Name: LORAZEPAM (AtivanR)
Classification: anxiolytic agent; sedative; anticonvulsant
  • used in the initial control of seizures or in the treatment of status epilepticus
  • has no long-term anticonvulsant activity
  • useful in the management of alcohol withdrawal and delirium tremens
  • muscle relaxant - useful in patient with tetanus
Dose:
  • Bolus:
    • 0.044 mg/kg IV direct (up to 2 mg) q 1-8h; titrate to individual need
    • (generally sufficient for adequate sedation in most patients; this dose should not be exceeded in patients older than 50 years)
  • Infusion:
    • initiate at 1-3 mg/hr and adjust according to effect and target VAMAAS (tolerance may occur)
  • anticonvulsant:
    • 0.05 mg/kg IV (up to 7 mg) which can be repeated in 5 min
Administration:
  • IV Direct:
    • dilute with equal volume of IV solution and inject at a rate not greater than 2 mg/min
  • IV Infusion:
    • 4 mg/mL undiluted in syringe or in viaflex bag
  • intermittent administration prefered over continuous infusion due to poor stability and adherence of lorazepam to PVC bags and tubing
  • ampoules must be refrigerated and protected from light for long term storage
Adverse Effects:
  • respiratory depression and partial airway obstruction, especially when combined with narcotics
  • hypotension
  • paradoxical reactions (irritability, excitability); may make depression or psychosis worse
  • amnesia, lack of recall
  • pain and redness at the injection site
Antidote:
Drug Interactions:
  • lorazepam + other CNS depressants = increased sedation
  • lorazepam + scopolamine = increased sedation, hallucinations
Monitoring Therapy:
  • arterial blood pressure
  • respiratory rate
  • response to sedation
CCTC Protocol:
  • May be given IV direct by an approved nurse in CCTC.
  • Continuous infusion must be administered by infusion pump.
  • If ordered as a sedative/anxiolytic agent for a patient receiving mechanical ventilation, must be discontinued when mechanical ventilation ceases.
  • May be continued IV direct post-ventilation if specifically ordered following assessment by physician.


Lynne Kelly, Pharmacist, CCTC
Brenda Morgan, Clinical Nurse Specialist, CCTC
Last Update: January 12, 2017

LHSCHealth Professionals

Last Updated January 12, 2017 | © 2007, LHSC, London Ontario Canada