From the Guidelines

Combining Ativan (Lorazepam) and Versed (Midazolam) in a patient with status epilepticus increases the risk of apnea and respiratory depression.

When using benzodiazepines like lorazepam and midazolam, monitor oxygen saturation and be prepared to provide respiratory support 1.
Flumazenil may be administered to reverse life-threatening respiratory depression caused by these medications, but it will also counteract the anticonvulsant effects and may precipitate recurrence of seizures 1.

For status epilepticus, the recommended dosage of lorazepam is 0.05-0.10 mg/kg (maximum: 4 mg per dose), which may be repeated every 10-15 minutes if needed 1.
Midazolam can be used as a loading dose of 0.15-0.20 mg/kg, followed by a continuous infusion of 1 mg/kg per min, increasing by increments of 1 mg/kg per min every 15 minutes until seizures stop 1.

Increased incidence of apnea when combined with other sedative agents, emphasizing the need for close monitoring and preparedness for respiratory support 1.

From the Research

The combination of lorazepam and midazolam in the treatment of status epilepticus is not directly addressed in the provided studies 2, 3, 4, 5, 6.
However, the individual effects of lorazepam and midazolam in the treatment of status epilepticus are discussed in several studies:
- Lorazepam is recommended as a first-line treatment for status epilepticus, with a typical dose of 2-8 mg/70kg 3.
- Midazolam is also used as a first-line treatment, particularly when intravenous access is not available, and can be administered via non-intravenous routes such as intramuscularly or buccally 4, 5.
A study comparing the effects of midazolam and lorazepam in an animal model of status epilepticus found that both drugs were effective in reducing EEG epileptiform activity, but midazolam resulted in superior recovery of normal behaviors at 24 hours 6.
Another study found that intramuscular midazolam was non-inferior to intravenous lorazepam in the pre-hospital treatment of convulsive status epilepticus in adults 5.
The efficacy of combining lorazepam and midazolam in the treatment of status epilepticus is not explicitly stated in the provided studies, and further research would be needed to determine the safety and effectiveness of this combination 2, 3, 4, 5, 6.

Lorazepam and midazolam are both effective in the treatment of status epilepticus 2, 3, 4, 5, 6.
Midazolam may have advantages over lorazepam in terms of recovery of normal behaviors at 24 hours in an animal model of status epilepticus 6.
Intramuscular midazolam is non-inferior to intravenous lorazepam in the pre-hospital treatment of convulsive status epilepticus in adults 5.

The choice of benzodiazepine and route of administration may depend on individual patient factors and the specific clinical scenario 3, 4, 5.
Further research is needed to determine the optimal treatment strategy for status epilepticus, including the potential benefits and risks of combining lorazepam and midazolam 2, 3, 4, 5, 6.