Maximum Oral Ativan (Lorazepam) Dose in 24 Hours
The maximum dose of oral lorazepam in 24 hours is 10 mg/day for adults, though the usual therapeutic range is 2-6 mg/day in divided doses. 1
Standard Adult Dosing
For anxiety management in adults who can swallow: maximum 4 mg in 24 hours (typically given as 0.5-1 mg four times daily as needed). 2, 3
For elderly or debilitated patients: maximum 2 mg in 24 hours (typically given as 0.25-0.5 mg doses). 2, 3
The FDA-approved absolute maximum is 10 mg/day, though most patients require only 2-6 mg/day in divided doses, with the largest dose taken at bedtime. 1
Dosing by Clinical Indication
For anxiety disorders:
- Usual range: 2-3 mg/day given twice or three times daily. 1
- The dose may be increased gradually up to the 10 mg/day maximum when clinically indicated, with evening doses increased before daytime doses. 1
For insomnia due to anxiety or transient stress:
- Single daily dose of 2-4 mg, usually at bedtime. 1
Critical Safety Considerations
Tolerance and dependence develop rapidly:
- Regular use leads to tolerance, addiction, depression, and cognitive impairment. 3
- Gradual taper is mandatory when discontinuing to avoid withdrawal reactions. 1
Paradoxical reactions occur in approximately 10% of patients, manifesting as agitation rather than sedation. 3
Respiratory depression risk increases significantly when combined with other sedative agents, requiring oxygen saturation monitoring and readiness to provide respiratory support. 3
Practical Dosing Algorithm
Start low, especially in vulnerable populations:
- Standard adults: Begin with 2-3 mg/day in divided doses. 1
- Elderly/debilitated: Begin with 1-2 mg/day in divided doses. 1
Titrate gradually upward only when needed:
- Increase evening doses before daytime doses to minimize daytime sedation. 1
- Never exceed 4 mg in 24 hours for routine anxiety management in outpatients. 2, 3
- Reserve the 10 mg/day maximum for severe cases under close monitoring. 1
Avoid chronic use beyond 2-4 weeks due to rapid development of dependence and cognitive impairment. 3