lorazepam ATIVAN

Class: Benzodiazepine/​3-Hydroxy
FDA Indications: Anxiety Disorders, Status Epilepticus (IM Only), Preanesthetic (IM Only)
Off-Label Use: Alcohol Withdrawal, Preanesthetic, Insomnia, Catatonia, Delirium, Acute Dystonia, Agitation In The ICU Patient, Agitation/aggression
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.

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 May 19 2018 15:53:20. Disclaimer: This website does not provide medical advice, nor is it a substitute for clinical judgment.