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

Recommended Dosage of Lorazepam for Anxiety

For adults with anxiety, lorazepam should be administered at 0.5-1 mg orally four times a day as required, with a maximum of 4 mg in 24 hours. 1

Dosing Algorithm for Lorazepam in Anxiety

Standard Adult Dosing

• Initial dose: 2-3 mg/day divided into 2-3 doses 2
• Usual range: 2-6 mg/day in divided doses 2
• Maximum daily dose: 10 mg/day 2
• Largest dose: Should be taken before bedtime 2

Special Populations

• Elderly or debilitated patients:
  • Start with 0.25-0.5 mg orally per dose (maximum 2 mg in 24 hours) 1
  • Initial dosage of 1-2 mg/day in divided doses 2

Administration

• Mix lorazepam oral concentrate with liquid or semi-solid food (water, juices, soda, applesauce, puddings)
• Use only the calibrated dropper provided with the product
• Consume the mixture immediately 2

Clinical Considerations

Before Starting Treatment

• Address reversible causes of anxiety first:
  • Explore patient's concerns and anxieties
  • Ensure effective communication
  • Explain to caregivers how they can help
  • Treat medical causes (e.g., hypoxia, urinary retention, constipation) 1

Monitoring and Adjustments

• Increase dosage gradually when needed to avoid adverse effects
• When higher dosage is indicated, increase the evening dose before daytime doses 2
• Most patients achieve anxiety relief at average doses of 3.2 mg twice daily 3
• Low doses (below standard therapeutic doses) can be effective for mild to moderate anxiety states with fewer side effects 4

Duration of Treatment

• For situational/transient anxiety: Short-term use is preferred
• For chronic anxiety: Regular reassessment is needed
• Long-term users typically maintain their initial dose or decrease it over time 5

Potential Pitfalls and Cautions

Major Warnings

• Dependence risk: Regular use can lead to tolerance, addiction, depression, and cognitive impairment 1
• Withdrawal reactions: Use gradual taper when discontinuing 2
• Paradoxical reactions: Paradoxical agitation occurs in about 10% of patients treated with benzodiazepines 1

Specific Precautions

• Increased risk of falls, especially in elderly patients 1
• Avoid use in patients with severe pulmonary insufficiency, severe liver disease, or myasthenia gravis (unless in imminently dying patients) 1
• Subcutaneous injection may cause irritation 1
• May cause drowsiness and dizziness 1

Best Practices

• Infrequent, low doses of agents with a short half-life are least problematic 1
• Oral tablets can be used sublingually (off-label use) 1
• For insomnia due to anxiety, a single daily dose of 2-4 mg may be given at bedtime 2
• When co-administered with antipsychotics, use lower doses (0.25-0.5 mg) 1

Lorazepam at appropriate doses has been shown to be highly effective in relieving anxiety with minimal serious adverse effects when properly prescribed and monitored 3, 6. Studies have demonstrated comparable efficacy to other benzodiazepines like alprazolam in treating anxiety disorders 7.