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Lorazepam (Monograph)

Brand name: Ativan
Drug class: Benzodiazepines
VA class: CN302

Medically reviewed by Drugs.com on Oct 27, 2023. Written by ASHP.

Warning

    Concomitant Use with Opiates
  • Concomitant use of benzodiazepines and opiates may result in profound sedation, respiratory depression, coma, and death.700 701 703 705 706 707

  • Reserve concomitant use for patients in whom alternative treatment options are inadequate; use lowest effective dosages and shortest possible duration of concomitant therapy and monitor closely for respiratory depression and sedation.700 703 (See Specific Drugs under Interactions.)

    Potential for Abuse, Addiction, and Other Serious Risks
  • A boxed warning has been included in the prescribing information for all benzodiazepines describing risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions.900

  • Abuse and misuse can result in overdose or death, especially when benzodiazepines are combined with other medicines, such as opioid pain relievers, alcohol, or illicit drugs.900

  • Assess a patient’s risk of abuse, misuse, and addiction.900 Standardized screening tools are available ([Web]).900

  • To reduce risk of acute withdrawal reactions, use a gradual dose taper when reducing dosage or discontinuing benzodiazepines.900 Take precautions when benzodiazepines are used in combination with opioid medications.900

Introduction

Benzodiazepine; anticonvulsant, anxiolytic, and sedative.283 435 a b

Uses for Lorazepam

Anxiety Disorders

Management of anxiety disorders and short-term relief of anxiety or anxiety associated with depressive symptoms.283 547

Preoperative Sedation, Anxiolysis, and Amnesia

Used preoperatively to produce sedation, anxiolysis, and anterograde amnesia.435

Particularly useful when relief of anxiety and diminished recall of events associated with the surgical procedure are desired.435

Status Epilepticus

Treatment of status epilepticus.435 543 545 546

Benzodiazepines are considered initial drugs of choice for management of status epilepticus because of their rapid onset of action, demonstrated efficacy, safety, and tolerability.545 563 756 757 758 759 761 762 763 764 765 766 767 771 Evidence supports use of IV lorazepam, IV diazepam, or IM midazolam.545 763 764 765 766 767 768 769 Individualize choice of therapy based on local availability, route of administration, pharmacokinetics, cost, and other factors (e.g., treatment setting).545 756 757 758 759 760 761 762 763 764 765 766 767 769

Sedation in Critical Care Settings

Has been used for sedation of intubated and mechanically ventilated patients in critical care settings [off-label] (e.g., ICU).565 800 801 819

Nonbenzodiazepine sedatives (dexmedetomidine or propofol) are generally preferred to benzodiazepines in mechanically ventilated, critically ill adults because of some modest clinical benefits that have been demonstrated (e.g., reduced duration of mechanical ventilation, shorter time to extubation, reduced risk of delirium).800 801 817 818 819 820

When selecting an appropriate sedative agent, consider patient's individual sedation goals in addition to specific drug-related (e.g., pharmacology, pharmacokinetics, adverse effects, availability, cost) and patient-related (e.g., comorbid conditions such as anxiety, seizures, or alcohol or benzodiazepine withdrawal) factors.800 801

Schizophrenia

Benzodiazepines have been used for augmentation of antipsychotic therapy or adjunctive therapy in patients with schizophrenia [off-label].529

The American Psychiatric Association (APA) suggests that a benzodiazepine may be used for the treatment of akathisia associated with antipsychotic therapy; however, potential benefits of benzodiazepine therapy should be weighed against potential adverse effects.529

Benzodiazepines (e.g., lorazepam) also have been used for augmentation treatment of catatonia.529

Cancer Chemotherapy-induced Nausea and Vomiting

Has been used in the management of nausea and vomiting [off-label] associated with emetogenic cancer chemotherapy.492 493 494 495 496 497 498 499 500 501 502 503 504

The American Society of Clinical Oncology (ASCO) guidelines on antiemetic therapy state that lorazepam is a useful adjunct to antiemetic drugs, but is not recommended as a single-agent antiemetic.630

