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lorazepam
Ativan · Loreev XR
Benzodiazepine⚠ Unverified beta content
At a glance
- Class
- Intermediate-acting benzodiazepine (CIV); no active metabolites; glucuronidated
- Black box
- ⚠ Concomitant use with opioids may result in profound sedation, respiratory depression, coma, and…
- ⚠ Abuse, misuse, and addiction – can lead to overdose or death.
- ⚠ Dependence and withdrawal reactions (including seizures) – abrupt discontinuation or rapid dose…
- Key monitoring
- Respiratory rate, SpO2, sedation level
- Withdrawal signs (tremor, anxiety, insomnia, tachycardia, seizure)
- Usual adult dose
- Anxiety (PO): 2–6 mg/day in divided doses
- Call provider / escalate if
- Slow, shallow breathing; very hard to wake • Confusion, severe drowsiness or agitation instead of calm (paradoxical) • Withdrawal signs: shaking, sweating, severe anxiety, hallucinations, seizure
Built-in explanation — generated offline from this app’s structured data (no AI, no network). Still unverified beta content.
What it is
- lorazepam (Ativan, Loreev XR) — intermediate-acting benzodiazepine (CIV); no active metabolites; glucuronidated.
- Used for: Anxiety disorders / short-term relief of anxiety symptoms; Preanesthetic sedation and status epilepticus.
Usual adult dosing
- Anxiety (PO): 2–6 mg/day in divided doses (Typical start 1–2 mg/day in 2–3 doses; max ~10 mg/day.)
- Insomnia (PO): 2–4 mg at bedtime
- Acute agitation (PO/IM): 0.5–2 mg per dose (facility protocols vary)
- Status epilepticus (IV): 4 mg slow IV (≤2 mg/min); may repeat once after 10–15 min
Boxed warning
- Concomitant use with opioids may result in profound sedation, respiratory depression, coma, and death.
- Abuse, misuse, and addiction – can lead to overdose or death.
- Dependence and withdrawal reactions (including seizures) – abrupt discontinuation or rapid dose reduction can be life-threatening; use gradual taper.
Monitor
- Respiratory rate, SpO2, sedation level [Before/after parenteral doses and per policy; closer with opioids/alcohol]
- Withdrawal signs (tremor, anxiety, insomnia, tachycardia, seizure) [With long-term use or dose reductions]
Nursing priorities
- Baseline RR, SpO2, BP, HR, level of consciousness / sedation score.
- Substance use (alcohol, opioids, benzodiazepines); risk for withdrawal and overdose.
- Check sedation/RR before and after IV/IM doses per policy; have flumazenil/airway support available per policy.
- IV: dilute with equal volume compatible diluent, inject slowly (≤2 mg/min) into large vein; refrigerate injectable.
- Give IM deep into large muscle.
Major interactions
- Opioids: Profound sedation, respiratory depression, coma, death (boxed warning).
- Alcohol, other CNS depressants (barbiturates, sedatives): Additive CNS/respiratory depression.
- Olanzapine IM / clozapine: Cardiorespiratory depression/collapse.
Key teaching
- This medicine can make you sleepy and unsteady. Do not drive or use machines until you know how it affects you.
- Do not drink alcohol or take opioid pain medicines or other sedatives with it unless your provider says so – this can slow your breathing dangerously.
- It can be habit-forming. Take only as prescribed; do not share it.
Optional: AI explanation
Off by default. To enable, add your own API key in Settings (stored only on this device).
Boxed warning
- Concomitant use with opioids may result in profound sedation, respiratory depression, coma, and death.
- Abuse, misuse, and addiction – can lead to overdose or death.
- Dependence and withdrawal reactions (including seizures) – abrupt discontinuation or rapid dose reduction can be life-threatening; use gradual taper.
Other serious warnings
- Respiratory depression
- Falls and cognitive impairment (Beers criteria for older adults)
- Paradoxical reactions
- Withdrawal seizures with abrupt stop
- Suicidality risk (benzodiazepines/anxiolytics)
- Neonatal sedation/withdrawal in pregnancy
- Benzyl alcohol / propylene glycol toxicity with high-dose IV
- Respiratory/cardiac effects when combined with olanzapine IM or clozapine
Sources: FDA label (DailyMed): ATIVAN (LORAZEPAM) TABLET [BAUSCH HEALTH US LLC] · FDA Drug Safety Communication (Sept 2020): boxed warning update for be
- Respiratory rate, SpO2, sedation levelWhen: Before/after parenteral doses and per policy; closer with opioids/alcohol
- Blood pressure / heart rate
- Withdrawal signs (tremor, anxiety, insomnia, tachycardia, seizure)When: With long-term use or dose reductions
- Falls / cognition
- Use pattern / misuse riskPDMP check per prescriber/facility policy
Sources: FDA label (DailyMed): ATIVAN (LORAZEPAM) TABLET [BAUSCH HEALTH US LLC] · FDA Drug Safety Communication (Sept 2020): boxed warning update for be
Assessment
- Baseline RR, SpO2, BP, HR, level of consciousness / sedation score.
