ATIVAN. Wyeth-Ayerst. Lorazepam. Anxiolytic – Sedative. Action And Clinical Pharmacology: Lorazepam is a benzodiazepine with CNS depressant, anxiolytic and sedative properties. Lorazepam has also been shown to possess anticonvulsant activity. Peak plasma concentrations of free lorazepam after oral.
Subsequent prescriptions, when required, should be limited to short courses of therapy. Initially, not more than 1 week’s supply of the drug should be provided and automatic prescription renewals should not be allowed. Dosage And Administration: Dosage must be individualized and carefully titrated in order to avoid excessive sedation or mental and motor impairment. As with other anxiolytic sedatives, short courses of treatment should usually be the rule for the symptomatic relief of disabling anxiety in psychoneurotic patients and the initial course of treatment should not last longer than 1 week without reassessment of the need for a limited extension.
As with any premedicant, extreme care must be used in administering lorazepam injection to elderly or very ill patients and to those with limited pulmonary reserve, because of the possibility that apnea and/or cardiac arrest may occur.
Onset. After IV administration, the onset of anticonvulsant, anxiolytic, or sedative action occurs in 1–5 minutes.b. After IM administration, the onset of action is 15–30 minutes.b.
2.5 mg the evening before and just after initiation of chemotherapy.496.
Possibility of suicide in depressed patients; prescribe drug in the smallest feasible quantity.b c.
Use oral lorazepam with caution in patients with compromised respiratory function (e.g., chronic pulmonary insufficiency, sleep apnea).b c.
Repeated or prolonged use of general anesthetics and sedation drugs, including lorazepam, in children <3 years of age or during the third trimester of pregnancy may adversely affect neurodevelopment.750 753 In animals, use for >3 hours of anesthetic and sedation drugs that block N -methyl-d-aspartic acid (NMDA) receptors and/or potentiate GABA activity leads to widespread neuronal apoptosis in the brain and long-term deficits in cognition and behavior;750 751 752 753 clinical relevance to humans is unknown.750 Some evidence suggests similar deficits may occur in children following repeated or prolonged exposure to anesthesia early in life.750 752 Some evidence also indicates that a single, relatively brief exposure to general anesthesia in generally healthy children is unlikely to cause clinically detectable deficits in global cognitive function or serious behavioral disorders.750 751 752 Most studies to date have substantial limitations; further research needed to fully characterize effects, particularly for prolonged or repeated exposures and in more vulnerable populations (e.g., less healthy children).750 Consider benefits and potential risks when determining the timing of elective procedures requiring anesthesia.750 FDA states that medically necessary procedures should not be delayed or avoided.750 753 (See Advice to Patients.).
Concomitant use of benzodiazepines and opiates may result in profound sedation, respiratory depression, coma, and death.700 701 703 705 706 707.
Reduce usual lorazepam dosage by 50%d.
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.a d For amnesic effects, doses up to 0.05 mg/kg (maximum 4 mg) may be administered.a d.
Reduce lorazepam dosage by 50%c d Propranolol.
Dosage of parenteral lorazepam may need to be increased d Haloperidol.
Some pediatric patients (premature and low-birth weight infants or those receiving high doses of the injection) may be susceptible to adverse effects associated with benzyl alcohol, polyethylene glycol, and propylene glycol.435 Large amounts of benzyl alcohol (i.e., 100–400 mg/kg daily) have been associated with toxicity in neonates;435 584 585 586 587 588 589 590 each mL of lorazepam injection contains 2 mg of benzyl alcohol.d (See Propylene Glycol or Polyethylene Glycol Toxicity under Cautions.).
Use with caution to avoid overdosagec d Avoid alcohol use700 Contraceptives, oral.
Opiate analgesics: Use concomitantly only if alternative treatment options are inadequate; use lowest effective dosages and shortest possible duration of concomitant therapy; monitor closely for respiratory depression and sedation700 703.
Additive CNS effectsc d.
Concomitant use of other CNS depressants may increase the risk of apnea.a c.
Initially, 4 mg.435 If seizures continue or recur after a 10- to 15-minute observation period, administer an additional 4-mg dose.435 Manufacturer states that experience with administration of additional doses is limited.435.
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.a d If pain occurs during the injection, immediay stop the injection and determine whether intra-arterial injection or extravasation has occurred.d.
No additional benefit from the combinationd Theophylline Decreased sedative effectsd Valproate.
Injection contraindicated in patients with sleep apnea.435.
A drug of choice in the management of status epilepticus.435 543 545 546 a.
With parenteral therapy for the management of status epilepticus, hypotension, somnolence, respiratory failure; with parenteral therapy for preoperative use, excessive sleepiness, drowsiness.d Drug Interaction Comments Cimetidine.
No dosage adjustment of lorazepam requiredd Scopolamine.
In patients receiving lorazepam, initiate opiate analgesic, if required, at reduced dosage and titrate based on clinical response700.
Possible increased sedation, hallucinations, and irrational behaviord.
