Daily Dose Limit of Ativan (Lorazepam)
The maximum daily dose of lorazepam is 10 mg/day for adults, with a typical therapeutic range of 2-6 mg/day in divided doses, and a reduced maximum of 2 mg/day for elderly or debilitated patients. 1
Standard Adult Dosing
- The usual therapeutic range is 2-6 mg/day given in divided doses, with the largest dose typically taken at bedtime 1
- The daily dosage may vary from 1 mg/day up to a maximum of 10 mg/day 1
- For anxiety management, most patients require an initial dose of 2-3 mg/day given twice or three times daily 1
- For insomnia related to anxiety or situational stress, a single daily dose of 2-4 mg may be given, usually at bedtime 1
- The standard dosing regimen is 0.5-1 mg orally four times daily, with a maximum of 4 mg/24 hours according to British Medical Journal guidelines 2
Elderly and Debilitated Patients
- For elderly or debilitated patients, the maximum daily dose is reduced to 2 mg/24 hours 2, 1
- Initial dosing should be 0.25-0.5 mg in this population 2
- An initial dosage of 1-2 mg/day in divided doses is recommended, to be adjusted as needed and tolerated 1
- This dose reduction is necessary due to increased sensitivity and risk of falls in elderly patients 2
Acute Care Settings
- For acute agitation, lorazepam 1 mg SC/IV is recommended, with a maximum single dose of 2 mg 2
- In status epilepticus, the recommended IV dose is 0.1 mg/kg/dose, up to a maximum of 4 mg per single dose 3
- For pediatric status epilepticus, IV dosing is 0.1-0.3 mg/kg every 5-10 minutes with a maximum of 10 mg per dose 4
Critical Safety Considerations
- Regular use of benzodiazepines leads to tolerance, addiction, depression, and cognitive impairment, so infrequent low doses are least problematic 4, 2
- Paradoxical agitation occurs in approximately 10% of patients treated with benzodiazepines 4, 2
- When higher dosage is indicated, the evening dose should be increased before daytime doses 1
- There is increased risk of respiratory depression when combined with other sedatives, and respiratory support should be available 2
- Side effects including hangover, impaired functioning, and anterograde amnesia are common with higher doses (4 mg) during initial days of treatment 5
Dose Escalation and Discontinuation
- Dosage should be increased gradually when needed to help avoid adverse effects 1
- To reduce the risk of withdrawal reactions, use a gradual taper to discontinue lorazepam or reduce dosage 1
- If withdrawal reactions develop, consider pausing the taper or increasing dosage to the previous level, then decrease more slowly 1
- Duration of treatment should be limited to the acute episode only when possible 2
- Rebound insomnia and anxiety can occur after withdrawal, particularly with doses of 4 mg or higher 5, 6