Critical Care Trauma Centre

LORAZEPAM (Ativan)

 

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:
  • blood pressure
  • respiratory rate
  • response to sedation
Adult Critical Care Protocol:
  • May be administered IV direct or by IV infusion by a nurse in Adult Critical Care
  • May be titrated by a nurse in Adult Critical Care.
  • Continuous infusions must be administered by infusion device and the pump library must be enabled.
  • Order written to provide sedation during mechanical ventilation should be discontinued when patient is not longer receiving mechanical ventilation support.


Lynne Kelly, Pharmacist, CCTC
Brenda Morgan, Clinical Nurse Specialist, CCTC
Last Update: September 19, 2018