Oral Lorazepam Dosing for Anxiety
For adults with anxiety, lorazepam should be administered at a dose of 0.5-1 mg orally four times a day as required (maximum 4 mg in 24 hours). 1
Standard Dosing Recommendations
- For most adult patients with anxiety, the recommended initial dose is 2-3 mg/day given in divided doses (typically 2-3 times daily) 2
- The usual therapeutic range is 2-6 mg/day, though daily dosage may vary from 1-10 mg/day depending on severity of symptoms 2
- For insomnia due to anxiety, a single daily dose of 2-4 mg may be given at bedtime 2
Special Populations
- For elderly or debilitated patients, reduce the dose to 0.25-0.5 mg orally (maximum 2 mg in 24 hours) 1
- For elderly or debilitated patients, an initial dosage of 1-2 mg/day in divided doses is recommended, to be adjusted as needed and tolerated 2
Administration Considerations
- When higher dosage is indicated, increase the evening dose before the daytime doses 2
- Oral tablets can also be used sublingually (off-label use) for patients who can swallow but may need faster onset of action 1
- For optimal results, dose, frequency of administration, and duration of therapy should be individualized according to patient response 2
Clinical Evidence
- Clinical studies have shown that most patients with anxiety respond well to an average daily dose of 3.2 mg twice daily 3
- Lorazepam has been shown to be highly effective in relieving anxiety symptoms at these doses with statistically significant differences over placebo 3
- Most patients with hypertension-associated anxiety were effectively controlled with 3 mg/day 4
Discontinuation
- To reduce the risk of withdrawal reactions, use a gradual taper when discontinuing lorazepam or reducing the dosage 2
- If withdrawal reactions develop, consider pausing the taper or increasing to the previous dosage level before continuing with a slower taper 2
Common Pitfalls and Caveats
- Regular use can lead to tolerance, addiction, depression, and cognitive impairment 1
- Paradoxical agitation occurs in approximately 10% of patients treated with benzodiazepines 1
- Side effects are typically mild and transient, with somnolence being most common, particularly during the first few days of treatment 5
- Before initiating pharmacological treatment, address reversible causes of anxiety first by exploring the patient's concerns, ensuring effective communication, and explaining treatment options 1