Delirium

Has been used in the management of delirium [off-label].533 535 536 537

Although there is little evidence to support use of benzodiazepines alone for general cases of delirium, these drugs may be useful for certain types of delirium (e.g., delirium related to alcohol or benzodiazepine withdrawal).533

Drug-induced Cardiovascular Emergencies

Adjunct in the management of certain drug-induced cardiovascular emergencies [off-label].696 May be beneficial adjunctively in patients with cocaine-induced acute coronary syndrome.696

Lorazepam Dosage and Administration

General

Administration

Administer orally, IM, or by IV injection or IV infusion.283 435 547 a Avoid intra-arterial injection (arteriospasm may cause gangrene, possibly requiring amputation).435

Oral Administration

Mix oral concentrate solution with a liquid (e.g., water, juice, carbonated or soda-like beverage) or semi-solid food (e.g., applesauce, pudding).547 Use the calibrated dropper provided by manufacturer.547 Stir liquid or food mixture gently for a few seconds and then consume immediately; do not store mixture for future use.547

IM Administration

Administer undiluted and inject deep into the muscle mass.435 IM administration usually not recommended in the treatment of status epilepticus, but may be used if IV access not available.435

IV Administration

For solution and drug compatibility information, see Compatibility under Stability.

Administer by direct IV injection or into tubing of an existing IV infusion.435 a

Equipment necessary to maintain a patent airway and to support respiration and ventilation should be immediately available prior to IV administration.435 Monitor vital signs during IV infusion of the drug.435

IV injection:For administration as a direct IV injection, dilute commercially available injection with an equal volume of compatible diluent (e.g., sterile water for injection, 0.9% sodium chloride injection, or 5% dextrose injection).435 Following dilution, mix solution thoroughly by gently inverting container repeatedly until a homogenous solution is obtained; do not shake vigorously.435 Administer IV injection slowly at a rate not exceeding 2 mg/minute.435 Direct IV injection should be made with repeated aspiration to ensure that none of the drug is injected intra-arterially and that perivascular extravasation does not occur.435 If pain occurs during injection, immediately stop administration and determine whether intra-arterial injection or extravasation has occurred.435

IV infusion: A standard concentration of 1 mg/mL has been recommended (see Standardize 4 Safety section below).250

Standardize 4 Safety

Standardize 4 safety (S4S) is a national patient safety initiative to standardize drug concentrations to reduce medication errors, especially during transitions of care. Multidisciplinary expert panels were convened to determine recommended standard concentrations. Because recommendations from the S4S panels may differ from the manufacturer’s prescribing information, caution is advised when using concentrations that differ from labeling, particularly when using rate information from the label. For additional information on S4S (including updates that may be available), see [Web].250

Table 1: Standardize 4 Safety Standards for Lorazepam Continuous IV Infusions250

Patient Population

Concentration Standard

Dosing Units

Adults

1 mg/mL

mg/hour

Dosage

Pediatric Patients

Status Epilepticus†
IV

Doses of 0.05–0.1 mg/kg have been used.543 546

Sedation in Critical Care Settings†
IV

Children ≥2 months of age: Some clinicians have suggested intermittent IV infusions of 0.025–0.05 mg/kg (up to 2 mg as initial dose) every 2–4 hours.565 Alternatively, a continuous IV infusion at a rate of 0.025 mg/kg per hour (up to 2 mg/hour) has been given with supplemental injections as needed to provide the desired level of sedation.565 Reduce initial dose by 50% in children <2 months of age because of wide interpatient variations in dosage requirements and low hepatic metabolic function.565

Adults

Anxiety
Oral

Initially, 2–3 mg daily divided in 2 or 3 doses.283 547 Maintenance dosage of 1–10 mg daily (usually 2–6 mg) in divided doses, with the largest dose administered at bedtime.283 547 Increase dosage gradually if higher dosage is indicated; increase the evening dose before the daytime doses.a

For insomnia caused by anxiety or transient situational stress, 2–4 mg as a single daily dose, usually at bedtime.283 547

