lorazepam ATIVAN

Class: Benzodiazepine/​3-Hydroxy
FDA Indications: Anxiety Disorders, Status Epilepticus (IM Only), Preanesthetic (IM Only)
Off-Label Use: Acute Dystonia, Agitation/aggression, Alcohol Withdrawal, Catatonia, Delirium, Insomnia, Preanesthetic, Agitation In The ICU Patient
Prescribing
FDA Schedule IV
Forms: 0.5, 1, 2mg tablet; 2 mg/mL, 4 mg/mL IM
Dose Range: 0.5-10 mg/day
Starting: 2-3 mg daily in 2 to 3 divided doses
Stopping: Taper 0.5 mg q3 days, slower (0.25 mg per week) for more difficult cases

NAMI drug fact sheet

Precautions
Contraindications: Sleep apnea, acute narrow-angle glaucoma
Serious Side Effects: Overdose can result in hypotension, respiratory depression, and coma
Side Effects: sedation/somnolence, dizziness, confusion, disequilibrium, ataxia, lightheadedness, weakness/asthenia, decreased libido, dysarthria, constipation, increased appetite, weight gain
Pharmacodynamics
1° MOA: GABAAR PAM
Target: GABAA: α2, α3, γ2 (high); α1 (low)
Pharmacokinetics
t½: 15 (8-24)° TMAX: 1-4°
Absorption Rate: Medium
Lipid Solubility: Low-moderate
Substrate of: Conjugation
Inhibits: ∅ ; Induces:
Active Metabolites:
DDIs
  • - CNS depression with combined use of opioids
  • - VPA ↑'s plasma concentration and reduces clearance via impairing hepatic glucuronidation
Misc
  • - dosage should be ↓ by 50% with concurrent use of valproate or probenecid
  • - the only benzodiazepine with predictable intramuscular absorption
  • - one of few benzodiazepines available as po liquid
Special Populations

Category D—↑ risk of oral cleft by 0.01%, use just before delivery associated with floppy infant syndrome, 3rd trimester use can cause withdrawal in newborns

Short t½ benzodiazepines such as lorazepam (RID 2.9%) are excreted into breast milk in miniscule amounts and ∴ preferred over longer-acting agents; ∅ AE's have been reported

Per Beers Criteria, should be avoided in patients ≥65 years. If used, start low 1-2 mg in divided doses.


2019 BEE℞S Recommendation: Avoid. Older adults have increased sensitivity to benzodiazepines and decreased metabolism of long- acting agents; in general, all benzodiazepines increase risk of cognitive impairment, delirium, falls, fractures, and motor vehicle crashes in older adults. May be appropriate for seizure disorders, RBD, benzodiazepine withdrawal, EtOH withdrawal, severe GAD, and periprocedural anesthesia.

No dosage adjustment necessary


No dose adjustment necessary with mild-moderate liver dz; use with caution if severe insufficiency

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Last updated March 25 2019 15:25:58. Disclaimer: This website does not provide medical advice, nor is it a substitute for clinical judgment.