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Lorazepam Dosage

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Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for ICU Agitation

IV, intermittent:
Initial dose: 1 to 4 mg IV every 10 to 20 minutes to control acute agitation.
Maintenance dose: 1 to 4 mg IV every 2 to 6 hours and as needed to maintain desired level of sedation.

IV, continuous infusion:
0.01 to 0.1 mg/kg/hr IV to maintain desired level of sedation.
High-dose infusions (greater than 18 mg/hour for more than 4 weeks, or greater than 25 mg/hour for several hours or days) have been associated with tubular necrosis, lactic acidosis and hyperosmolality states due to the polyethylene glycol and propylene glycol solvents.

Usual Adult Dose for Anxiety

Oral:
Initial dose: 1 mg orally 2 to 3 times a day.
Maintenance dose: 1 to 2 mg orally 2 to 3 times a day. The daily dosage may vary from 1 to 10 mg/day orally.

IV:
Alternatively, an initial intravenous dose of 2 mg or 0.044 mg/kg, whichever is smaller, may be given.

Usual Adult Dose for Insomnia

2 to 4 mg orally at bedtime

Usual Adult Dose for Light Anesthesia

Premedication for Anesthesia:
IM: 0.05 mg/kg up to a maximum of 4 mg.
IV: 2 mg total, or 0.044 mg/kg, whichever is smaller.
This dose should not ordinarily be exceeded in patients over 50 years of age.
Larger doses as high as 0.05 mg/kg up to a total of 4 mg may be administered.

Usual Adult Dose for Nausea/Vomiting

Oral or IV: 0.5 to 2 mg every 4 to 6 hours as needed

Usual Adult Dose for Status Epilepticus

4 mg/dose slow IV over 2 to 5 minutes (maximum rate: 2 mg/minute); may repeat in 10 to 15 minutes; usual total maximum dose: 8 mg

Usual Pediatric Dose for Nausea/Vomiting - Chemotherapy Induced

Children: IV: Limited information exists, especially for multiple doses:

Single dose: 0.04 to 0.08 mg/kg/dose prior to chemotherapy (maximum dose: 4 mg)

Multiple doses: Some centers use 0.02 to 0.05 mg/kg/dose (maximum dose: 2 mg) every 6 hours as needed

Usual Pediatric Dose for Anxiety

Infants and Children: Usual: 0.05 mg/kg/dose (maximum dose: 2 mg/dose) every 4 to 8 hours; range: 0.02 to 0.1 mg/kg

Usual Pediatric Dose for Sedation

Sedation (preprocedure): Infants and Children:

Oral, IM, IV: Usual: 0.05 mg/kg; range: 0.02 to 0.09 mg/kg

IV: May use smaller doses (e.g., 0.01 to 0.03 mg/kg) and repeat every 20 minutes, as needed to titrate to effect

Usual Pediatric Dose for Status Epilepticus

Infants and Children: 0.05 to 0.1 mg/kg (maximum: 4 mg/dose) slow IV over 2 to 5 minutes (maximum rate: 2 mg/minute); may repeat every 10 to 15 minutes if needed.

Adolescents: 0.07 mg/kg (maximum: 4 mg/dose) slow IV over 2 to 5 minutes (maximum rate: 2 mg/minute); may repeat in 10 to 15 minutes if needed; usual total maximum dose: 8 mg.

Renal Dose Adjustments

Should be used with caution in patients with renal impairment due to decreased clearance and increased half-life.

Liver Dose Adjustments

Use with caution is recommended. Benzodiazepines may worsen hepatic encephalopathy. The dosage should be decreased in patients with severe hepatic insufficiency.

Dose Adjustments

Reduce dose by 50% if administered concurrently with probenecid or valproate.

The dosage of lorazepam should be increased gradually to help avoid adverse effects. When higher dosage is indicated for outpatients, the evening dose should be increased before the daytime doses.

Precautions

Benzyl alcohol preservative in the injection has been associated with fatal gasping syndrome in neonates.

Polyethylene glycol and propylene glycol solvents in the injection have been associated with hyperosmolality and seizures in neonates.

Dialysis

40% of a lorazepam dose is removed as the glucuronide conjugate during a 6 hour hemodialysis session.

Other Comments

Doses of other injectable central nervous system depressant drugs should ordinarily be reduced. For optimum effect, measured as lack of recall, IV lorazepam should be administered 15-20 minutes before the anticipated operative procedure.

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