Preoperative Sedation, Anxiolysis, and Amnesia
IM

0.05 mg/kg (up to 4 mg) at least 2 hours prior to surgery.435

IV

Initially, 0.044 mg/kg (or total of 2 mg, whichever is smaller) 15–20 minutes prior to surgery; do not routinely exceed this dosage in patients >50 years of age.435 For amnestic effects, doses up to 0.05 mg/kg (maximum 4 mg) may be administered.435

Status Epilepticus
IV

Initially, 4 mg.435 If seizures continue or recur after a 10- to 15-minute observation period, administer an additional 4-mg dose.435 Manufacturer states that experience with administration of additional doses is limited.435

Sedation in Critical Care Settings†
IV

Some experts recommend loading dose of 0.02–0.04 mg/kg (up to 2 mg), followed by intermittent injections of 0.02–0.06 mg/kg every 2–6 hours as needed or a continuous IV infusion at a rate of 0.01–0.1 mg/kg per hour (not to exceed 10 mg/hour).801

Cancer Chemotherapy-induced Nausea and Vomiting†
Oral

2.5 mg the evening before and just after initiation of chemotherapy.496

IV

1.5 mg/m2 (up to 3 mg) over 5 minutes, given 45 minutes before administration of chemotherapy.a

Delirium†
IV

0.5–1 mg, immediately following 3 mg of haloperidol.533

Prescribing Limits

Adults

Preoperative Sedation, Anxiolysis, and Amnesia
IM

Manufacturer recommends maximum dose of 4 mg.435

IV

Manufacturer states initial dose of up to 2 mg usually administered for sedation and relief of anxiety.435 Doses up to 4 mg may be administered for amnestic effects.435

Status Epilepticus
IV

Manufacturer states experience with doses beyond the usual (4 mg initially, followed by an additional 4-mg dose 10–15 minutes later if seizures continue or recur) very limited.435

Sedation in Critical Care Settings†
IV

Some experts recommend that IV loading doses not exceed 2 mg.801

If a continuous IV infusion is used, some experts recommend that the infusion be administered no faster than 10 mg/hour.801

Special Populations

Hepatic Impairment

Dosage adjustments not required for parenteral administration.435

Adjust oral dosage carefully in patients with severe hepatic insufficiency because oral therapy may exacerbate hepatic encephalopathy; lower than recommended dosages may be sufficient in these patients.283

Renal Impairment

Dosage adjustment not required for single doses of lorazepam injection; however, exercise caution with administration of multiple doses over a short period of time.435

Geriatric Patients

Cautious dosage selection recommended because of greater sensitivity and possible age-related decreases in hepatic or renal function; initiate therapy at the lower end of the usual range.283 435

Anxiety Disorders

Oral: Initially, 1–2 mg daily divided in 2 or 3 doses.a

Preoperative Sedation, Anxiolysis, and Amnesia

Patients >50 years of age generally should not receive initial IV dose >2 mg.435 Excessive and prolonged sedation may occur.435

Cautions for Lorazepam

Contraindications

Warnings/Precautions

Warnings

Concomitant Use with Opiates

Concomitant use of benzodiazepines, including lorazepam, and opiates may result in profound sedation, respiratory depression, coma, and death.700 701 703 705 706 707 (See Boxed Warning.) Substantial proportion of fatal opiate overdoses involve concurrent benzodiazepine use.700 701 705 706 707 711

Reserve concomitant use of lorazepam and opiates for patients in whom alternative treatment options are inadequate.700 703 (See Specific Drugs under Interactions.)

