Blood Pressure Parameters for Lorazepam (Ativan)
There are no specific blood pressure parameters that would contraindicate the use of lorazepam, as the available guidelines do not indicate blood pressure monitoring requirements for this medication. While lorazepam can be safely administered in most patients, clinical vigilance is still warranted.
Administration Considerations
Lorazepam is a benzodiazepine with multiple indications including:
- Sedation/analgesia
- Psychosis with agitation
- Seizure management
Dosing Information
- For psychosis with agitation: 0.05-0.15 mg/kg IM/IV; may repeat hourly as necessary (maximum single dose: 5 mg) 1
- For seizure management: 0.1 mg/kg IV/IO 1
Cardiovascular Effects
Lorazepam has minimal effects on blood pressure and cardiovascular parameters:
- Research shows that lorazepam does not significantly alter systemic arterial blood pressure 2
- When used as a hypnotic in hypertensive patients, lorazepam did not affect 24-hour and daytime systolic or diastolic blood pressure 3
- A slight increase in nighttime diastolic blood pressure (+3.7%) was observed with lorazepam in hypertensive patients, but this is not clinically significant enough to warrant specific blood pressure parameters 3
Monitoring Recommendations
While specific blood pressure parameters are not required for lorazepam administration, the following monitoring is prudent:
- Standard vital sign monitoring during administration, particularly with IV administration
- Be aware that hypotension can occur as a potential side effect, especially with rapid IV administration 1
- When administering IV lorazepam, monitor for:
- Changes in respiratory status
- Level of consciousness
- Heart rate
Special Considerations
High-Risk Situations
- Elderly patients: May be more sensitive to the effects of lorazepam and may require lower doses
- Patients with respiratory compromise: Benzodiazepines can cause respiratory depression
- Patients with severe hepatic impairment: Metabolism may be reduced
Administration Precautions
- IV lorazepam should be administered slowly to minimize risk of hypotension
- Have resuscitation equipment available when administering IV lorazepam
- Consider reduced dosing in elderly patients or those with compromised cardiopulmonary function
Clinical Pearls
- Lorazepam has been shown to decrease cerebral blood flow by approximately 26% and increase cerebral vascular resistance by about 25% 2
- Lorazepam is completely absorbed regardless of administration route (IV, IM, oral, or sublingual) with high bioavailability (94-100%) 4
- The peak plasma concentration typically occurs around 2 hours after oral administration 5
- The elimination half-life of lorazepam is approximately 12 hours 5, 4
In summary, while monitoring vital signs during lorazepam administration is good clinical practice, there are no specific blood pressure cutoffs that would preclude its use based on current guidelines.