Lorazepam injection
ATIVAN INJECTION
Pronunciation: lor-A-ze-pam (AT-i-van)
“Lorax’s ATV”
hot pink → benzo theme
available PO, commonly given IM for agitation
What it isInjectable GABA-A positive modulator; status epilepticus and preanesthetic sedation.
Why this oneFor inpatient agitation it offers reliable IM absorption, no active metabolites, and conjugation-only metabolism.
What limits itRespiratory depression, especially stacked with opioids or in pulmonary disease; propylene glycol load with prolonged infusions.
FDA-approved for
- status epilepticus (~1980)
- preanesthetic sedation (~1980)
FDA label
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| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Status epilepticus | Adults ≥18 yr | 4 mg IV slow (2 mg/min) | May repeat 4 mg IV after 10–15 min if seizures persist | |
| Preanesthetic (sedation, anxiety relief, decreased recall) | Adults ≥18 yr | IM: 0.05 mg/kg (max 4 mg) ≥2 h pre-op; IV: 2 mg or 0.044 mg/kg (whichever smaller), up to 0.05 mg/kg (max 4 mg) | 4 mg |
Renal No adjustment for acute (single) dosing; not recommended in renal failure; caution with frequent doses.
Hepatic No adjustment for acute (single) dosing; not recommended in hepatic failure.
Instructions
- Dilute with an equal volume of compatible solution immediately before IV use; IV rate ≤2 mg/min
- Give undiluted deep IM
- Have airway/ventilatory equipment immediately available
- Reduce dose 50% with probenecid or valproate
Available strengths
- inj 2, 4 mg/mL
- tab 0.5, 1, 2 mg
- ER cap 1, 1.5, 2, 3 mg
- sol 2 mg/mL
Contraindications
- Acute narrow-angle glaucoma
- Sleep apnea syndrome
- Severe respiratory insufficiency (except for mechanically ventilated patients needing anxiety relief/amnesia)
- Intra-arterial administration (arteriospasm/gangrene risk)
- Premature infants (formulation contains benzyl alcohol)
Cautions
- Respiratory depression/hypoventilation
- Contains benzyl alcohol and propylene/polyethylene glycol (toxicity at high doses)
- Paradoxical reactions
- Caution in elderly/debilitated/limited pulmonary reserve
Adverse reactions
- Respiratory depression
- Hypotension
- Somnolence
- Respiratory failure
Pregnancy Late-pregnancy use can cause neonatal sedation (respiratory depression, hypotonia) and withdrawal symptoms.
Lactation Undefined.
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 2 mg/mL | inj | per unit | $2.17/mL | not offered |
| 4 mg/mL | inj | per unit | not offered |
Other forms: Lorazepam (ATIVAN)
⚠ BOXED WARNINGS
- Risk from concomitant use with opioids
- Abuse, misuse and addiction
- Dependence and withdrawal reactions
Classes and tags
Clinical profile
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