From the FDA Drug Label
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 The maximum daily dose of Ativan (lorazepam) is 10 mg/day 1.
- The dose may be given in divided doses, with the largest dose taken before bedtime.
- It is recommended to individualize the dose, frequency of administration, and duration of therapy according to patient response.
From the Research
The maximum daily dose of Ativan (lorazepam) for adults is typically 10 mg per day, though most patients require only 2-6 mg daily divided into 2-3 doses. For anxiety, the usual starting dose is 2-3 mg/day in divided doses, while insomnia treatment typically begins with 2-4 mg at bedtime. Elderly or debilitated patients should start with lower doses, usually half the recommended adult dose. Ativan is a benzodiazepine that works by enhancing the effect of the inhibitory neurotransmitter GABA in the brain, producing calming effects. It should be used for the shortest duration possible, as prolonged use (beyond 2-4 weeks) can lead to dependence and withdrawal symptoms. Patients should never abruptly stop taking Ativan after regular use, as this can cause serious withdrawal effects. Side effects may include drowsiness, dizziness, and impaired coordination, so patients should avoid driving or operating machinery until they know how the medication affects them.
The provided evidence does not directly address the maximum daily dose of Ativan, but it does discuss the treatment of insomnia and anxiety in various populations, including those with comorbid insomnia and sleep apnea 2, chronic low back pain 3, advanced cancer 4, and posttraumatic stress disorder 5. However, none of these studies provide information on the maximum daily dose of Ativan. Therefore, the recommendation is based on general knowledge of the medication and its typical usage.
Key points to consider when prescribing Ativan include:
- Starting with a low dose and gradually increasing as needed
- Using the shortest duration possible to minimize the risk of dependence and withdrawal symptoms
- Monitoring patients for side effects, such as drowsiness and impaired coordination
- Avoiding abrupt discontinuation of the medication after regular use.
It is essential to weigh the benefits and risks of Ativan treatment and to consider alternative therapies, such as cognitive behavioral therapy for insomnia (CBT-i), which has been shown to be effective in improving sleep quality and reducing symptoms of insomnia 6, 2, 5.