Management of anxiety disorders and short-term relief of anxiety or anxiety associated with depressive symptoms.a c.
Effect on lorazepam pharmacokinetics unlikelyd.
Dosage adjustments are not required for parenteral administration.435.
May be helpful in patients experiencing akathisia † while receiving antipsychotic drugs (e.g., for management of schizophrenia).529.
Seizures and myoclonus reported in pediatric patients, especially low birth weight neonates, receiving lorazepam injection.435 Brief tonic-clonic seizures reported in children receiving lorazepam for the management of atypical petit mal status epilepticus.435.
Risk of profound sedation, respiratory depression, coma, or death700 701 703 705 706 707.
Administer orally, IM, or by IV injection or continuous infusion.a b c d Avoid intra-arterial injection (arteriospasm may cause gangrene, possibly requiring amputation).a d.
Because of the prolonged duration of action, sedative effects of lorazepam (especially after multiple doses) may increase impairment of consciousness observed in the postictal state.435.
With oral therapy, sedation, dizziness, weakness, unsteadiness.c.
Possible increased clearance of parenteral lorazepamd.
Careful monitoring of respiratory rate and maintenance of an adequate, patent airway is required; ventilatory support may be necessary.435.
2 mg for sedation and relief of anxiety.a d For amnesic effects, 4 mg;a d 3 mg for management of chemotherapy-induced nausea and vomiting.a.
Known hypersensitivity to benzodiazepines or any ingredient in the formulation (e.g., benzyl alcohol, polyethylene glycol, or propylene glycol in the injection).283 435.
No dosage adjustment of lorazepam requiredd Clozapine.
Patients with a history of drug or alcohol dependence or abuse are at risk of habituation or dependence; use only with careful surveillance in such patients.b c.
Decreased lorazepam clearancec d.
No dosage adjustment of lorazepam requiredd.
Oral lorazepam may exacerbate hepatic encephalopathy; therefore, use with caution in patients with severe hepatic insufficiency and/or encephalopathy.283.
Administer by direct injection into a vein or the tubing of a free-flowing compatible IV infusion at a rate ≤2 mg/minute.a (See Solution Compatibility under Stability.).
Sedation † of intubated and mechanically ventilated patients in a critical care setting.564 565 Other agents with more rapid onset (e.g., diazepam, midazolam) preferred for rapid sedation of acute agitated patients.564.
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.564 (See Solution Compatibility under Stability.).
Paradoxical excitation (e.g., tremors, agitation, euphoria, logorrhea, brief episodes of visual hallucinations) reported in 10–30% of children <8 years of age.435.
May cause excessive sedation for 6–8 hours or longer after surgery in this population.435.
Lorazepam injection is not recommended for use in renal failure; use with caution in patients with mild to moderate renal disease.a d (See Renal Impairment under Dosage and Administration.).
Whenever possible, avoid concomitant use708 709 710 711.
Select initial dosages at the lower end of the usual range because of potential for greater sensitivity and age-related decreases in hepatic or renal function.283 435 (See Geriatric Patients under Dosage and Administration.).
For insomnia caused by anxiety, 2–4 mg as a single daily dose at bedtime.a c.
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.565 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.565 Children <2 months of age: Reduce initial dose by 50% because of wide interpatient variations in dosage requirements and low hepatic metabolic function.565.
Facilities, age- and size-appropriate equipment for bag/mask/valve ventilation and intubation, drugs, and skilled personnel necessary for ventilation and intubation, administration of oxygen, assisted or controlled respiration, airway management, and cardiovascular support should be immediay available when lorazepam is administered IV.435 566 567 d.
Safety and efficacy of tablets and oral concentrate solution not established in children <12 years of age.283.
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.a.
For solution and drug compatibility information, see Compatibility under Stability.
Reserve concomitant use for patients in whom alternative treatment options are inadequate; use lowest effective dosages and shortest possible duration of concomitant therapy and monitor closely for respiratory depression and sedation.700 703 (See Specific Drugs under Interactions.).
No dosage adjustment of lorazepam requiredd Disulfiram.
Consider offering naloxone to patients receiving benzodiazepines and opiates concomitantly709 712 Probenecid.
Initially, 2–3 mg daily divided in 2 or 3 doses.a c Maintenance dosage of 1–10 mg daily (usually 2–6 mg) in divided doses, with the largest dose administered at bedtime.a c Increase dosage gradually if higher dosage is indicated; increase the evening dose before the daytime doses.a.
Effect on lorazepam pharmacokinetics unlikelyd.
Benzodiazepine; anticonvulsant, anxiolytic, and sedative.a b c d.
Oral: Initially, 1–2 mg daily divided in 2 or 3 doses.a.
May interfere with assessment of level of anesthesia when administered IV prior to regional or local anesthesia, especially when given at doses >0.5 mg/kg or when opiate agonists or partial agonists are used concomitantly with recommended lorazepam doses.a d.
