What is the dose of Lorazepam (Ativan) for agitation?

From the Guidelines

For agitation, the recommended dose of Ativan (lorazepam) is 0.5-1 mg orally four times a day as required, with a maximum of 4 mg in 24 hours, as per the latest guidelines from the BMJ in 2020 1. When managing agitation, it is essential to consider the patient's age and debilitated status, as the dose may need to be reduced.

• For elderly or debilitated patients, the dose should be reduced to 0.25-0.5 mg, with a maximum of 2 mg in 24 hours, to minimize the risk of adverse effects 1.
• Oral tablets can be used sublingually, which may be beneficial for patients who have difficulty swallowing, as an off-label use. It is crucial to monitor patients for potential side effects, such as respiratory depression, excessive sedation, and hypotension, especially when administering Ativan to elderly patients or those taking other CNS depressants.
• The goal of treatment should be to address the underlying cause of agitation, rather than relying on benzodiazepines long-term, due to the risks of dependence and tolerance associated with prolonged use. By following these guidelines and considering the individual patient's needs, healthcare providers can effectively manage agitation while minimizing the risks associated with Ativan use, as supported by the latest evidence from the BMJ in 2020 1.

From the FDA Drug Label

For anxiety, most patients require an initial dose of 2 mg/day to 3 mg/day given twice daily or three times daily. The recommended dose of Ativan (lorazepam) for agitation is not explicitly stated, but for anxiety, the initial dose is 2 mg/day to 3 mg/day given twice daily or three times daily 2.

• The dosage range is 2 mg/day to 6 mg/day given in divided doses.
• The daily dosage may vary from 1 mg/day to 10 mg/day. It is essential to individualize the dose, frequency of administration, and duration of therapy according to patient response.

From the Research

Ativan Dose for Agitation

• There is no direct mention of Ativan (lorazepam) dosage for agitation in the provided studies. However, lorazepam is mentioned as a comparison to other medications in the treatment of agitation.
• In the study 3, lorazepam is used in combination with haloperidol to treat agitation in patients with psychiatric conditions, with a sedation rate of 94.1% within 20 minutes.
• The study 4 mentions that haloperidol plus lorazepam has a high rate of adverse effects, but does not specify the dosage of lorazepam used.
• The study 5 does not mention lorazepam as a treatment option for psychomotor agitation.

Alternative Medications and Dosages

• The study 3 suggests that IM olanzapine 10 mg is effective for rapid sedation in acute undifferentiated agitation.
• The study 6 compares the effectiveness of droperidol, olanzapine, and haloperidol for treating agitation, with olanzapine and droperidol leading to lower rates of rescue sedation.
• The study 4 finds that olanzapine, haloperidol plus promethazine, and droperidol are effective and safe for use as rapid tranquilization.
• The study 7 characterizes the dose of prn oral IR quetiapine, haloperidol, loxapine, and chlorpromazine used to manage acute agitation in a pediatric ED, with mean doses ranging from 0.07 to 0.54 mg/kg per dose.
• The study 5 compares the efficacy and safety of low-dose pharmacological interventions, including haloperidol (2.5 mg) + promethazine (25 mg), haloperidol (2.5 mg) + midazolam (7.5 mg), ziprasidone (10 mg), and olanzapine (10 mg), for controlling psychomotor agitation.