Lorazepam Tapering Dosage for Moderate Alcohol Withdrawal
For moderate alcohol withdrawal, lorazepam should be initiated at 2-4 mg orally every 6 hours as needed based on withdrawal symptoms, with a gradual taper of 10-20% per day over 7-10 days. 1, 2
Initial Assessment and Dosing
For moderate alcohol withdrawal (CIWA-Ar score 8-14):
- Initial dose: 2-4 mg orally every 6 hours as needed based on symptoms 1
- Maximum daily dose: 8 mg/day (divided doses) 2
- Administration: Mix with liquid or semi-solid food using the calibrated dropper 2
Tapering Schedule
- Days 1-2: Full dose (e.g., 2 mg every 6 hours = 8 mg/day)
- Days 3-4: Reduce to 80% of original dose (e.g., 6-7 mg/day in divided doses)
- Days 5-6: Reduce to 60% of original dose (e.g., 5 mg/day in divided doses)
- Days 7-8: Reduce to 40% of original dose (e.g., 3 mg/day in divided doses)
- Days 9-10: Reduce to 20% of original dose (e.g., 1-2 mg/day)
- Day 11: Discontinue 1
Dosage Adjustment Considerations
- For elderly or debilitated patients: Start with 1-2 mg/day in divided doses 2
- For patients with hepatic dysfunction: Lorazepam is preferred over other benzodiazepines due to its shorter half-life and lack of active metabolites 1, 3
- For symptom breakthrough: If withdrawal symptoms worsen during taper, pause the taper or return to the previous dosage level before continuing with a slower taper 2
Monitoring During Tapering
- Assess withdrawal symptoms using CIWA-Ar scale daily
- Monitor for:
- Seizures
- Delirium tremens
- Hallucinations
- Autonomic hyperactivity 1
Important Clinical Considerations
- Lorazepam has been shown to be as effective as chlordiazepoxide in reducing alcohol withdrawal symptoms 3, 4
- The dosage interval can be gradually increased during the taper (from every 6 hours to every 8 hours, then every 12 hours, then every 24 hours) 1
- Avoid abrupt discontinuation to prevent withdrawal reactions 2
- Ensure adequate hydration and electrolyte replacement during withdrawal management 1
- Administer thiamine supplementation (100-300 mg/day) to prevent Wernicke encephalopathy 1
Cautions
- Regular use can lead to tolerance and dependence 5
- Paradoxical agitation occurs in approximately 10% of patients 5
- Increased risk of falls, especially in elderly patients 5
- Use lower doses if co-administered with antipsychotics 5
This tapering schedule balances the need to control withdrawal symptoms while minimizing the risk of benzodiazepine dependence, providing a structured approach to safely managing moderate alcohol withdrawal.