From the Guidelines
The recommended starting dose of Ativan (lorazepam) for sleep assistance in hospitalized adults is typically 0.5 to 1 mg taken orally at bedtime. This recommendation is based on the principle of using the lowest effective dose to minimize side effects and the risk of dependence, as suggested by various guidelines for managing insomnia 1. When considering the use of lorazepam for sleep, it's crucial to weigh the benefits against the potential risks, especially in vulnerable populations such as the elderly or those with hepatic impairment, for whom a starting dose of 0.5 mg may be more appropriate.
The choice of lorazepam should be guided by the patient's specific needs and response to the medication. For instance, if a patient complains of waking up during the night (WASO), a drug with a longer half-life might be considered, whereas a patient experiencing residual sedation might benefit from a shorter-acting drug 1. It's also important to note that benzodiazepines, including lorazepam, are not recommended for the long-term management of insomnia due to concerns about tolerance, dependence, and withdrawal.
In addition to pharmacological interventions, non-pharmacological approaches to improve sleep hygiene should be implemented concurrently. These include maintaining a regular sleep schedule, creating a comfortable sleep environment, and limiting stimulants before bedtime, as outlined in guidelines for the management of chronic insomnia 1. Techniques such as stimulus control, relaxation training, and cognitive behavioral therapy for insomnia (CBT-I) can also be beneficial in addressing underlying sleep issues and improving sleep quality.
Key considerations when prescribing lorazepam for sleep assistance in hospitalized patients include:
- Starting with a low dose and titrating as needed
- Monitoring for adverse effects such as excessive sedation, respiratory depression, confusion, and paradoxical reactions
- Implementing non-pharmacological strategies to improve sleep hygiene
- Regularly reviewing the need for ongoing benzodiazepine use to minimize the risk of dependence and withdrawal.
From the FDA Drug Label
For insomnia due to anxiety or transient situational stress, a single daily dose of 2 mg to 4 mg may be given, usually at bedtime. The recommended starting dose of Ativan (lorazepam) PO for sleep assistance in a hospitalized patient is 2 mg to 4 mg, given as a single daily dose, usually at bedtime 2.
- The dose may vary depending on the patient's response and individual needs.
- For elderly or debilitated patients, an initial dosage of 1 mg/day to 2 mg/day in divided doses is recommended.
From the Research
Recommended Dose of Ativan (Lorazepam) PO for Sleep Assistance
The recommended starting dose of Ativan (lorazepam) PO for sleep assistance in a hospitalized patient can vary.
- According to a study published in 1975 3, lorazepam was found to be a potent nighttime sedative, with 1 to 1.25 mg of lorazepam equivalent to 100 mg sodium pentobarbital for measures of sleep quality and duration.
- Another study from 1999 4 used lorazepam 0.5 mg TID and lorazepam 1.5 mg HS, and found both doses to be effective in improving objective and subjective measures of sleep.
- A study from 2004 5 used lorazepam 0.5-1.0 mg orally at bedtime as needed for 7 days, and found it to be equally effective as zopiclone in the treatment of insomnia in stroke and brain-injured patients.
Considerations for Dosage
When determining the dosage of Ativan (lorazepam) PO for sleep assistance, consider the following:
- The patient's medical history and current condition
- The potential for interactions with other medications
- The risk of adverse effects, such as rebound anxiety and confusion, as reported in the 1999 study 4
- The therapeutic index of lorazepam, which was found to be wide in the 1975 study 3
Alternative Treatments
Other studies have explored alternative treatments for insomnia in hospitalized patients, such as melatonin 6 and quetiapine 7. However, the use of these medications may have different indications and considerations.