From the FDA Drug Label
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From the Research
The recommended initial intravenous (IV) dose of lorazepam for treating catatonia is 1-2 mg given slowly over 2-3 minutes, with vital sign monitoring throughout administration, as supported by the most recent study 1. This dose can be repeated every 4-6 hours as needed based on clinical response. If there is partial improvement, the dose can be gradually increased to 3-4 mg per administration. A positive response to lorazepam is both diagnostic and therapeutic for catatonia, with improvement typically occurring within minutes to hours after administration. For maintenance therapy after initial response, patients are usually transitioned to oral lorazepam at equivalent doses (typically 2-8 mg daily in divided doses). Treatment should continue for at least several days after symptoms resolve, with gradual tapering to prevent withdrawal or symptom recurrence. Lorazepam works by enhancing GABA neurotransmission, which helps normalize the dysregulated glutamate-GABA balance thought to underlie catatonia, as discussed in 2. During administration, have resuscitation equipment available and monitor for respiratory depression, hypotension, and excessive sedation, especially in elderly patients or those with respiratory conditions. Some studies, such as 3 and 4, also support the use of lorazepam in treating catatonia, but the most recent and highest quality study 1 provides the most relevant guidance for current clinical practice. It's also worth noting that alternative benzodiazepines, such as clonazepam and diazepam, may be considered in certain cases, as reported in 1. However, lorazepam remains the most commonly recommended and studied option for treating catatonia, with a long history of use supported by studies like 5.