From the FDA Drug Label
For acute dose administration, adjustment is not needed for patients with renal disease. However, in patients with renal disease, caution should be exercised if frequent doses are given over relatively short periods of time Mean volume of distribution and terminal half-life values of lorazepam were 40% and 25% higher, respectively, in renally impaired patients than in normal subjects.
Lorazepam Dosing in CKD:
- No dosage adjustment is needed for acute dose administration in patients with renal disease.
- However, caution should be exercised if frequent doses are given over relatively short periods of time in patients with renal disease.
- Renally impaired patients may have higher volume of distribution and terminal half-life values of lorazepam compared to normal subjects.
- It is recommended to exercise caution when administering lorazepam to patients with CKD, as the kinetics of lorazepam glucuronide may be affected by renal dysfunction 1, 1.
From the Research
Lorazepam dosing should be reduced in patients with chronic kidney disease (CKD). For patients with CKD, start with 50% of the normal dose of lorazepam. The typical starting dose for adults with normal kidney function is 1-2 mg, so for CKD patients, begin with 0.5-1 mg. Administer the medication less frequently and monitor closely for side effects such as excessive sedation, confusion, respiratory depression, and worsening kidney function. Lorazepam is primarily metabolized by the liver through glucuronidation, but its metabolites are excreted by the kidneys. In CKD, these metabolites can accumulate, potentially leading to increased drug effects and toxicity. Unlike some benzodiazepines, lorazepam does not have active metabolites, making it a relatively safer choice in kidney disease compared to diazepam or chlordiazepoxide. However, the reduced clearance of the parent compound and its metabolites still necessitates dose adjustment. Regular assessment of the patient's mental status, respiratory function, and kidney function is essential during treatment.
Key Considerations
- The patient's kidney function should be closely monitored, and the dose of lorazepam adjusted accordingly 2.
- The use of lorazepam in patients with CKD requires careful consideration of the potential risks and benefits, and alternative treatments should be considered if possible 3.
- The management of pain in patients with CKD is challenging, and the use of NSAIDs should be avoided if possible due to the risk of nephrotoxicity 3.
- The preservation of kidney function is crucial in patients with CKD, and non-pharmacological strategies such as dietary and lifestyle adjustments should be implemented to mitigate glomerular hyperfiltration and preserve renal function 4.
Monitoring and Adjustments
- Monitor the patient's kidney function regularly, and adjust the dose of lorazepam as needed.
- Monitor for side effects such as excessive sedation, confusion, respiratory depression, and worsening kidney function.
- Consider alternative treatments if the patient experiences adverse effects or if the dose of lorazepam needs to be adjusted frequently.