From the Guidelines
The recommended dose of Ativan (lorazepam) for status epilepticus is 0.05-0.10 mg/kg administered intravenously, with a maximum initial dose of 4 mg. This dose may be repeated every 10-15 minutes if needed for continued seizures, as indicated in the study published in Pediatrics 1. It is crucial to monitor oxygen saturation and be prepared to provide respiratory support due to the increased incidence of apnea when combined with other sedative agents. The use of lorazepam in status epilepticus is supported by its ability to enhance the inhibitory effects of GABA in the brain, helping to suppress abnormal electrical activity causing seizures. Key considerations for administration include:
- Monitoring respiratory function closely due to the risk of respiratory depression
- Having resuscitation equipment immediately available
- Being aware of the potential for apnea, especially when used with other sedatives
- Considering the use of flumazenil to reverse life-threatening respiratory depression, although this may precipitate recurrence of seizures. Given the potential risks, particularly respiratory depression, careful patient monitoring and readiness for intervention are paramount when administering lorazepam for status epilepticus, as noted in the guidelines 1.
From the Research
Ativan Dose for Status Epilepticus
The recommended dose of Ativan (lorazepam) for status epilepticus is:
- 2-8 mg/70kg or 0.1 mg/kg intravenously, as stated in the study 2
- 4 or 8 mg of the drug controlled status in 22 of the 25 patients, as reported in the study 3
- The dose of lorazepam for status epilepticus can be compared to other treatments, such as diazepam and phenytoin, as seen in the study 4
Comparison with Other Treatments
Some key points to consider when comparing lorazepam to other treatments for status epilepticus are:
- Lorazepam was successful in 64.9 percent of patients with overt generalized convulsive status epilepticus, as compared to other treatments in the study 4
- Lorazepam is easier to use than phenobarbital or diazepam plus phenytoin, as stated in the study 4
- Levetiracetam (LEV) is an alternative to lorazepam (LOR) for the treatment of status epilepticus, and may be preferred in patients with respiratory compromise and hypotension, as reported in the study 5
Key Findings
Some key findings related to the use of lorazepam for status epilepticus include:
- Lorazepam appears to be an effective and safe drug for treatment of status epilepticus, with a duration of control longer than that achieved with diazepam, as stated in the study 3
- The outcome of status epilepticus depends on the underlying etiology, age, rapidity of SE, and adequacy of care, as reported in the study 6
- Lorazepam is recommended as a 'first-line' therapy for status epilepticus, along with phenytoin, as stated in the study 2