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lorazepam
generic
Black Box Warnings .
Risks from Concomitant Opioid Use
concomitant benzodiazepine use w/ opioids may result in profound sedation, resp. depression, coma, and death; reserve concomitant use for pts w/ inadequate alternative tx options; limit to minimum required dosage and duration; monitor pts for s/sx of resp. depression and sedation
Addiction, Abuse, and Misuse
benzodiazepines expose users to risk of abuse, misuse, and addiction, can lead to overdose or death; commonly involves concomitant use w/ other meds, alcohol, and/or illicit substances, which is assoc. w/ incr. frequency of serious adverse outcomes; assess risk for abuse, misuse, and addiction before prescribing and throughout tx
Dependence and Withdrawal Reactions
cont. benzodiazepine use may lead to clinically significant physical dependence; risk of dependence and withdrawal incr. w/ longer tx duration and higher daily dose; use gradual taper to D/C after cont. use as abrupt D/C or rapid dose reduction may cause acute withdrawal reactions, potentially life-threatening
Adult Dosing .
Dosage forms: TAB: 0.5 mg, 1 mg, 2 mg; SOL: 2 mg per mL; INJ: 2 mg per mL, 4 mg per mL
anxiety
- [2-6 mg/day PO/IM/IV divided bid-tid]
- Start: 2-3 mg/day PO/IM/IV divided bid-tid; Max: 10 mg/day; Info: start 1-2 mg/day PO/IM/IV divided bid-tid in elderly or debilitated pts; taper dose gradually to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
insomnia, short-term tx
- [2-4 mg PO qhs prn]
- Info: taper dose gradually to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
status epilepticus
- [4 mg IV x1]
- Info: may repeat x1 after 10-15min
preoperative sedation
- [IM route]
- Dose: 0.05 mg/kg/dose IM x1; Start: >2h before surgery; Max: 4 mg/dose
- [IV route]
- Dose: 0.044-0.05 mg/kg/dose IV x1; Start: 15-20min before surgery; Max: 4 mg/dose; Info: max 2 mg/dose in elderly pts
chemo-related nausea/vomiting, adjunct tx (off-label)
- [0.5-1 mg PO/IV/SL q6h prn]
- Info: use lowest effective dose, shortest effective tx duration; search 'CINV' for epocrates Chemo-Induced Nausea & Vomiting in Adults decision tool
chemo-related nausea/vomiting, anticipatory (off-label)
- [0.5-1 mg PO/IV/SL q6h prn]
- Info: may give 1st dose night before chemo, then 2nd dose 1-2h before chemo; start 0.5 mg/dose in elderly or debilitated pts; use lowest effective dose, shortest effective tx duration; search 'CINV' for epocrates Chemo-Induced Nausea & Vomiting in Adults decision tool
refractory nausea/vomiting, chemo-related (off-label)
- [0.5-1 mg PO/IV/SL q6h]
- Info: use lowest effective dose, shortest effective tx duration; search 'CINV' for epocrates Chemo-Induced Nausea & Vomiting in Adults decision tool
alcohol withdrawal, acute (off-label)
- [fixed-dose regimen]
- Dose: 2 mg PO/IM/IV q8h x2 days, then 1 mg PO/IM/IV q8h x1 day, then 1 mg PO/IM/IV q12h x1 day, then 1 mg PO/IM/IV qhs x1 day; Info: give additional doses prn; refer to institution protocol
- [symptom-triggered regimen]
- Dose: 2-4 mg PO/IM/IV q1h prn; Info: refer to institution protocol
delirium tremens (off-label)
- [1-4 mg IV q5-15min prn]
- Alt: 1-4 mg IM q30-60min prn; Info: refer to institution protocol
neuroleptic malignant syndrome (off-label)
- [1-2 mg IM/IV q4-6h]
renal dosing
- [PO route]
- renal impairment: no adjustment
- HD/PD: not defined
- [IM/IV route]
- renal failure: avoid use; Info: caution advised if freq. or high-dose use in renal impairment due to incr. risk of propylene/polyethylene glycol toxicity
- HD/PD: not defined
hepatic dosing
- [PO route]
- severe impairment: consider decr. usual dose
- [IM/IV route]
- hepatic impairment: not defined, caution advised; hepatic failure: avoid use
Peds Dosing .
- Dosage forms: TAB: 0.5 mg, 1 mg, 2 mg; SOL: 2 mg per mL; INJ: 2 mg per mL, 4 mg per mL
anxiety (off-label)
- [children]
- Dose: 0.05 mg/kg/dose PO/IV q4-8h; Max: 2 mg/dose; Info: taper dose gradually to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
status epilepticus (off-label)
- [0.05-0.1 mg/kg/dose IV x1]
- Max: 4 mg/dose; Info: may repeat x1 after 10-15min
chemo-related nausea/vomiting, adjunct tx (off-label)
- [children]
- Dose: 0.02-0.05 mg/kg/dose IV q6h prn; Max: 2 mg/dose; Info: give w/ antiemetic; use lowest effective dose, shortest effective tx duration
preoperative sedation (off-label)
- [children]
- Dose: 0.05 mg/kg/dose PO/IM/IV x1; Start: PO 1h, IM >2h, IV 15-20min before surgery; Max: 2 mg/dose
renal dosing
- [PO route]
- renal impairment: no adjustment
- HD/PD: not defined
- [IM/IV route]
- renal failure: avoid use; Info: caution advised if freq. or high-dose use in renal impairment due to incr. risk of propylene/polyethylene glycol toxicity
- HD/PD: not defined
hepatic dosing
- [not defined]
- hepatic impairment: consider adult hepatic dosing for guidance