contraindications:

Acute narrow-angle glaucoma, psychosis

Side Effects:

Cautions:

Precautions:

Elderly, debilitated, hepatic disease, renal disease, suicidal patients, COPD, history of drug abuse 

Interaction:

Drugs

Ethanol: Increased adverse psychomotor effects of lorazepam

Fluconazole: Potential for increased lorazepam concentrations

Itraconazole: Potential for increased lorazepam concentrations 

Warnings:

Adverse Effects:

Lactations:

(other benzodiazepines associated with cleft lip, cleft palate, microcephaly, pyloric stenosis); neonatal withdrawal, hypotonia; excreted into breast milk in low quantities; effect on infant unknown 

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

CNS: Anxiety, confusion, depression, dizziness, drowsiness, fatigue, hallucinations, headache, insomnia, stimulation, tremors, unsteadiness

CV: ECG changes, orthostatic hypotension, tachycardia

EENT: Blurred vision, mydriasis, tinnitus

GI: Anorexia, constipation, diarrhea, dry mouth, nausea, vomiting

SKIN: Dermatitis, itching, rash 

Patient And Carer Advice: