From the Research
For catatonia in patients 65 years and older, the recommended initial intramuscular lorazepam dose is typically 0.5-1 mg, which can be repeated every 4-8 hours as needed, as supported by the most recent study 1 that highlights the effectiveness of lorazepam in treating catatonia. When considering the treatment of catatonia in elderly patients, it is essential to prioritize their increased sensitivity to benzodiazepines and higher risk of side effects.
- Start at the lower end of the dosing range (0.5 mg) for elderly patients due to these concerns.
- Careful monitoring is essential after administration, watching for respiratory depression, excessive sedation, and fall risk.
- Dose adjustments should be made based on clinical response and tolerability.
- If the patient shows improvement, continue the effective dose and consider transitioning to oral lorazepam when possible. The effectiveness of lorazepam in catatonia is attributed to its enhancement of GABA neurotransmission, which helps reduce the excessive glutamatergic activity thought to contribute to catatonic symptoms, as discussed in 2 and further emphasized by the rapid therapeutic effects observed in 1. For persistent catatonia, the dose may be gradually increased while monitoring for side effects, though electroconvulsive therapy (ECT) should be considered if there's inadequate response to lorazepam, as suggested by 3.