Respiratory and Cardiovascular Effects

Use oral lorazepam with caution in patients with compromised respiratory function (e.g., COPD, sleep apnea).283 547 b

Possible apnea, hypotension, bradycardia, or cardiac arrest with parenteral administration, particularly in geriatric or severely ill patients, in patients with limited pulmonary reserve or unstable cardiovascular status, or if the drug is administered IV too rapidly.b 566 567

Concomitant use of other CNS depressants may increase the risk of apnea.a

Administer IV only in settings in which continuous monitoring of respiratory and cardiac function (i.e., pulse oximetry) is possible.435 Monitoring of vital signs should continue during recovery period.435 566 567

Facilities, age- and size-appropriate equipment for bag/mask/valve ventilation and intubation, drugs, and skilled personnel necessary for ventilation and intubation, administration of oxygen, assisted or controlled respiration, airway management, and cardiovascular support should be immediately available when lorazepam is administered IV.435 566 567

Status Epilepticus

Should be used for the treatment of status epilepticus only by clinicians experienced in the comprehensive management of the disease.435

Careful monitoring of respiratory rate and maintenance of an adequate, patent airway is required; ventilatory support may be necessary.435

Because of the prolonged duration of action, sedative effects of lorazepam (especially after multiple doses) may increase impairment of consciousness observed in the postictal state.435

CNS Effects

Performance of activities requiring mental alertness and physical coordination (operating machinery, driving a motor vehicle) may be impaired.a b Impairment may persist for 24–48 hours following parenteral administration.435 a Premature ambulation may result in falls.435

Concurrent use of other CNS depressants may cause additive or potentiated CNS depression.283 547 a b (See Concomitant Use with Opiates under Cautions and also see Specific Drugs under Interactions.)

May interfere with assessment of level of anesthesia when administered IV prior to regional or local anesthesia, especially when given at doses >0.05 mg/kg or when opiate agonists or partial agonists are used concomitantly with recommended lorazepam doses.435 a

Psychiatric Indications

Do not use in patients with primary depressive disorder or psychosis.283 547 a

Abuse Potential

Possible tolerance, psychologic dependence, and physical dependence following prolonged administration.283 b

Patients with a history of drug or alcohol dependence or abuse are at risk of habituation or dependence; use only with careful surveillance in such patients.283 547 b

Withdrawal

Symptoms of withdrawal (similar to barbiturates or alcohol) may occur if discontinued abruptly.283 547 a Avoid abrupt discontinuance; gradually taper dosage following extended therapy.283 547 a

Endoscopic Procedures

Insufficient data to support use for outpatient endoscopic procedures; when used for inpatient endoscopic procedures, adequate recovery room observation time required.435

General Precautions

Suicide

Possibility of suicide in depressed patients; do not use in such patients without adequate antidepressant therapy.283 547 b

Paradoxical Reactions

Paradoxical reactions (e.g., anxiety, excitation, hostility, aggression, rage, sleep disturbances/insomnia, sexual arousal, hallucinations) may occur, particularly in children and geriatric patients.283 547 b Discontinue drug if such reactions occur.283 547 b

Propylene Glycol or Polyethylene Glycol Toxicity

Possible adverse effects associated with propylene glycol (e.g., lactic acidosis, hyperosmolality, hypotension) or polyethylene glycol (e.g., acute tubular necrosis) in patients receiving higher than recommended parenteral dosages.435 More likely to occur in patients with renal impairment.435

Specific Populations

Pregnancy

Category D.435

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.750 753 (See Pediatric Use under Cautions and also see Advice to Patients.)

Lactation

Distributed into milk.435

Administer orally to nursing women only if the potential benefits to the woman outweigh the possible risk to the infant.283 Monitor nursing infants for adverse effects (e.g., sedation, irritability).283

Do not administer lorazepam injection to nursing women because of possible adverse effects to the infant (e.g., sedation).435

Pediatric Use

Safety and efficacy of tablets and oral concentrate solution not established in children <12 years of age.283

Safety of the injection for treatment of status epilepticus or efficacy for preoperative sedation not established in children <18 years of age.435

Paradoxical excitation (e.g., tremors, agitation, euphoria, logorrhea, brief episodes of visual hallucinations) reported in 10–30% of children <8 years of age.435

Seizures and myoclonus reported in pediatric patients, especially low birth weight neonates, receiving lorazepam injection.435 Brief tonic-clonic seizures reported in children receiving lorazepam for the management of atypical petit mal status epilepticus.435

