Lorazepam Starting Dose
For adults with anxiety, start with lorazepam 0.5-1 mg orally 2-3 times daily, with a typical initial total daily dose of 2-3 mg divided into 2-3 doses. 1
Standard Adult Dosing
- The FDA-approved usual dosage range is 2-6 mg/day in divided doses, with the largest dose taken at bedtime 1
- For anxiety management specifically, most patients require an initial dose of 2-3 mg/day given twice daily or three times daily 1
- For insomnia related to anxiety or situational stress, a single daily dose of 2-4 mg may be given at bedtime 1
- The maximum daily dosage can range from 1-10 mg/day depending on clinical response 1
Elderly or Debilitated Patients
Reduce the starting dose by 50% in elderly or debilitated patients to 0.25-0.5 mg per dose 2
- Initial dosage should be 1-2 mg/day in divided doses for elderly or debilitated patients 1
- Maximum daily dose in elderly patients should not exceed 2 mg in 24 hours when used for acute anxiety or agitation 2
- Elderly patients have significantly increased sensitivity to benzodiazepine sedative effects and decreased clearance with age 3
Dosing Frequency Considerations
- Divide the total daily dose into 2-3 administrations (every 8-12 hours) for maintenance therapy 1
- When higher dosages are needed, increase the evening dose before increasing daytime doses 1
- For acute anxiety or agitation in adults able to swallow, 0.5-1 mg orally four times daily as needed (maximum 4 mg in 24 hours) is recommended by NICE guidelines 2
Dose Titration Strategy
- Increase dosage gradually when needed to help avoid adverse effects 1
- When discontinuing or reducing dose, use a gradual taper to reduce withdrawal risk 1
- If withdrawal reactions develop, pause the taper or increase to the previous dosage level, then decrease more slowly 1
Critical Safety Considerations
- Monitor for paradoxical agitation, which occurs in approximately 10% of patients 3, 4
- Assess for respiratory depression, especially when combined with other CNS depressants 3, 4
- Monitor oxygen saturation when used with opioids or in patients with baseline respiratory insufficiency 3
- Regular benzodiazepine use leads to tolerance, and the lowest effective dose should be used for the shortest duration 3
Common Pitfall to Avoid
Do not start with doses higher than 1 mg in elderly patients or those with debilitating disease, as they are particularly sensitive to benzodiazepine effects and have increased fall risk 4, 1. The most common error is failing to reduce the initial dose by 50% in these vulnerable populations 2.