From the Guidelines
Lorazepam (Ativan) does not have a direct effect on preventing or causing Cerebrovascular Accident (CVA), but it is used to manage seizures that may occur in patients with acute stroke.
Use of Lorazepam in CVA
- Lorazepam IV is recommended for treating new-onset seizures in patients with acute stroke if they are not self-limiting 1.
- A single, self-limiting seizure occurring at the onset or within 24 hours of an acute stroke should not be treated with long-term anticonvulsant medications, including lorazepam 1.
- Patients who have an immediate post-stroke seizure should be monitored for recurrent seizure activity and treated with lorazepam or other short-acting medications as needed 1.
Important Considerations
- Prophylactic use of anticonvulsant medications, including lorazepam, is not recommended in patients with acute stroke, as there is no evidence to support its use and possible harm with negative effects on neural recovery 1.
- Lorazepam should be used with caution and only when necessary, as it can have adverse effects, particularly in elderly patients or those with compromised renal or hepatic function.
- The dosage of lorazepam for seizure management in acute stroke patients is typically 1-2 mg IV, repeated as needed, but the specific dosage and administration should be guided by clinical judgment and patient factors.
From the Research
Effect of Lorazepam on Cerebrovascular Accident (CVA)
- There is limited direct evidence on the effect of lorazepam on CVA. However, some studies provide insights into the relationship between lorazepam and cerebrovascular events.
- A study published in 2005 2 compared the incidence rates of cerebrovascular accidents and transient ischemic attacks in patients prescribed risperidone, quetiapine, or olanzapine in general practice in England. The study found that dementia appears to be an important risk factor for CVA/TIA events.
- Another study published in 2004 3 suggested that the immobility of advanced dementia could be a form of lorazepam-responsive catatonia, implying a potential link between lorazepam and cerebrovascular events in patients with dementia.
- A more recent study published in 2024 4 explored the association between intravenous lorazepam and mortality among older hospitalized patients with and without cognitive impairment. The study found that IV lorazepam was associated with increased mortality in both groups, but the relationship between lorazepam and CVA was not directly examined.
- Other studies, such as those published in 2018 5 and 2016 6, focused on the effects of lorazepam on traumatic brain injury and convulsive status epilepticus, respectively, but did not provide direct evidence on the effect of lorazepam on CVA.
Key Findings
- Dementia may be an important risk factor for CVA/TIA events 2.
- Lorazepam may be associated with increased mortality in older hospitalized patients with and without cognitive impairment 4.
- There is limited direct evidence on the effect of lorazepam on CVA, and more research is needed to fully understand the relationship between lorazepam and cerebrovascular events.