From the FDA Drug Label
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 For anxiety, most patients require an initial dose of 2 mg/day to 3 mg/day given twice daily or three times daily. The recommended dose of lorazepam (Ativan) for an 81-year-old patient going for a dental procedure who has anxiety is 0.5 mg to 1 mg before the procedure.
- The patient can repeat a 0.5 mg PO dose if needed, but the exact timing is not specified in the label.
- However, considering the usual dosing frequency for anxiety is twice daily or three times daily, it can be inferred that the dose can be repeated in 4 to 6 hours if needed, but this should be done with caution and under medical supervision 1.
From the Research
For an 81-year-old with anxiety undergoing a dental procedure, a conservative starting dose of Ativan (lorazepam) would be 0.25-0.5 mg taken orally 1-2 hours before the procedure, as recommended by recent guidelines 2. When considering the management of dental anxiety, it is essential to prioritize nonpharmacological methods before opting for pharmacological sedation techniques, as highlighted in a systematic review 3. Key considerations for the use of Ativan in this context include:
- The patient's sensitivity to benzodiazepines, which may increase the risk of side effects like excessive sedation, confusion, and falls 2
- The importance of informing the dental provider about any medication taken before the procedure
- Arranging for someone to drive the patient home afterward, as even low doses can impair coordination and thinking
- Avoiding alcohol while taking Ativan, and discussing potential interactions with other medications or conditions like respiratory problems or liver disease with the primary care physician If needed, an additional 0.5 mg dose could be taken 4-6 hours after the initial dose, but this should be done cautiously, taking into account the patient's response to the initial dose and their overall health status. Alternative approaches to managing dental anxiety, such as music, cognitive behavioral therapy, relaxation, massage, acupuncture/acupressure, hypnosis, and natural sounds, have been shown to be effective in reducing anxiety in over 70% of experiments, as reported in a systematic review 4. However, in the context of an 81-year-old patient undergoing a dental procedure, the use of Ativan may be necessary to ensure the patient's comfort and safety, and should be carefully monitored by the dental provider.