What is the intravenous (IV) dose of Lorazepam (Ativan) for seizure management?

From the Guidelines

The recommended IV dose of Ativan (lorazepam) for seizure management is 0.05-0.10 mg/kg (maximum: 4 mg per dose), which can be repeated every 10-15 min if needed for continued seizures. This dose is based on the most recent and highest quality study available, which prioritizes the safety and efficacy of the treatment 1. The administration rate should not exceed 2 mg/minute, and patients should be closely monitored for respiratory depression, hypotension, and sedation.

Key Considerations

• The dose may need to be adjusted for elderly patients and those with hepatic impairment due to altered drug metabolism.
• Continuous cardiorespiratory monitoring is essential, and resuscitation equipment should be immediately available.
• Ativan works quickly, with an onset of action within 2-3 minutes and a duration of 12-24 hours.
• The treatment is effective for seizure control because it enhances the inhibitory effects of GABA in the brain, which helps suppress the abnormal electrical activity causing seizures.

Administration Guidelines

• IV/IM: 0.05-0.10 mg/kg (maximum: 4 mg per dose) can be administered for status epilepticus.
• The dose may be repeated every 10-15 min if needed for continued seizures.
• Monitor oxygen saturation and be prepared to provide respiratory support, as there is an increased incidence of apnea when combined with other sedative agents.
• Flumazenil may be administered to reverse life-threatening respiratory depression caused by lorazepam; however, it will also counteract the anticonvulsant effects and may precipitate recurrence of seizures 1.

From the FDA Drug Label

For the treatment of status epilepticus, the usual recommended dose of lorazepam injection is 4 mg given slowly (2 mg/min) for patients 18 years and older. If seizures cease, no additional lorazepam injection is required If seizures continue or recur after a 10- to 15-minute observation period, an additional 4 mg intravenous dose may be slowly administered.

The IV dose for Ativan (lorazepam) for seizure is 4 mg given slowly (2 mg/min) for patients 18 years and older, with the possibility of an additional 4 mg dose after a 10- to 15-minute observation period if seizures continue or recur 2.

From the Research

IV Dose for Ativan (Lorazepam) in Seizure Treatment

• The provided studies do not specifically mention the IV dose for Ativan (Lorazepam) in seizure treatment. However, some studies mention the use of lorazepam as a first-line treatment for status epilepticus:
  • A study published in 2016 3 mentions that lorazepam controlled SE in 75.1% of patients as a first choice.
  • Another study published in 2015 4 used an IV dose of 0.1mg/kg of lorazepam, followed by another antiepileptic drug.
• It is essential to consult a medical professional or a reliable medical source for the specific dosage and treatment guidelines for Ativan (Lorazepam) in seizure treatment.

Alternative Treatment Options

• The studies suggest that other antiepileptic drugs, such as midazolam, valproate, levetiracetam, and phenobarbital, can be effective in treating status epilepticus:
  • A study published in 2021 5 found that midazolam ranked the best for primary and secondary outcomes among first-line antiseizure medications.
  • A study published in 2016 3 found that levetiracetam was effective in 88.9% of patients as a second choice.
  • A study published in 2015 4 found that valproate, phenytoin, and levetiracetam were safe and equally efficacious following lorazepam in GCSE.
• The choice of antiepileptic drug may depend on individual patient factors and should be determined by a medical professional.