From the Research
Nurse practitioners can prescribe up to a 7-day supply of lorazepam, which is a Schedule IV controlled substance, with a maximum dose of 2 mg/day when given for more than 1 week, as recommended by the most recent and highest quality study 1. This means that if a patient is taking lorazepam 1 mg twice daily, a nurse practitioner could prescribe up to 14 tablets (7 days × 2 tablets per day). The prescription authority for nurse practitioners regarding controlled substances varies by state, but generally, Schedule IV medications like lorazepam have less restrictive prescribing limitations than Schedule II or III medications. Lorazepam is a benzodiazepine used for anxiety, insomnia, and seizures, and has potential for dependence and abuse, which is why prescribing is limited. When prescribing lorazepam, nurse practitioners should document the clinical indication, consider non-pharmacological alternatives, and develop a plan for monitoring and eventual discontinuation when appropriate. Some key points to consider when prescribing lorazepam include:
- Potential side effects, such as sedation, cognitive impairment, and the risks of combining with other central nervous system depressants 2
- The risk of dependence and abuse, particularly with long-term use 1
- The importance of monitoring and adjusting the dose as needed to minimize the risk of adverse effects 3
- The potential for withdrawal symptoms, such as rebound insomnia, when the medication is discontinued 3, 4 It's also important to note that the most recent study 2 highlights the significance of lorazepam in managing anxiety, insomnia, and seizures, and its potential as a first-line treatment option. However, the study also emphasizes the need for caution when prescribing lorazepam, particularly in patients with a history of substance abuse or dependence. Overall, nurse practitioners should exercise caution and careful consideration when prescribing lorazepam, and prioritize the patient's safety and well-being above all else.