Lorazepam
ATIVAN
Pronunciation: lor-A-ze-pam (AT-i-van)
“Lorax’s ATV”
hot pink → benzo theme
available PO, commonly given IM for agitation
What it isGABA-A positive allosteric modulator; anxiety, status epilepticus and acute agitation or withdrawal.
Why this oneDirect glucuronidation and reliable intramuscular absorption make it unusually useful in liver disease and emergency psychiatry.
What limits itSedation, falls and dependence limit ongoing use; abrupt withdrawal can provoke seizures. Opioids add fatal respiratory risk.
FDA-approved for
- anxiety (1977)
- status epilepticus (~1980)
Off-label
- agitation
- alcohol withdrawal
- catatonia
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Anxiety | Adults | 2–3 mg/day BID–TID | 2–6 mg/day divided (range 1–10 mg/day) | 10 mg/day |
| Insomnia due to anxiety or transient stress | Adults | 2–4 mg QHS | ||
| Anxiety | Elderly / debilitated | 1–2 mg/day divided |
Renal Undefined
Hepatic Undefined
Instructions
- Individualize dose; take the largest dose at bedtime
- Increase the evening dose before daytime doses
- Taper gradually to discontinue; if withdrawal occurs, pause taper or return to prior dose, then decrease more slowly
Available strengths
- tab 0.5, 1, 2 mg
- ER cap 1, 1.5, 2, 3 mg
- sol 2 mg/mL
- inj 2, 4 mg/mL
Contraindications
- Acute narrow-angle glaucoma
Cautions
- Respiratory depression/sedation with opioids or other CNS depressants
- Abuse, misuse, and addiction
- Physical dependence and life-threatening withdrawal (taper to stop)
- Paradoxical reactions (agitation, aggression, hallucinations)
- Anterograde amnesia
Adverse reactions
- Sedation
- Dizziness
- Weakness
- Unsteadiness
- Amnesia / memory impairment
- Confusion
- Respiratory depression
Pregnancy Neonatal sedation and withdrawal with late-pregnancy use; no clear association with major birth defects
Lactation Undefined
Cost
| Strength | #/mo | generic $/mo | CostPlus | |
|---|---|---|---|---|
| 0.5 mg | tab | 60 BID | $2.07 | not offered |
| 1 mg | tab | 60 BID | $2.20 | not offered |
| 2 mg | tab | 60 BID | $4.39 | not offered |
Other forms: Lorazepam injection (ATIVAN INJECTION)
Generic entry1985
⚠ BOXED WARNINGS
- Risk from concomitant use with opioids
- Abuse, misuse and addiction
- Dependence and withdrawal reactions
Classes and tags
Clinical profile
Legacy pregnancy categoryD
Defining liabilitySedation, falls, dependence and dangerous additive respiratory depression with opioids.
Open Lorazepam in the interactive console ↗
Memory aids: interaction avatars
