What is the maximum recommended daily dose of Ativan (lorazepam)?

Maximum Daily Dose of Ativan (Lorazepam)

The maximum recommended daily dose of Ativan (lorazepam) for adults is 10 mg per day, though most patients require between 2-6 mg/day divided into multiple doses. 1

Dosing Guidelines for Adults

• For anxiety disorders, the typical dosage range is 2-6 mg/day given in divided doses (2-3 times daily), with the largest dose usually taken before bedtime 1
• For insomnia due to anxiety or transient situational stress, a single daily dose of 2-4 mg may be given at bedtime 1
• For elderly or debilitated patients, a lower initial dosage of 1-2 mg/day in divided doses is recommended 1
• When higher dosage is needed, the evening dose should be increased before the daytime doses 1
• While the usual range is 2-6 mg/day, the daily dosage may vary from 1 mg/day to a maximum of 10 mg/day based on individual patient response 1

Special Populations and Considerations

• Elderly or debilitated patients: Start with 1-2 mg/day in divided doses 1
• Patients with anxiety and hypertension: Most patients can be controlled with 3 mg/day 2
• For management of anxiety or agitation in adults:
  • Patients who can swallow: 0.5-1 mg orally four times a day as required (maximum 4 mg in 24 hours) 3
  • Elderly or debilitated patients who can swallow: 0.25-0.5 mg orally (maximum 2 mg in 24 hours) 3

Specific Clinical Scenarios

• Status epilepticus: 0.05-0.1 mg/kg IV (maximum: 4 mg per dose); may repeat every 10-15 minutes if needed 3, 4
• Psychosis with agitation: 0.05-0.15 mg/kg IM/IV; may repeat hourly as necessary with a maximum single dose of 5 mg 3
• Sedation/anxiolysis: 0.05-0.1 mg/kg IV given over 2-3 minutes (maximum single dose: 5 mg) 3

Important Precautions

• Regular use can lead to tolerance, addiction, depression, and cognitive impairment 3
• Paradoxical agitation occurs in approximately 10% of patients treated with benzodiazepines 3
• There is an increased incidence of apnea when lorazepam is combined with other sedative agents 3
• Monitor oxygen saturation and be prepared to provide respiratory support when administering lorazepam 3
• Higher doses (4 mg) may cause significant side effects including:
  • Severe hangover and impaired functioning 5
  • Anterograde amnesia 5
  • Rebound insomnia and anxiety upon withdrawal 5, 6

Discontinuation

• To reduce the risk of withdrawal reactions, use a gradual taper to discontinue lorazepam or reduce the dosage 1
• If withdrawal reactions develop, consider pausing the taper or temporarily increasing the dosage to the previous level before continuing with a slower taper 1
• Even at moderate doses (2 mg), withdrawal can lead to significant rebound insomnia and increased daytime anxiety 6

Administration

• Lorazepam oral concentrate should be mixed with liquid or semi-solid food such as water, juices, soda, applesauce, or puddings 1
• The entire mixture should be consumed immediately and not stored for future use 1