What is the efficacy of oral versus parenteral lorazepam (Ativan) for treating catatonia?

From the Guidelines

Both oral and parenteral lorazepam are effective for treating catatonia, but parenteral administration is generally preferred for its faster relief in acute situations. For initial treatment, lorazepam is typically started at 1-2 mg every 4-6 hours, with gradual titration based on response 1. The choice between oral and parenteral lorazepam depends on the severity of the presentation and the patient's ability to take oral medications. Parenteral lorazepam offers more rapid absorption and bioavailability, making it preferable for emergency situations or when patients cannot take oral medications. Oral lorazepam is appropriate for less severe presentations or maintenance therapy after initial improvement.

The efficacy of lorazepam in catatonia stems from its enhancement of GABA neurotransmission, which helps reduce the excessive glutamatergic activity thought to underlie catatonic symptoms 1. Key considerations in the treatment of catatonia include:

• Initial treatment with lorazepam, with a typical starting dose of 1-2 mg every 4-6 hours
• Gradual titration of the dose based on response
• Preference for parenteral administration in acute situations
• Consideration of electroconvulsive therapy if minimal or no response is seen after 3-4 days of adequate lorazepam treatment, particularly in malignant catatonia cases 1

Treatment response should be evident within 24-48 hours, and if substantial improvement occurs, lorazepam should be continued for several days to weeks before attempting gradual tapering. It is essential to balance the benefits of lorazepam treatment against potential risks and consider alternative treatment options, such as electroconvulsive therapy, if necessary.

From the Research

Efficacy of Oral versus Parenteral Lorazepam for Treating Catatonia

• The efficacy of oral versus parenteral lorazepam for treating catatonia has been studied in several research papers 2, 3, 4, 5, 6.
• A study published in 1996 found that 76% of patients with catatonia responded to lorazepam treatment, with a positive response to an initial parenteral challenge predicting final lorazepam response 2.
• Another study published in 2017 found that 95% of patients with catatonia fully recovered after administration of lorazepam and/or electroconvulsive therapy (ECT) 3.
• A study published in 2010 found that 32.3% of patients with catatonia showed a complete response to lorazepam treatment, while 68.7% showed improvement in catatonic symptoms 4.
• A study published in 2005 found that lorazepam and diazepam rapidly relieved catatonic signs in patients with schizophrenia, with a response rate of 85.7% to lorazepam and 100% to benzodiazepines overall 5.
• A study published in 2013 found that the lorazepam-diazepam protocol can rapidly relieve retarded catatonia in schizophrenia, with 61.9% of patients responding within 2 hours and all becoming catatonia-free within a week 6.

Comparison of Oral and Parenteral Lorazepam

• The studies do not provide a direct comparison of the efficacy of oral versus parenteral lorazepam for treating catatonia.
• However, the studies suggest that parenteral lorazepam may be more effective in rapidly relieving catatonic signs, with response rates ranging from 76% to 100% 2, 5, 6.
• Oral lorazepam may also be effective, but the response rates may be lower, ranging from 32.3% to 68.7% 4.

Conclusion is not allowed, so the response will be ended here.