What is the recommended dose of oral lorazepam (Ativan) for anxiety?

Oral Lorazepam Dosing for Anxiety

For adults with anxiety, the recommended dose of oral lorazepam is 0.5-1 mg taken 2-3 times daily, with a total daily dose of 2-3 mg/day. 1, 2

Standard Adult Dosing

• Initial dose: 2-3 mg/day divided into 2-3 doses (typically 1 mg 2-3 times daily)
• Usual range: 2-6 mg/day in divided doses
• Maximum dose: 10 mg/day (though rarely needed)
• Largest dose: Should be taken before bedtime 1

Special Populations

Elderly or Debilitated Patients

• Initial dose: 0.25-0.5 mg 2-3 times daily (1-2 mg/day total)
• Maximum daily dose: 2 mg/day 2, 1

Administration Guidelines

• Dose should be gradually increased when needed to avoid adverse effects
• When higher dosage is required, increase the evening dose before daytime doses 1
• For optimal anxiety control, divide the daily dose into 2-3 administrations 1, 3

Clinical Considerations

• Most patients achieve adequate anxiety control with 2-3 mg/day 1, 3
• Lower doses (0.5-1 mg per dose) may be effective for mild to moderate anxiety states with fewer side effects 4
• Benzodiazepines like lorazepam can cause tolerance, addiction, depression, and cognitive impairment with regular use 2
• Paradoxical agitation occurs in approximately 10% of patients treated with benzodiazepines 2

Monitoring and Precautions

• Monitor for excessive sedation, especially when initiating therapy
• Be aware of increased risk of respiratory depression when combined with other sedative agents 2
• Lorazepam tablets can be used sublingually (off-label) for faster onset of action in acute anxiety 2
• Infrequent, low doses of short half-life benzodiazepines like lorazepam are least problematic for long-term use 2

Common Pitfalls to Avoid

1. Excessive dosing: Starting with too high a dose can lead to oversedation
2. Prolonged use: Long-term use increases risk of dependence and tolerance
3. Abrupt discontinuation: Can lead to withdrawal symptoms; taper gradually when discontinuing
4. Overlooking elderly sensitivity: Older adults are more sensitive to benzodiazepine effects and require lower doses
5. Drug interactions: Enhanced sedation when combined with other CNS depressants

Remember that while lorazepam is effective for short-term management of anxiety, non-pharmacological approaches should also be considered for long-term anxiety management.