Page 143 - 2026 SMOG

LORAZEPAM (ATIVAN)
Class/Mechanism of Action
• Benzodiazepine
Acts as an anxiolytic/hypnotic, anticonvulsant, and sedative.
˚ Onset of action—IV: Sedation 2–3min, IM: Hypnotic 15–30min; Duration—IV: 8–12hr
Indications
• Labeled Indications
˚ Anesthesia premedication
˚
Status epilepticus
• Off-Label Indications
˚ Rapid tranquilization of the combative/agitated patient
˚ Alcohol withdrawal delirium/syndrome
˚ Seizures
˚ Induce sedation and amnesia (Midazolam is the primary medication)
Contraindications
• Hypersensitivity to Lorazepam or any component of the formulation or other benzodiazepines
• Acute narrow-angle glaucoma, Acute Alcohol Intoxication, sleep apnea
• Respiratory Insufficiency/Depression (except during mechanical ventilation)
˚ Overdose Reversal: FLUMAZENIL can be used; however, it carries an elevated risk.
Respiratory support until the medication is metabolized is traditionally the best care for a
benzodiazepine overdose
• Neurologic Depression (Head Trauma) (unless having an active seizure)
Adverse Reactions/Precautions
• No analgesic properties (narcotic pain control is needed for RSI/intubated trauma patients)
• May cause respiratory depression: do not give without a stable IV line and BVM (airway
control) ready.
• Hypotension, vasodilation
• Amnesia, confusion, drowsiness, slurred speech (paradoxical reactions possible: aggressiveness,
agitation, anxiety, inappropriate behavior)
Dose/Administration
PEDIATRIC
ADULT
(Always reference Broselow Tape)
Acute Seizures Acute Seizures/Status Epilepticus
Note: Not recommended IM for seizure due to • IV/IO
erratic absorption ˚ 0.1mg/kg slow push. May repeat ×1 dose in
• IV 5–10min (max dose: 4mg/dose)
˚ 4mg q5min Agitation
Anxiety • IV/IM
• IV ˚ 0.02–0.1mg/kg q4–8hr prn (max dose:
˚ 0.5–2mg slow IVP 2mg/dose)
Rapid Tranquilization of Agitated/Combative
Patient
• IV/IM
˚ 2–4mg q30–60min; may be used alone
or administered with an antipsychotic
(i.e., haloperidol)

2026 Standard Medical Operating Guidelines (SMOG) • 135