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1 Contraindications/Precautions
Contraindicated in: Hypersensitivity; Cross-sensitivity with other benzodiaze- PDF Page #1
LORazepam (lor-az-e-pam) pines may exist; Comatose patients or those with pre-existing CNS depression; Uncon-
Ativan trolled severe pain; Angle-closure glaucoma; Severe hypotension; Sleep apnea; OB,
Lactation: Use in pregnancy and lactation may cause CNS depression, flaccidity,
Classification feeding difficulties, hypothermia, seizures, and respiratory problems in the neonate;
Therapeutic: anesthetic adjuncts, antianxiety agents, sedative/hypnotics discontinue drug or bottle-feed.
Pharmacologic: benzodiazepines Use Cautiously in: Severe hepatic/renal/pulmonary impairment; Myasthenia
Schedule IV gravis; Depression; Psychosis; History of suicide attempt or drug abuse/substance
Pregnancy Category D use disorder; COPD; Sleep apnea; Pedi: Use cautiously in children under 12 yr. Inq
doses, benzyl alcohol in injection may cause potentially fatal gasping syndrome in
neonates; Geri: Lower doses recommended for geriatric or debilitated patients; Hyp-
Indications notic use should be short-term.
Anxiety disorder (oral). Preoperative sedation (injection). Decreases preoperative
anxiety and provides amnesia. Unlabeled Use: IV: Antiemetic prior to chemother- Adverse Reactions/Side Effects
apy. Insomnia, panic disorder, as an adjunct with acute mania or acute psychosis. CNS: dizziness, drowsiness, lethargy, hangover, headache, ataxia, slurred speech,
forgetfulness, confusion, mental depression, rhythmic myoclonic jerking in pre-term
Action infants, paradoxical excitation. EENT: blurred vision. Resp: respiratory depres-
Depresses the CNS, probably by potentiating GABA, an inhibitory neurotransmitter. sion. CV: rapid IV use only APNEA, CARDIAC ARREST, bradycardia, hypotension. GI:
Therapeutic Effects: Sedation. Decreased anxiety. Decreased seizures. constipation, diarrhea, nausea, vomiting, weight gain (unusual). Derm: rashes.
Misc: physical dependence, psychological dependence, tolerance.
Pharmacokinetics
Absorption: Well absorbed following oral administration. Rapidly and completely Interactions
absorbed following IM administration. Sublingual absorption is more rapid than oral Drug-Drug: Additive CNS depression with other CNS depressants including al-
and is similar to IM. cohol, antihistamines, antidepressants, opioid analgesics, clozapine, and
Distribution: Widely distributed. Crosses the blood-brain barrier. Crosses the pla- other sedative/hypnotics including other benzodiazepines. Maypthe efficacy of le-
centa; enters breast milk. vodopa. Smoking mayqmetabolism andpeffectiveness. Valproate and canqlev-
Metabolism and Excretion: Highly metabolized by the liver. els (pdose by 50%). Oral contraceptives mayplevels.
Half-life: Full-term neonates: 18 73 hr; Older children: 6 17 hr; Adults: 10 16 Drug-Natural Products: Concomitant use of kava-kava, valerian, or chamo-
hr. mile canqCNS depression.
TIME/ACTION PROFILE (sedation) Route/Dosage
ROUTE ONSET PEAK DURATION
PO (Adults): Anxiety 1 3 mg 2 3 times daily (up to 10 mg/day). Insomnia
2 4 mg at bedtime.
PO 1560 min 16 hr 812 hr PO (Geriatric Patients or Debilitated Patients): Anxiety 0.5 2 mg/day in
IM 3060 min 12 hr 812 hr divided doses initially. Insomnia 0.25 1 mg initially,qas needed.
IV 1530 min 1520 min 812 hr PO (Children): Anxiety/sedation 0.02 0.1 mg/kg/dose (not to exceed 2 mg) q
Amnestic response 4 8 hr. Preoperative sedation 0.02 0.09 mg/kg/dose.
Canadian drug name. Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough Discontinued.
Name /bks_53161_deglins_md_disk/lorazepam 02/17/2014 07:10AM
2 Anxiety: Assess degree and manifestations of anxiety and mental status (orienta-
PO (Infants): Anxiety/sedation 0.02 0.1 mg/kg/dose (not to exceed 2 mg) q
4 8 hr. Preoperative sedation 0.02 0.09 mg/kg/dose.
SL (Adults and adolescents 18 yr): Anxiety 2 3 mg/day in divided doses,
not to exceed 6 mg/day; preoperative sedation 0.05 mg/kg, up to 4 mg total given
1 2 hr before surgery.
