Lorazepam Dosing for Pediatric Patients
For status epilepticus in children, lorazepam should be dosed at 0.05-0.1 mg/kg IV/IM, with a maximum single dose of 4 mg. 1
Status Epilepticus (Primary Indication)
Intravenous/Intraosseous Administration:
- Dose: 0.1 mg/kg IV slowly 1
- Maximum single dose: 4 mg 1
- Administration rate: Infuse slowly over 2-5 minutes to minimize hypotension and respiratory depression 1
- Repeat dosing: May repeat the same dose if seizures continue after 5-10 minutes 1
- Important: This is the most commonly used benzodiazepine for acute pediatric agitation and seizures 1
Intramuscular Administration:
- Dose: 0.05-0.15 mg/kg IM 1
- Maximum single dose: 5 mg 1
- Repeat interval: May repeat hourly as necessary 1
Sedation/Agitation Management
For acute agitation or procedural sedation:
- Dose: 0.05-0.1 mg/kg PO/IM/IV 1
- Usual adult dose for reference: 2 mg PO/IM (may repeat every 30-60 minutes) 1
- Onset of action:
- Duration: 6-8 hours PO/IM 1
Critical Safety Considerations
Respiratory Monitoring:
- There is an increased incidence of apnea when lorazepam is combined with other sedative agents, particularly opioids 1
- Equipment to maintain a patent airway must be immediately available before IV administration 2
- Be prepared to provide respiratory support and monitor oxygen saturation continuously 1
Contraindications and Precautions:
- Contraindicated in patients with respiratory compromise 1
- Use with caution in intoxicated patients 1
- Contains benzyl alcohol, which requires special consideration in neonates and young infants 2
- The FDA label notes that safety in pediatric patients has not been fully established, though extensive clinical use supports the dosing recommendations above 2
Advantages Over Other Benzodiazepines:
- Preferred agent for many intoxications (e.g., cocaine-induced seizures) and withdrawal syndromes (e.g., alcohol) 1
- No extrapyramidal symptoms 1
- Low addiction potential and high therapeutic index 1
- Lack of tolerance development 1
Common Pitfalls to Avoid
- Do not underdose: Children require weight-based dosing (0.05-0.1 mg/kg), not simply a reduced adult dose, because drug elimination does not change in direct proportion to weight 3
- Do not exceed 2 mg/min IV infusion rate to prevent hypotension and respiratory depression 2
- Monitor for paradoxical disinhibition: This can occur especially in younger children and those with developmental disabilities 1
- Avoid in outpatient settings: Due to prolonged duration of action (up to 72 hours of residual effects), lorazepam should not be used in patients with expected hospital stays less than 72 hours 4