From the Guidelines
Lorazepam (Ativan) should be prescribed at a dose of 0.5-1 mg orally four times a day as required, with a maximum dose of 4 mg in 24 hours, according to the most recent guidelines 1. When considering the use of Lorazepam, it's essential to take into account the patient's age and health status.
- For elderly or debilitated patients, the dose should be reduced to 0.25-0.5 mg, with a maximum dose of 2 mg in 24 hours 1.
- The medication can be used sublingually (off-label use) if necessary, and oral tablets can be administered in this manner. The guidelines emphasize the importance of using the lowest effective dose to minimize the risk of adverse effects and dependence. Key considerations for prescribing Lorazepam include:
- Starting with a low dose and titrating as needed
- Monitoring patients for signs of dependence and withdrawal
- Gradually reducing the dose under medical supervision when discontinuing the medication
- Avoiding driving or operating machinery until the patient knows how the medication affects them It's crucial to prioritize the patient's safety and well-being when prescribing Lorazepam, and to carefully weigh the potential benefits against the risks of adverse effects and dependence 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION ... The usual range is 2 mg/day to 6 mg/day given in divided doses, the largest dose being taken before bedtime, but the daily dosage may vary from 1 mg/day to 10 mg/day For anxiety, most patients require an initial dose of 2 mg/day to 3 mg/day given twice daily or three times daily. For insomnia due to anxiety or transient situational stress, a single daily dose of 2 mg to 4 mg may be given, usually at bedtime. For elderly or debilitated patients, an initial dosage of 1 mg/day to 2 mg/day in divided doses is recommended, to be adjusted as needed and tolerated
The recommended dose and frequency of Lorazepam (Ativan) is:
- 2 mg/day to 6 mg/day given in divided doses for optimal results
- 2 mg/day to 3 mg/day given twice daily or three times daily for anxiety
- 2 mg to 4 mg given once daily, usually at bedtime, for insomnia due to anxiety or transient situational stress
- 1 mg/day to 2 mg/day in divided doses for elderly or debilitated patients, to be adjusted as needed and tolerated 2
From the Research
Recommended Dose and Frequency of Lorazepam
The recommended dose and frequency of Lorazepam (Ativan) can vary depending on the specific condition being treated and the individual patient.
- For patients with primary insomnia, a dose of 0.5 mg TID (three times a day) or 1.5 mg HS (at bedtime) was found to be effective in improving sleep and reducing nocturnal whole body metabolic rate 3.
- In another study, a dose of 4 mg of Lorazepam was evaluated for its efficacy in inducing and maintaining sleep in insomniac subjects, and was found to be effective but with significant side effects and rebound phenomena 4.
- A more recent study characterized the pharmacokinetics of extended-release Lorazepam, which was developed to reduce fluctuations in plasma levels compared to immediate-release Lorazepam, and found that a dose of 3 mg once daily was bioequivalent to 1 mg TID of immediate-release Lorazepam 5.
- For patients with hypertension-associated anxiety, a dose of 3 mg/day was found to be effective in relieving symptoms of anxiety, with most patients being controlled with this dose and experiencing only mild and transient side effects 6.
- Another study evaluated the effects of Lorazepam on sleep and withdrawal phenomena, and found that a dose of 2 mg was moderately effective in inducing and maintaining sleep, but with significant side effects and rebound phenomena 7.