Possible paradoxical excitation (e.g., anxiety, excitation, hostility, aggression, rage, sleep disturbances/insomnia, sexual arousal, hallucinations).b c.
CNS depressants (e.g., barbiturates, sedatives, anticonvulsants, alcohol).
Acute angle-closure glaucoma (but may be administered to patients with open-angle glaucoma who are receiving appropriate therapy);c d 283 435 however, clinical rationale for this contraindication has been questioned.b.
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) immediay prior to IV administration.a d.
Use with cautionc d.
Do not use in patients with depressive neuroses or psychotic reactions in which anxiety is not prominent.a c.
Administer undiluted injection deeply into a large muscle mass.435 IM administration is not usually recommended, but may be used if IV access is not available.435.
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.435.
Administer IV only in settings in which continuous monitoring of respiratory and cardiac function (i.e., pulse oximetry) is possible.435 Monitoring of vital signs should continue during recovery period.435 566 567.
Effect on lorazepam pharmacokinetics unlikelyd.
Safety of the injection for treatment of status epilepticus or efficacy for preoperative sedation not established in children <18 years of age.435.
Equipment necessary to maintain a patent airway and to support respiration and ventilation should be immediay available prior to IV administration.435 Monitor vital signs during IV infusion of the drug.435.
Injection contraindicated in patients with severe respiratory insufficiency, except in those patients receiving mechanical ventilation requiring relief of anxiety and/or diminished recall of events.435.
Insufficient experience in patients ≥65 years of age to determine whether geriatric patients respond differently than younger adults.283 435 Possibility of greater sensitivity to the drug (e.g., respiratory or CNS depression) in some geriatric individuals.d.
Use smallest effective dosage to avoid oversedation.a b.
Opiate agonists and partial agonists.
Adjunct in the management of certain drug-induced cardiovascular emergencies †.
Diazepam (Valium). Lorazepam (Ativan). Dosage (oral). 0.3-0.5 mg/kg. 0.15-0.2 mg/kg. 0.015-0.03 mg/kg. Time to peak effect. 30 minutes-60 minutes. 1-1.5 hours. 2-4 hours. Duration. 1-2 hours. 2-2.5 hours. 4-6 hours. Elimination halftime (time to reduce drug concentration by 50%). 1-4 hours. 20-100 hours (includes active.
Medical Pharmacology Chapter 12: Anxiolytics and Sedative-Hypnotics.
From On-Line Airway Atlas 2000, John Sherry, II, M.D 1999,2000 Epiglottis (with Abscess).
From On-Line Airway Atlas 2000, John Sherry, II, M.D 1999,2000 Intranasal midazolam (Versed) administration (0.2 mg/kg) Less patient cooperation required (appropriate for combative children) Quicker onset compared to oral Route of Administration Occasionally (rare), midazolam (Versed) made evoked a hyperexcitability reaction-some anesthesia providers may wish to employ midazolam (Versed) only with relatively uncooperative patients 3Lorazepam (Ativan) Overview No active metabolites; short half-life (approximay 15 hours) Half-life not influenced by patient age Pharmacokinetic/metabolism characteristics Reduced, compared to diazepam (Valium), rate of CNS access secondary to relatively less lipophilicity Onset of action for both diazepam (Valium) and lorazepam (Ativan) is similar, about 30-60 minutes CNS effects e.g.
Bipolar disorder description. Benzodiazepines valium, sedation-specific dosing. Counsel the body: headaches. Feb 12. 0 Mg, lorazepam Full Report use. Jul 15 to lorazepam works for a slower than lorazepam was compared to take weeks or lorazepam, rapid onset of ativan. Single dose administered and how long.
- Patients with arterial hypotension, cerebral sclerosis, heart failure or low body weight should adjust the dosage regimen.
Your attending doctor should indicate the optimal dosage regimen based on the therapy results and sensitivity of the patient to the active components of the drug.
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- The maximum daily dose for adult patient is 10 mg.
*Materials which are provided herein have informative character and are not an instruction for the obligatory action.
Lorazepam. Apo-Lorazepam ◇, Ativan, Novo-Lorazem ◇. Pharmacologic classification: benzodiazepine. Therapeutic classification: anxiolytic, sedative-hypnotic. Pregnancy risk Anxiolytic and sedative actions: Lorazepam depresses the CNS at the limbic and subcortical levels of the brain. Route, Onset, Peak, Duration.
Calendula, catnip, hops, kava, lady’s slipper, passionflower, valerian: May increase sedative effect of drug. Drug-lifestyle. Discourage smoking. Heavy smoking: Accelerates lorazepam metabolism, thus lowering clinical effectiveness. Use together cautiously. Use together cautiously. Discourage alcohol use. Cimetidine, possibly disulfiram: Diminishes hepatic metabolism of lorazepam, which increases its plasma level. Alcohol use: Potentiates CNS depressant effects of alcohol. Scopolamine: Combined use of parenteral lorazepam and scopalamine may cause an increased risk of hallucinations, irrational behavior, and increased sedation.