From the Guidelines
For breakthrough seizures, lorazepam (Ativan) should be administered as a PRN medication at a dose of 0.05 mg/kg (maximum 1 mg) intravenous (i.v.), which can be repeated every 5 minutes (to a maximum of 4 doses) to control electrographical seizures, as recommended in the most recent guidelines 1. The dosage of lorazepam for breakthrough seizures is crucial in managing seizure activity, and the recommended dose is based on the patient's weight.
- The dose of 0.05 mg/kg (maximum 1 mg) i.v. is recommended for breakthrough seizures, with the option to repeat the dose every 5 minutes if seizures persist, up to a maximum of 4 doses 1.
- It is essential to monitor the patient's vital signs, especially respiratory rate and oxygen saturation, as benzodiazepines like lorazepam can cause respiratory depression.
- The administration of lorazepam should be done slowly over 2-5 minutes to minimize the risk of respiratory depression.
- Resuscitation equipment should be available when administering lorazepam, and the patient should be closely monitored for any adverse effects.
- The use of lorazepam for breakthrough seizures is supported by the most recent guidelines, which prioritize the management of seizure activity to prevent further complications 1.
From the FDA Drug Label
For the treatment of status epilepticus, the usual recommended dose of lorazepam injection is 4 mg given slowly (2 mg/min) for patients 18 years and older. If seizures cease, no additional lorazepam injection is required If seizures continue or recur after a 10- to 15-minute observation period, an additional 4 mg intravenous dose may be slowly administered.
The prn (as needed) dosing for breakthrough seizures with lorazepam is not explicitly stated in the label for this specific indication. However, for status epilepticus, an additional 4 mg intravenous dose may be administered if seizures continue or recur after a 10- to 15-minute observation period.
- Key points:
- Initial dose: 4 mg IV
- Additional dose: 4 mg IV if seizures continue or recur after 10-15 minutes
- Important consideration: The label does not provide explicit guidance for prn dosing for breakthrough seizures, and the treatment of status epilepticus requires a comprehensive approach beyond just administering an anticonvulsant agent 2.
From the Research
PRN Ativan Dosing for Breakthrough Seizures
- The use of benzodiazepines, such as Ativan (lorazepam), is a common practice in the management of breakthrough seizures and status epilepticus 3, 4, 5.
- Lorazepam is often used as the initial treatment agent in seizure emergencies, due to its rapid onset of action and efficacy 3, 4.
- The dosing of Ativan for breakthrough seizures is typically done on a PRN (as needed) basis, with the goal of quickly controlling the seizure activity 6.
- However, the specific dosing regimen for Ativan in this context is not explicitly stated in the available evidence, and may vary depending on the individual patient's needs and medical history.
- It is important to note that benzodiazepines, including Ativan, can be associated with adverse effects such as hypotension, respiratory depression, and sedation, particularly with chronic use 3, 4, 5.
- Alternative routes of administration, such as intranasal or intrapulmonary, are being developed for benzodiazepines, which may offer advantages in terms of ease of use and rapid onset of action 4.
Considerations for Clinical Management
- Clinical management decisions, including the adjustment of antiepileptic drug regimens, are often best made in coordination with a consulting neurologist 6.
- Communication between emergency physicians, neurologists, and primary care physicians is critical for ensuring continuity of care for patients with epilepsy 6.
- The use of extended-release or immediate-release anti-seizure medications with a long half-life, such as perampanel or lamotrigine, may help improve adherence to treatment regimens and reduce the risk of breakthrough seizures 7.