Repeated or prolonged use of general anesthetics and sedation drugs, including lorazepam, in children <3 years of age or during the third trimester of pregnancy may adversely affect neurodevelopment.750 753 In animals, use for >3 hours of anesthetic and sedation drugs that block N-methyl-d-aspartic acid (NMDA) receptors and/or potentiate GABA activity leads to widespread neuronal apoptosis in the brain and long-term deficits in cognition and behavior;750 751 752 753 clinical relevance to humans is unknown.750 Some evidence suggests similar deficits may occur in children following repeated or prolonged exposure to anesthesia early in life.750 752 Some evidence also indicates that a single, relatively brief exposure to general anesthesia in generally healthy children is unlikely to cause clinically detectable deficits in global cognitive function or serious behavioral disorders.750 751 752 Most studies to date have substantial limitations; further research needed to fully characterize effects, particularly for prolonged or repeated exposures and in more vulnerable populations (e.g., less healthy children).750 Consider benefits and potential risks when determining the timing of elective procedures requiring anesthesia.750 FDA states that medically necessary procedures should not be delayed or avoided.750 753 (See Advice to Patients.)

Some pediatric patients (premature and low-birth weight infants or those receiving high doses of lorazepam injection) may be susceptible to adverse effects associated with benzyl alcohol, polyethylene glycol, and propylene glycol.435 Large amounts of benzyl alcohol (i.e., 100–400 mg/kg daily) have been associated with toxicity in neonates.435 584 585 586 587 588 589 590 (See Propylene Glycol or Polyethylene Glycol Toxicity under Cautions.)

Geriatric Use

Insufficient experience in patients ≥65 years of age to determine whether geriatric patients respond differently than younger adults.283 435 Possibility of greater sensitivity to the drug (e.g., respiratory or CNS depression. sedation) in some geriatric individuals.435

Select initial dosages at the lower end of the usual range because of potential for greater sensitivity and age-related decreases in hepatic or renal function.283 435 (See Geriatric Patients under Dosage and Administration.)

May cause excessive sedation for 6–8 hours or longer after surgery in this population.435

Possible paradoxical excitation (e.g., anxiety, excitation, hostility, aggression, rage, sleep disturbances/insomnia, sexual arousal, hallucinations).b 283

Hepatic Impairment

Lorazepam injection is not recommended for use in patients with hepatic failure; use with caution in patients with mild to moderate hepatic disease.435 (See Hepatic Impairment under Dosage and Administration.)

Oral lorazepam may exacerbate hepatic encephalopathy; therefore, use with caution in patients with severe hepatic insufficiency and/or encephalopathy.283

Renal Impairment

Lorazepam injection is not recommended for use in patients with renal failure; use with caution in patients with mild to moderate renal disease.435 (See Renal Impairment under Dosage and Administration.)

Common Adverse Effects

With oral therapy, sedation, dizziness, weakness, unsteadiness.283

With parenteral therapy for the management of status epilepticus, hypotension, somnolence, respiratory failure; with parenteral therapy for preoperative use, excessive sleepiness, drowsiness.435

With IM injections, local effects (e.g., pain, sensation of burning, redness) observed at the injection site.435

Drug Interactions

Specific Drugs

Drug

Interaction

Comments

Cimetidine

No effect on lorazepam pharmacokinetics435

No dosage adjustment of lorazepam required435

Clozapine

Marked sedation, excessive salivation, ataxia, hypotension, delirium, respiratory arrest, and, rarely, death reported283 435

Use concomitantly with caution435

CNS depressants (e.g., barbiturates, sedatives, anticonvulsants, alcohol)