SL (Geriatric Patients and debilitated patients): 0.5 mg/day, dose may be ad-
justed as necessary.
IM (Adults): Preoperative sedation 50 mcg (0.05 mg)/kg 2 hr before surgery
(not to exceed 4 mg).
IM (Children): Preoperative sedation 0.02 0.09 mg/kg/dose.
IM (Infants): Preoperative sedation 0.02 0.09 mg/kg/dose.
IV (Adults): Preoperative sedation 44 mcg (0.044 mg)/kg (not to exceed 2 mg)
15 20 min before surgery. Operative amnestic effect up to 50 mcg/kg (not to
exceed 4 mg). Antiemetic 2 mg 30 min prior to chemotherapy; may be repeated q
4 hr as needed (unlabeled). Anticonvulsant 50 mcg (0.05 mg)/kg, up to 4 mg;
may be repeated after 10 15 min (not to exceed 8 mg/12 hr; unlabeled).
IV (Children): Preoperative sedation 0.02 0.09 mg/kg/dose; may use smaller
doses (0.01 0.03 mg/kg) and repeat q 20 min. Antiemetic Single dose: 0.04
0.08 mg/kg/dose prior to chemotherapy (not to exceed 4 mg). Multiple doses: 0.02
0.05 mg/kg/dose q 6 hr prn (not to exceed 2 mg). Anxiety/sedation 0.02 0.1
mg/kg (not to exceed 2 mg) q 4 8 hr. Status epilepticus-0.1 mg/kg over 2 5 min
(not to exceed 4 mg); may repeat with 0.05 mg/kg if needed.
IV (Infants): Preoperative sedation: 0.02 0.09 mg/kg/dose; may use smaller
doses (0.01 0.03 mg/kg) and repeat q 20 min. Anxiety/sedation 0.02 0.1 mg/
kg/dose (not to exceed 2 mg) q 4 8 hr. Status epilepticus 0.1 mg/kg over 2 5
min (not to exceed 4 mg); may repeat with 0.05 mg/kg if needed.
IV (Neonates): Status epilepticus 0.05 mg/kg over 2 5 min; may repeat in 10
15 min.
NURSING IMPLICATIONS
Assessment
Conduct regular assessment of continued need for treatment.
Pedi: Assess neonates for prolonged CNS depression related to inability to metab-
olize lorazepam.
Geri: Assess geriatric patients carefully for CNS reactions as they are more sensi-
tive to these effects. Assess falls risk.
Plate # 0-Composite pg 2 # 2
tion, mood, behavior) prior to and periodically throughout therapy.
Prolonged high-dose therapy may lead to psychological or physical dependence. PDF Page #2
Restrict amount of drug available to patient.
Status Epilepticus: Assess location, duration, characteristics, and frequency of
seizures. Institute seizure precautions.
Lab Test Considerations: Patients on high-dose therapy should receive rou-
tine evaluation of renal, hepatic, and hematologic function.
Toxicity and Overdose: If overdose occurs, flumazenil (Romazicon) is the an-
tidote. Do not use with patients with seizure disorder. May induce seizures.
Potential Nursing Diagnoses
Anxiety (Indications)
Risk for injury (Indications) (Side Effects)
Implementation
Do not confuse Ativan (lorazepam) with Atarax (hydroxyzine). Do not
confuse lorazepam with alprazolam or clonazepam.
Following parenteral administration, keep patient supine for at least 8 hr and ob-
serve closely.
PO: Tablet may also be given sublingually (unlabeled) for more rapid onset.
Take concentrated liquid solution with water, soda, pudding, or applesauce.
IM: Administer IM doses deep into muscle mass at least 2 hr before surgery for
optimum effect.
IV Administration
Direct IV: Diluent: Dilute immediately before use with an equal amount of ster-
ile water for injection, D5W, or 0.9% NaCl for injection. Pedi: To decrease the
amount of benzyl alcohol delivered to neonates, dilute the 4 mg/mL injection with
preservative-free sterile water for injection to make a 0.4 mg/mL dilution for IV
use. Do not use if solution is colored or contains a precipitate. Rate: Administer
at a rate not to exceed 2 mg/min or 0.05 mg/kg over 2 5 min. Rapid IV
administration may result in apnea, hypotension, bradycardia, or car-
diac arrest.
