Lorazepam Dosing for Anxiety
For adults with anxiety, the typical starting dose of lorazepam (Ativan) is 0.5-1 mg orally 2-3 times daily, with a total daily dose of 2-3 mg/day. 1, 2
Standard Dosing Protocol
- Initial dose for most adults: 0.5-1 mg orally 2-3 times daily 1, 2
- Usual daily dosage range: 2-3 mg/day divided into multiple doses 2
- Maximum daily dose: 10 mg/day, though most patients respond to lower doses 2
- The largest dose should typically be taken before bedtime to minimize daytime sedation 2
Special Population Considerations
- For elderly or debilitated patients: Start with 0.25-0.5 mg orally 2-3 times daily (maximum 2 mg in 24 hours) 1, 2
- Dose should be gradually increased when needed to avoid adverse effects 2
- When higher dosage is required, increase the evening dose first before adjusting daytime doses 2
Administration Guidelines
- Lorazepam can be taken with or without food 2
- For faster onset in acute anxiety situations, tablets can also be used sublingually (off-label) 1
- Concentrated oral solution should be mixed with liquid or semi-solid food such as water, juice, soda, applesauce, or pudding 2
Monitoring and Discontinuation
- Monitor for effectiveness and side effects, particularly sedation, cognitive impairment, and paradoxical agitation 3, 1
- Regular use can lead to tolerance, addiction, depression, and cognitive impairment 3, 1
- Approximately 10% of patients may experience paradoxical agitation with benzodiazepines 3, 1
- To discontinue, use a gradual taper to reduce withdrawal risk 2
- If withdrawal reactions develop, consider pausing the taper or temporarily returning to the previous dose 2
Clinical Pearls
- Infrequent, low doses of short half-life benzodiazepines like lorazepam are least problematic for long-term use 3
- Most patients with anxiety show significant improvement in symptoms like emotional tension, irritability, and apprehension within the first week of treatment 4
- Symptoms with a cognitive element may respond more slowly 4
- Side effects are typically dose-related and often occur during the first few days of treatment 4
- Lorazepam has been shown to reduce cerebral activity in anxiety-related brain regions including the superior frontal gyrus, anterior insula, and cingulate gyrus 5