From the Guidelines
For seizure management, the recommended dose of lorazepam (Ativan) is 0.05-0.10 mg/kg IV (maximum: 4 mg per dose). This dose can be repeated every 10-15 min if needed for continued seizures 1. It is essential to monitor oxygen saturation and be prepared to provide respiratory support, as there is an increased incidence of apnea when combined with other sedative agents. The medication works by enhancing the effect of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter in the brain, which helps suppress excessive neuronal activity causing seizures.
Key Considerations
- Lorazepam should be administered as soon as possible after seizure onset for maximum effectiveness.
- Respiratory and cardiovascular monitoring is essential during administration.
- Resuscitation equipment should be available when administering lorazepam for seizures.
- Flumazenil may be administered to reverse life-threatening respiratory depression caused by lorazepam; however, it will also counteract the anticonvulsant effects and may precipitate recurrence of seizures 1.
Administration
- The dose can be given intravenously (IV) or intramuscularly (IM).
- If given IV, it should be administered slowly over 2-5 minutes.
- For children, the dose is 0.05-0.1 mg/kg IV (maximum 4 mg).
- A second dose may be given after 10-15 minutes if seizures continue.
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 recommended dose of lorazepam for seizure management is 4 mg given slowly (2 mg/min) for patients 18 years and older, with the option to administer an additional 4 mg dose if seizures continue or recur after a 10- to 15-minute observation period 2.
From the Research
Recommended Dose of Lorazepam for Seizure Management
The recommended dose of lorazepam for seizure management can vary depending on the specific condition being treated and the patient's response to the medication.
- For the management of status epilepticus, lorazepam is often administered intravenously at a dose of 0.1 mg/kg over 2-4 minutes 3.
- In another study, lorazepam was given in doses ranging from 1 to 9 mg (mean, 4 mg) intravenously to treat status epilepticus 4.
- A review of studies on the management of status epilepticus recommends an initial dose of intravenous lorazepam of 2-8 mg/70kg 5.
Efficacy and Safety of Lorazepam
Lorazepam has been shown to be effective in controlling seizures in patients with status epilepticus, with response rates ranging from 75.6% to 82% 3, 4.
- However, lorazepam can also cause adverse effects such as respiratory depression, hypotension, and decorticate posturing 4.
- Compared to other anticonvulsant medications, lorazepam has been found to be more effective than diazepam and phenytoin in reducing the risk of non-cessation of seizures and continuation of status epilepticus requiring a different drug or general anaesthesia 6.
Comparison with Other Treatments
Lorazepam has been compared to other treatments for status epilepticus, including midazolam and levetiracetam.