Y-Site Compatibility: acyclovir, albumin, alemtuzumab, alfentanil, allopurinol,
amifostine, amikacin, aminocaproic acid, aminophylline, amiodarone, amphoter-
icin B cholesteryl, amphotericin B colloidal, amphotericin B lipiod complex, am-
sacrine, anakinra, anidulafungin, argatroban, atracurium, bivalirudin, bleomycin,
2015 F.A. Davis Company CONTINUED
Name /bks_53161_deglins_md_disk/lorazepam 02/17/2014 07:10AM Plate # 0-Composite pg 3 # 3

3 Patient/Family Teaching
CONTINUED
LORazepam
bumetanide, buprenorphine, bulsulfan, butorphanol, calcium chloride, calcium
gluconate, carboplatin, carmustine, cefazolin, cefepime, cefotaxime, cefotetan,
cefoxitin, ceftaroline, ceftazidime, ceftriaxone, cefuroxime, chloramphenicol,
ciprofloxacin, cisatracurium, cisplatin, cladribine, clindamycin, cyclophospha-
mide, cyclosporine, cytarabine, dactinomycin, daptomycin, dexamethasone so-
dium phosphate, dexmedetomidine, digoxin, diltiazem, diphenhydramine, dobu-
tamine, docetaxel, dopamine, doxorubicin, doxorubicin liposome, doxycycline,
droperidol, enalaprilat, ephedrine, epinephrine, epirubicin, eptifibatide, ertape-
nem, erythromycin lactobionate, esmolol, etomidate, etoposide phosphate, fam-
otidine, fenoldopam, fentanyl, filgrastim, fluconazole, fludarabine, fosphenytoin,
furosemide, gemcitabine, gentamicin, glycopyrrolate, granisetron, haloperidol,
heparin, hydrocortisone sodium succinate, hydromorphone, ifosfamide, insulin,
irinotecan, isoproterenol, ketorolac, labetalol, lidocaine, linezolid, magnesium
sulfate, mannitol, mechlorethamine, melphalan, meropenem, metaraminol,
methadone, methotrexate, methyldopate, methylprednisolone sodium succinate,
metoclopramide, metoprolol, metronidazole, micafungin, midazolam, milrinone,
mitoxantrone, morphine, mycophenolate, nafcillin, nalbuphine, naloxone, nesir-
itide, nicardipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, oxal-
iplatin, oxytocin, paclitaxel, palonosetron, pamidronate, pancuronium, peme-
trexed, pentamidine, pentobarbital, phenobarbital, phenylephrine, piperacillin/
tazobactam, potassium acetate, potassium chloride, procainamide, prochlorper-
azine, promethazine, propofol, propranolol, quinupristin/dalfopristin, ranitidine,
remifentanil, rituximab, sodium acetate, sodium bicarbonate, sodium phos-
phates, streptozocin, succinylcholine, tacrolimus, teniposide, theophylline, thi-
otepa, ticarcillin/clavulanate, tigecycline, tirofiban, tobramycin, trastuzumab, tri-
methoprim/sulfamethoxazole, vancomycin, vasopressin, vecuronium, verapamil,
vincristine, vinorelbine, voriconazole, zidovudine, zoledronic acid.
Y-Site Incompatibility: aldesleukin, ampicillin, ampicillin/sulbactam, az-
treonam, dantrolene, doxacurium, fluorouracil, hydralazine, idarubicin, imipe-
nem/cilastatin, meperidine, omeprazole, ondansetron, pantoprazole, phenytoin,
potassium phosphates, rocuronium, sargramostim, sufentanil.
Canadian drug name. Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent.
Instruct patient to take medication exactly as directed and not to skip or double up
PDF Page #3
on missed doses. If medication is less effective after a few weeks, check with health
care professional; do not increase dose.
Advise patient that lorazepam is usually prescribed for short-term use and does
not cure underlying problem.
Advise patient to decrease lorazepam dose gradually to minimize withdrawal
symptoms; abrupt withdrawal may cause tremors, nausea, vomiting, and abdomi-
nal and muscle cramps.
Teach other methods to decrease anxiety, such as increased exercise, support
groups, relaxation techniques. Emphasize that psychotherapy is beneficial in ad-
dressing source of anxiety and improving coping skills.
May cause drowsiness or dizziness. Advise patient to avoid driving or other activi-
ties requiring alertness until response to medication is known.
Caution patient to avoid taking alcohol or other CNS depressants concurrently with
this medication.
Instruct patient to contact health care professional immediately if pregnancy is
planned or suspected.
Emphasize the importance of follow-up exams to determine effectiveness of the
medication.
Evaluation/Desired Outcomes
Increase in sense of well-being.
Decrease in subjective feelings of anxiety without excessive sedation.
Reduction of preoperative anxiety.
Postoperative amnesia.
Improvement in sleep patterns.
Why was this drug prescribed for your patient?
Strikethrough Discontinued.