What are the doses of Lorazepam (Ativan)?

From the Guidelines

Lorazepam is typically prescribed at doses of 0.5 to 2 mg for adults, taken 2-3 times daily as needed, with a maximum daily dose not exceeding 10 mg, as recommended by recent guidelines 1. For anxiety, the usual starting dose is 0.5-1 mg 2-3 times daily, while for insomnia, 1-2 mg at bedtime is common. Elderly patients or those with liver impairment should start with lower doses, usually 0.5 mg, and increase gradually if needed. Some key points to consider when prescribing lorazepam include:

• The medication has a medium duration of action (10-20 hours) compared to other benzodiazepines 1.
• Patients should be aware that lorazepam can cause dependence with prolonged use, typically after 2-4 weeks, so it's best used for short-term management 1.
• Side effects may include drowsiness, dizziness, and impaired coordination, so patients should avoid driving or operating machinery until they know how the medication affects them 1.
• In certain cases, such as delirium in adult cancer patients, lorazepam may be used as a crisis medication in the management of delirious patients with severe agitation and distress, with a suggested starting dose of 1 mg s.c. or i.v. stat, up to 2 mg maximum 1. It is essential to note that the use of lorazepam should be individualized and monitored closely, especially in vulnerable populations such as the elderly or those with liver impairment, to minimize the risk of adverse effects and dependence.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION ... The usual range is 2 mg/day to 6 mg/day given in divided doses, the largest dose being taken before bedtime, but the daily dosage may vary from 1 mg/day to 10 mg/day For anxiety, most patients require an initial dose of 2 mg/day to 3 mg/day given twice daily or three times daily. For insomnia due to anxiety or transient situational stress, a single daily dose of 2 mg to 4 mg may be given, usually at bedtime. For elderly or debilitated patients, an initial dosage of 1 mg/day to 2 mg/day in divided doses is recommended, to be adjusted as needed and tolerated

The recommended lorazepam doses are:

• Usual range: 2 mg/day to 6 mg/day
• Anxiety: 2 mg/day to 3 mg/day
• Insomnia: 2 mg to 4 mg
• Elderly or debilitated patients: 1 mg/day to 2 mg/day 2

From the Research

Lorazepam Doses

• The recommended intravenous (IV) lorazepam dose is 0.1 mg/kg/dose, up to a maximum of 4 mg for the emergent treatment of status epilepticus (SE) 3.
• A study found that patients who received less than 4 mg of IV lorazepam experienced an increased progression to refractory status epilepticus (RSE), supporting the current guideline-recommended dosing 3.
• For anxiety disorders, lorazepam is prescribed orally, but the exact dose is not specified in the provided studies 4.
• In intensive care units, lorazepam is sometimes administered as a continuous infusion, with doses ranging from 2-5.99 mg/hr (low-dose) to greater than or equal to 6 mg/hr (high-dose) 5.

Considerations for Lorazepam Use

• Benzodiazepines, including lorazepam, have a high risk of serious adverse effects, particularly in older adults, and their use is generally advised against in this population 6.
• The use of benzodiazepines can lead to dependence and withdrawal symptoms, requiring careful tapering of the medication when prescribed 7.
• Alternative treatments, such as nonpharmacological approaches and other pharmacological agents, may be considered for anxiety and insomnia in older adults 6.