Ativan (lorazepam)

Dosage of lorazepam must be individualized, and the smallest effective dosage should be used (especially in geriatric or debilitated patients, in those with low serum albumin, and in patients currently receiving other CNS depressants) to avoid oversedation.

The manufacturer states that a dosage adjustment is not required in patients with impaired renal function for single doses of lorazepam injection; however, caution should be exercised with administration of multiple doses of lorazepam injection over a short period of time.

Since the pharmacokinetics of parenteral lorazepam do not appear to be altered in patients with hepatic impairment, dosage adjustment is not necessary in such patients. However, because oral lorazepam may exacerbate hepatic encephalopathy, dosage of oral lorazepam should be adjusted carefully in patients with severe hepatic insufficiency and lower than recommended dosages may be sufficient in these patients.

Lorazepam is administered orally, IM, or by IV injection or IV infusion. The drug should not be administered by intra-arterial injection since arteriospasm can occur, which may cause gangrene and possibly require amputation.

No dosing information is available for this tab.

No dosing information is available for this tab.

There is no enhanced messaging for this drug.

There are no contraindication interactions for this drug.

There are no severe interactions for this drug.

There are no moderate interactions for this drug.

There is no enhanced messaging for this drug.

There are no contraindication contraindications for this drug.

There are no severe contraindications for this drug.

There are no moderate contraindications for this drug.

There is no enhanced messaging for this drug.

There are no severe adverse reactions for this drug.

There are no less severe adverse reactions for this drug.

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No enhanced messaging available.

Lorazepam may cause fetal toxicity when administered to pregnant women. An increased risk of congenital malformations associated with use of anxiolytic agents (i.e., chlordiazepoxide, diazepam, and/or meprobamate) during the first trimester of pregnancy has been suggested by several human studies. In humans, lorazepam and its glucuronide have been shown to cross the placenta (as determined from samples of umbilical cord blood). The drug has also been shown to cause various adverse fetal effects during reproduction studies in animals. Lorazepam injection should not be used during pregnancy. In addition, the manufacturer does not recommend preoperative use of the injection for obstetric procedures (e.g., cesarean section) or during labor and delivery, since safety of the injection has not been established in such procedures. Oral or injectable lorazepam should be used during pregnancy only in life-threatening situations or severe disease (e.g., status epilepticus) for which safer drugs cannot be used or are ineffective. The possibility that a woman of childbearing potential may be pregnant at the time lorazepam is initiated should be considered. When lorazepam is administered during pregnancy or if the patient becomes pregnant while receiving the drug, the patient should be advised of the potential hazard to the fetus and about the desirability of discontinuing lorazepam.

Based on animal data, repeated or prolonged use of general anesthetics and sedation drugs, including lorazepam, during the third trimester of pregnancy may result in adverse neurodevelopmental effects in the fetus. The clinical relevance of these animal findings to humans is not known; the potential risk of adverse neurodevelopmental effects should be considered and discussed with pregnant women undergoing procedures requiring general anesthetics and sedation drugs. (See Cautions: Pediatric Precautions.)

Lorazepam is distributed into milk. The potential exists that lorazepam can cause sedation or other adverse effects in nursing infants. The manufacturer of oral lorazepam states that the drug should not be administered to nursing women unless the potential benefits to the woman outweigh the possible risk to the infant. Nursing infants receiving oral lorazepam should be monitored for adverse effects (e.g., sedation, irritability). The manufacturer of lorazepam injection states that the drug should not be administered to nursing women because of possible adverse effects (e.g., sedation).

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