Page 155 - 2023 SMOG Digital

LORAZEPAM D Lactation Yes (not recommended) Trade Name: Ativan
Class / Mechanism of Action
Benzodiazepine
Acts as an Anxiolytic/Hypnotic, anticonvulsant and sedative.
Onset of action: IV Sedation 2-3 minutes; IM hypnotic, 15-30 minutes. Duration: IV, 8-12 hours.
Indications
Labeled Indications: Anesthesia premedication, Status epilepticus
Unlabeled:
• Rapid tranquilization of the combative / agitated patient
• Alcohol withdrawal delirium / syndrome
• Seizures
• Induce Sedation and Amnesia (Midazolam is 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)
o Overdose Reversal: FLUMAZENIL can be used, however it carries elevated risk.
Respiratory support until the medication is metabolized is traditionally the best care in
Benzodiazepine overdose
• Neurologic Depression (Head Trauma) (unless having active seizure)
Adverse Reactions / Precautions
• No Analgesic properties (Narcotic pain control is needed for RSI’d / Intubated trauma patients)
• May Cause Respiratory depression: Do not give without stable IV line and BVM (airway control) ready
• Hypotension, vasodilation
• Amnesia, confusion, drowsiness, slurred speech (Paradoxical Reactions possible: aggressiveness,
agitation, anxiety, inappropriate behavior)
Dose and Administration: ADULT PEDIATRIC Always Reference BROSELOW Tape
Acute Seizures / Status epilepticus (unlabeled
Acute Seizures: use):
IV: IV:
• 2-4mg slow IV push, may repeat x2 q3-5min • 0.05-0.1mg/kg; repeat doses q5min (max x2)
prn. for clinical effect. Max 4mg
Note: Not recommended IM for seizure due to Agitation:
erratic absorption. • 0.05mg/kg/dose q20-30min prn

Anxiety:
IV:
• 0.5-2mg slow IV push
Rapid tranquilization of agitated / combative
patient (Off-label use):
IV, IM:
• 2-4mg q30-60min; may be used alone or
administered with an antipsychotic (i.e.
haloperidol)

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