From the Guidelines
Ativan (lorazepam) 2 mg can typically be administered every 4-6 hours as needed for anxiety symptoms, but a dose as low as 0.05-0.15 mg/kg may be repeated hourly as necessary, with a maximum single dose of 5 mg, as indicated for psychosis with agitation 1. Since only 1.5 hours have passed since the previous dose, it would be premature to administer another full 2 mg dose. Consider giving 1 mg at this time if symptoms are severe, then resuming the regular 2 mg dosing schedule after 4-6 hours from the initial dose. Always monitor for respiratory depression, excessive sedation, and hypotension, especially when giving doses closer together than recommended. Ativan works by enhancing the effect of GABA, an inhibitory neurotransmitter in the brain, which produces a calming effect. For this hyperventilating patient, also consider non-pharmacological interventions such as:
- Breathing techniques
- Reassurance
- Addressing the underlying cause of anxiety while waiting for the appropriate time to administer the next full dose. It is crucial to weigh the benefits of administering another dose of Ativan against the potential risks, particularly in a patient who is already experiencing hyperventilation, which may be exacerbated by the medication 1.
From the FDA Drug Label
For anxiety, most patients require an initial dose of 2 mg/day to 3 mg/day given twice daily or three times daily. The FDA does not specify the exact time interval for administering 2 mg of Ativan, but it does provide a frequency of twice daily or three times daily for anxiety.
- The patient can receive another dose in 4 to 6 hours if we consider the twice daily or three times daily frequency and the patient has already received a dose 1.5 hours ago. However, caution should be exercised, and the decision to administer another dose should be based on the patient's response and medical judgment. 2
From the Research
Administration Frequency of Ativan
- The provided studies do not directly address the administration frequency of 2 mg Ativan 3, 4, 5, 6, 7.
- However, it is known that Ativan (lorazepam) is a benzodiazepine with a rapid onset of action, often used for anxiety and agitation 4, 6.
- One study compared the efficacy of combination haloperidol, lorazepam, and diphenhydramine to combination haloperidol and lorazepam in treating acute agitation, but did not specify the administration frequency of lorazepam 7.
- Another study evaluated the cognitive effects of beta-adrenergic antagonists and lorazepam after single doses, but did not provide information on the administration frequency of lorazepam 6.
Repeated Dosing of Ativan
- There is no direct evidence in the provided studies to support a specific administration frequency for 2 mg Ativan 3, 4, 5, 6, 7.
- It is essential to consider the potential for dependence and withdrawal symptoms associated with repeated use of benzodiazepines like Ativan 4.
- The decision to re-dose Ativan should be based on individual patient needs and medical judgment, taking into account the potential risks and benefits of repeated benzodiazepine use 4, 6.