| Name: |
LORAZEPAM (AtivanR) |
| Classification: |
Anxiolytic agent; sedative; anticonvulsant
- used in the initial control of seizures or in the treatment of status epilepticus
- has no long-term anticonvulsant activity
- useful in the management of alcohol withdrawal and delirium tremens
- muscle relaxant - useful in patient with tetanus
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| Dose: |
- Bolus:
- 0.044 mg/kg IV direct (up to 2 mg) q 1-8h; titrate to individual need
- Generally sufficient for adequate sedation in most patients; this dose should not be exceeded in patients older than 50 years
- Infusion:
- initiate at 1-3 mg/hr and adjust according to effect and target VAMAAS (tolerance may occur)
- Anticonvulsant:
- 0.05 mg/kg IV (up to 7 mg) which can be repeated in 5 min
- Alcohol Withdrawal
- 1 - 4 mg IV, Q 5 minutes to Q 6 hours
|
| Administration: |
IV Direct:
- Dilute with equal volume of IV solution and inject at a rate not greater than 2 mg/min
IV Infusion:
- 4 mg/mL undiluted in syringe or in viaflex bag
- Intermittent administration preferred over continuous infusion due to poor stability and adherence of lorazepam to PVC bags and tubing
- Ampoules must be refrigerated and protected from light for long term storage
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| Contraindications: |
Respiratory depression and partial airway obstruction, especially when combined with narcotics or in patients with hypercarbic respiratory disease |
| Adverse Effects: |
- Respiratory depression
- Hypotension
- Paradoxical reactions (irritability, excitability); may make depression or psychosis worse
- May increase risk for delirium
- Amnesia, lack of recall
- Pain and redness at the injection site
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| Antidote: |
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| Drug Interactions: |
- lorazepam + other CNS depressants = increased sedation
- lorazepam + scopolamine = increased sedation, hallucinations
|
| Monitoring Therapy: |
- Respiratory rate
- Oxygen Saturation
- Blood pressure
- Response to sedation
- Delirium screening
|
| Adult Critical Care Protocol: |
- May be administered IV direct or by IV infusion by a nurse in Adult Critical Care
- May be titrated by a nurse in Adult Critical Care.
- Continuous infusions must be administered by infusion device and the pump library must be enabled.
- Order written to provide sedation during mechanical ventilation should be discontinued when patient is no longer receiving mechanical ventilation support.
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