Lorazepam Administration: Dilution vs. Undiluted
Lorazepam should be diluted with an equal volume of compatible diluent before intravenous administration to reduce pain at injection site, minimize risk of vascular complications, and ensure proper medication delivery.
Proper Dilution Technique for IV Lorazepam
The FDA drug label for lorazepam explicitly states that "PRIOR TO INTRAVENOUS USE, LORAZEPAM INJECTION MUST BE DILUTED WITH AN EQUAL AMOUNT OF COMPATIBLE DILUENT" 1. This is not optional but a requirement for safe administration.
Rationale for Dilution:
- Safety concerns: Undiluted administration increases risk of:
- Pain at injection site
- Perivascular extravasation
- Potential intra-arterial injection
- Vascular irritation
Dilution Guidelines:
- Ratio: Equal parts (1:1) lorazepam and compatible diluent
- Compatible diluents:
- Normal saline (0.9% sodium chloride)
- Sterile water for injection
- Dextrose 5% in water (D5W)
Administration Technique:
- Dilute lorazepam with equal volume of compatible diluent
- Administer slowly (approximately 2 mg/min for adults) 1
- Perform repeated aspiration during administration
- Monitor for signs of pain during injection (may indicate improper placement)
Risks of Undiluted Administration
Administering undiluted lorazepam intravenously carries significant risks:
- Vascular complications: Increased risk of extravasation and tissue damage
- Patient discomfort: Significant pain at injection site
- Medication delivery issues: Potential for precipitation and inconsistent dosing
- Rapid absorption: May lead to increased risk of respiratory depression and hypotension 2
Special Considerations
Status Epilepticus Management:
For status epilepticus, proper dilution remains essential even in emergency situations:
- Adult dose: 4 mg given slowly (2 mg/min) 1
- Pediatric dose: 0.05-0.1 mg/kg (maximum 4 mg per dose) 3
- Administration should occur over approximately 2 minutes 3
Monitoring Requirements:
- Continuous respiratory monitoring is essential
- Have airway management equipment immediately available
- Monitor vital signs, particularly respiratory rate and blood pressure 1
Stability Considerations:
- Diluted lorazepam has limited stability (less than 7 days at room temperature) 4
- Prepare immediately before administration when possible
Conclusion
The evidence clearly demonstrates that lorazepam must be diluted prior to intravenous administration. Undiluted administration increases risks without providing any clinical benefit. Always follow the FDA-approved dilution guidelines to ensure patient safety and medication efficacy.