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Lorazepam

Classification

Benzodiazepine

Indications

CCP: Anxiety, procedural sedation, short-term amnesia, status epilepticus

Contraindications

Hypersensitivity
Hypersensitivity to propylene/polyethylene glycol
Neonates or infants
Renal failure
Respiratory impairment
Sleep apnea
Narrow-angle glaucoma
Myasthenia gravis

Caution

Pregnancy 3^rd trimester
Pediatrics <3 years of age
Pulmonary impairment
CNS depression
Alcohol or drug abuse
Hepatic impairment
Elderly

Adult dosages

CCP: Anxiety

0.5mg-3 mg

CCP: Short-term amnesia

044 mg/kg IV

CCP: Status Epilepticus

4 mg IV slow push 2 mg/min
If seizure persists a second 4 mg dose IV

CCP: Procedural sedation

Loading dose: 0.02-0.04 mg/kg (max single dose 4mg)
Maintenance: 0.01-0.1 mg/kg/hr IV infusion (not to exceed 10 mg/hr)

Pediatric Considerations And Dosing

CCP: Status epilepticus

Infants and children
- 0.05-0.1 mg/kg IV slow push (not to exceed 4 mg)
Adolescents
- 4 mg IV slow push 2mg/min
- If seizure persists a second 4 mg dose IV

CCP: Anxiety/Amnesia/Procedural sedation

Children
- 0.05 mg/kg/dose (max 2 mg single dose)

Mechanism Of Action

Sedative hypnotic that enhances the major inhibitory neurotransmitter gamma-aminobutyric acid (GABA) by binding to the benzodiazepine receptor. Lorazepam may depress all levels of the CNS, including limbic and reticular formation.

Pharmacokinetics

Onset: 1-3 minutes IV

Duration: up to 8 hours

Peak plasma time: 2 hours

Half-life: 14 hours in adults, 18 hours in children 2-12, adolescents 28 hours

Adverse Effects

Sedation
Dizziness
Unsteadiness
Weakness
Fatigue
Drowsiness
Amnesia
Confusion
Disorientation
Depression
Suicidal ideation
Vertigo
Ataxia
Tremor
Respiratory depression
Extrapyramidal symptoms
Convulsions
Dysarthria
Hypotension
Impotence
Jaundice
Increased liver transaminases
Increased ALP
Nausea
Constipation
Paradoxical reactions

Overdose

Symptomatic relief and support.

Flumazenil

Warning And Precautions

Concomitant use of benzodiazepines and opioids may result in profound sedation, respiratory depression, and coma.
Abuse and misuse of benzodiazepines commonly involve concomitant use of other medications and substances.
Prolonged use may lead to physical dependence.
Use of injectable dosage form in neonates and infants is associated with potentially fatal gasping syndrome due to the benzyl alcohol.
Avoid or minimize concomitant use of CNS depressants.
Use caution in patients with respiratory disease, including COPD or sleep apnea.
Weigh the risk benefit for pregnancy in 3^rd Possible risk of tetragenicity based on conflicting human data and the risk of floppy infant syndrome.
Excreted in human breast milk, therefore Lorazepam is not recommended.
Minor tranquilizers should be avoided in 1^st trimester of pregnancy due to an increased risk of congenital malformations.

Drug Interactions

Amifampridine
Bupropion
Dalfampridine
Metoclopramide
Muromonab-CD3
Benzhydrocodone/acetaminophen
Calcium/Magnesium/Potassium/Sodium oxybates
Hydrocodone
Selinexor
Sufentanil
Valerian