From the Guidelines
Intravenous (IV) administration is the preferred route for Ativan (lorazepam) when treating active seizures. According to the evidence-based guidelines for mental, neurological, and substance use disorders 1, IV access available, an IV benzodiazepine (lorazepam or diazepam) should be administered, with lorazepam preferred over diazepam. The advantages of IV administration include rapid onset of action, reliable absorption, and bioavailability. Key benefits of IV lorazepam include:
- Rapid onset of action within 2-3 minutes
- Reliable absorption and bioavailability
- Effective in terminating seizures quickly, which is crucial in preventing neurological damage
- Preferred over diazepam due to its pharmacokinetic profile and efficacy. If IV access cannot be established quickly, alternative routes such as rectal diazepam may be considered, as intramuscular (IM) administration of diazepam is not recommended due to erratic absorption 1. Respiratory monitoring is essential after administration as lorazepam can cause respiratory depression, particularly when given IV or in patients taking other central nervous system depressants.
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. IM lorazepam is not preferred in the treatment of status epilepticus because therapeutic lorazepam levels may not be reached as quickly as with IV administration
The preferred route of administration for Ativan (lorazepam) to break seizures is intravenous (IV), as it allows for quicker therapeutic levels to be reached compared to intramuscular (IM) administration 2.
From the Research
Administration Routes for Ativan (Lorazepam) to Break Seizures
- The preferred route of administration for Ativan (lorazepam) to break seizures is intravenous (IV) 3, 4, 5.
- IV administration allows for rapid delivery and complete bioavailability of the drug, which is essential in emergency situations such as status epilepticus 5.
- While intramuscular (IM) administration is an alternative route, it is not the preferred method for lorazepam due to its relatively slow absorption rate compared to IV administration 6.
- Midazolam, another benzodiazepine, can be administered intramuscularly and has been shown to be effective in pre-hospital treatment of status epilepticus 4, 5, 6.
- Rectal administration of lorazepam is not a recommended route due to its slow absorption rate, with a time to maximum concentration (Tmax) of 1-2 hours 6.
Efficacy of Lorazepam in Breaking Seizures
- Lorazepam has been shown to be effective in breaking seizures, with a high efficacy rate of 82-100% when administered intravenously 3.
- IV lorazepam is better than IV diazepam in reducing the risk of non-cessation of seizures and continuation of status epilepticus requiring a different drug or general anesthesia 4.
- Lorazepam is also better than IV phenytoin in reducing the risk of non-cessation of seizures 4.