Additive CNS effects283 435

Use concomitantly with caution283 435

Avoid alcohol use700

Contraceptives, oral

Increased clearance of parenteral lorazepam observed435

Dosage of parenteral lorazepam may need to be increased 435

Disulfiram

No effect on lorazepam pharmacokinetics435

Haloperidol

Apnea, coma, bradycardia, arrhythmia, cardiac arrest, and death reported435

Use concomitantly with caution435

Loxapine

Respiratory depression, stupor, and/or hypotension reported rarely435

Use concomitantly with caution435

Metoprolol

No effect on lorazepam pharmacokinetics 435

No dosage adjustment of lorazepam required435

Metronidazole

No effect on lorazepam pharmacokinetics435

No dosage adjustment of lorazepam required435

Opiate agonists and partial agonists

Risk of profound sedation, respiratory depression, coma, or death700 701 703 705 706 707

Whenever possible, avoid concomitant use708 709 710 711

Opiate analgesics: Use concomitantly only if alternative treatment options are inadequate; use lowest effective dosages and shortest possible duration of concomitant therapy; monitor closely for respiratory depression and sedation700 703

In patients receiving lorazepam, initiate opiate analgesic, if required, at reduced dosage and titrate based on clinical response700

In patients receiving an opiate analgesic, initiate lorazepam, if required for any indication other than epilepsy, at lower dosage than indicated in the absence of opiate therapy and titrate based on clinical response700

Opiate antitussives: Avoid concomitant use700 704

Consider offering naloxone to patients receiving benzodiazepines and opiates concomitantly709 712

Probenecid

Decreased clearance and increased half-life of lorazepam, possibly due to inhibition of glucuronidation283 435

Reduce lorazepam dosage by 50%283 435

Propranolol

No effect on lorazepam pharmacokinetics435

No dosage adjustment of lorazepam required435

Ranitidine

No effect on lorazepam pharmacokinetics435

No dosage adjustment of lorazepam required435

Scopolamine

Possible increased sedation, hallucinations, and irrational behavior435

Use concomitantly with caution435

Theophylline

Possible decreased sedative effects of lorazepam283

Valproate

Decreased clearance and increased plasma concentration of lorazepam, possibly due to inhibition of glucuronidation283

Reduce lorazepam dosage by 50%283

Lorazepam Pharmacokinetics

Absorption

Bioavailability

Readily absorbed following oral administration; absolute bioavailability is 90%.283

Completely and rapidly absorbed following IM administration.435

Peak plasma concentrations are attained in approximately 2 hours following oral administration283 and within 3 hours following IM administration.435

Onset

After IV administration, the onset of anticonvulsant, anxiolytic, or sedative action occurs in 1–5 minutes.b

After IM administration, the onset of action is 15–30 minutes.b

Duration

After IV or IM administration, the duration of anticonvulsant, anxiolytic, or sedative action is 12–24 hours.b

Distribution

Extent

Widely distributed into body tissues; crosses the blood-brain barrier.435 b

Crosses the placenta and is distributed into milk.435 b

Plasma Protein Binding

Approximately 85–91%.283 435 b

Elimination

Metabolism

Extensively metabolized in the liver to inactive metabolites.283 435

Elimination Route

Excreted principally in urine as metabolites.283 435

Half-life

10–20 hours.283 435 b

Special Populations

In neonates, clearance reduced by 80% compared with healthy adults.435

In geriatric patients or patients with hepatic cirrhosis, clearance not substantially altered.435 b

In patients with renal impairment, clearance of lorazepam glucuronide is reduced, but total clearance of lorazepam is not altered following single IV dose.435

Stability

Storage

Oral

Tablets

Tight containers at 25°C (may be exposed to 15–30°C).283

Oral Concentrate Solution

2–8°C; protect from light.547

Parenteral

Injection

2–8°C; protect from light.435

Compatibility

Parenteral

Solution CompatibilityHID

Variable

Dextrose 5% in water

Ringer’s injection, lactated

Sodium chloride 0.9%

Drug Compatibility
Admixture CompatibilityHID

Compatible

Levetiracetam

Incompatible

Dexamethasone sodium phosphate with diphenhydramine HCl

Y-Site CompatibilityHID

Compatible

Acetaminophen

Acyclovir sodium

Albumin human

Allopurinol sodium

Amifostine

Amikacin sulfate

Amiodarone HCl

Anakinra

Atracurium besylate

Bivalirudin

Bumetanide

Cangrelor tetrasodium

Caspofungin acetate

Cefotaxime sodium

Ceftaroline fosamil

Ceftolozane sulfate-tazobactam sodium

Ciprofloxacin

Cisatracurium besylate

Cladribine

Clonidine HCl

Co-trimoxazole

Dexamethasone sodium phosphate

Dexmedetomidine HCl

Diltiazem HCl

Dobutamine HCl

Docetaxel

Dopamine HCl

Doripenem

Doxorubicin HCl liposome injection

Epinephrine HCl

Erythromycin lactobionate

Etomidate

Etoposide phosphate

Famotidine

Fenoldopam mesylate

Fentanyl citrate

Filgrastim

Fluconazole

Fludarabine phosphate

Fosphenytoin sodium

Furosemide

Gemcitabine HCl

Gentamicin sulfate

Granisetron HCl

Haloperidol lactate

Heparin sodium

Hetastarch in lactated electrolyte injection (Hextend)

Hydrocortisone sodium succinate

Hydromorphone HCl

Isavuconazonium sulfate

Labetalol HCl

Levofloxacin

Linezolid

Melphalan HCl

Meropenem-vaborbactam

Methadone HCl

Metronidazole

Micafungin sodium

Midazolam HCl

Milrinone lactate

Morphine sulfate

Nicardipine HCl

Nitroglycerin

Norepinephrine bitartrate

Oritavancin diphosphate

Oxaliplatin

Paclitaxel

Palonosetron HCl

Pancuronium bromide

Pemetrexed disodium

Piperacillin sodium–tazobactam sodium

Plazomicin sulfate

Posaconazole

Potassium chloride

Propofol

Ranitidine HCl

Remifentanil HCl

Tacrolimus

Tedizolid phosphate

Teniposide

Thiotepa

Vancomycin HCl

Vecuronium bromide

Vinorelbine tartrate

Zidovudine

Incompatible

Aldesleukin

Aztreonam

Gallium nitrate

Idarubicin HCl

Imipenem–cilastatin sodium

Letermovir

Omeprazole sodium

Ondansetron HCl

Sargramostim

Variable

Foscarnet sodium

Actions

Advice to Patients

Additional Information

The American Society of Health-System Pharmacists, Inc. represents that the information provided in the accompanying monograph was formulated with a reasonable standard of care, and in conformity with professional standards in the field. Readers are advised that decisions regarding use of drugs are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and that the information contained in the monograph is provided for informational purposes only. The manufacturer’s labeling should be consulted for more detailed information. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug. The information contained in the monograph is not a substitute for medical care.

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

Lorazepam is subject to control under the Federal Controlled Substances Act of 1970 as a schedule IV (C-IV) drug.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

LORazepam

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

For solution, concentrate

2 mg/mL*

LORazepam Solution Concentrate (C-IV)

Tablets

0.5 mg*

Ativan (C-IV)

Valeant

LORazepam Tablets (C-IV)

1 mg*

Ativan (C-IV; scored)

Valeant

LORazepam Tablets (C-IV)

2 mg*

Ativan (C-IV; scored)

Valeant

LORazepam Tablets (C-IV)

Parenteral

Injection

2 mg/mL*

Ativan (C-IV)

West-Ward

LORazepam Injection (C-IV)

4 mg/mL*

Ativan (C-IV)

West-Ward

LORazepam Injection (C-IV)

AHFS DI Essentials™. © Copyright 2024, Selected Revisions October 27, 2023. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.

† Off-label: Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

250. ASHP. Standardize 4 Safety: adult continuous infusion standards. Updated 2023 Sep. From ASHP website. Updates may be available at ASHP website. https://www.ashp.org/standardize4safety

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363. Sieghart W. Benzodiazepine receptor subtypes and their possible clinical significance. Psychopharmacol Ser. 1989; 7:131-7. http://www.ncbi.nlm.nih.gov/pubmed/2574448?dopt=AbstractPlus

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