- Substance use (alcohol, opioids, benzodiazepines); risk for withdrawal and overdose.
- Fall risk and age; respiratory disease, sleep apnea.
- Current meds (opioids, other sedatives).
- Hepatic/renal impairment (lorazepam is preferred in hepatic impairment).
Interventions
- Check sedation/RR before and after IV/IM doses per policy; have flumazenil/airway support available per policy.
- IV: dilute with equal volume compatible diluent, inject slowly (≤2 mg/min) into large vein; refrigerate injectable.
- Give IM deep into large muscle.
- Fall precautions; assist with ambulation.
- Avoid combining with IM olanzapine; use extreme caution with opioids and clozapine.
- Prolonged use: taper gradually; monitor for withdrawal (CIWA-B / benzodiazepine withdrawal signs).
- Document PRN effectiveness.
Sources: General nursing drug reference conventions (e.g., Davis Drug Guide / L
- Slow, shallow breathing; very hard to wake
- Confusion, severe drowsiness or agitation instead of calm (paradoxical)
- Withdrawal signs: shaking, sweating, severe anxiety, hallucinations, seizure
- Falls or injury
- Suicidal thoughts
- Combined use with opioids or alcohol
- Allergic reaction (rash, swelling)
Sources: FDA label (DailyMed): ATIVAN (LORAZEPAM) TABLET [BAUSCH HEALTH US LLC] · General nursing drug reference conventions (e.g., Davis Drug Guide / L
- Sedation, drowsiness
- Dizziness, unsteadiness, ataxia
- Weakness
- Confusion / memory impairment (anterograde amnesia)
- Paradoxical agitation (rare)
- Respiratory depression (esp. with opioids/alcohol)
Sources: FDA label (DailyMed): ATIVAN (LORAZEPAM) TABLET [BAUSCH HEALTH US LLC]
- Opioids MajorProfound sedation, respiratory depression, coma, death (boxed warning).
- Alcohol, other CNS depressants (barbiturates, sedatives) MajorAdditive CNS/respiratory depression.
- Olanzapine IM / clozapine MajorCardiorespiratory depression/collapse.
- ValproateRaises lorazepam levels (reduce lorazepam dose ~50%).
- Probenecid↑ lorazepam effect (reduce dose).
- Theophylline, caffeineReduced sedative effect.
Sources: FDA label (DailyMed): ATIVAN (LORAZEPAM) TABLET [BAUSCH HEALTH US LLC]
- This medicine can make you sleepy and unsteady. Do not drive or use machines until you know how it affects you.
- Do not drink alcohol or take opioid pain medicines or other sedatives with it unless your provider says so – this can slow your breathing dangerously.
- It can be habit-forming. Take only as prescribed; do not share it.
- Do not stop suddenly if you take it regularly – this can cause seizures. Your provider will lower the dose slowly.
- Rise slowly to avoid falls.
- Store safely, away from others.
Sources: General nursing drug reference conventions (e.g., Davis Drug Guide / L
Indications
- Anxiety disorders / short-term relief of anxiety symptoms
- Preanesthetic sedation and status epilepticus (IV)
- Common psychiatric uses (often off-label): acute agitation, catatonia, alcohol withdrawal, akathisia/dystonia adjunct, insomnia (short-term)
Dosing
- Anxiety (PO): 2–6 mg/day in divided dosesTypical start 1–2 mg/day in 2–3 doses; max ~10 mg/day.
- Insomnia (PO): 2–4 mg at bedtime
- Acute agitation (PO/IM): 0.5–2 mg per dose (facility protocols vary)
- Status epilepticus (IV): 4 mg slow IV (≤2 mg/min); may repeat once after 10–15 min
- Catatonia lorazepam challenge: 1–2 mg IV/IM/PO; reassess in ~5–30 min (off-label)
- Older / debilitated: Lower doses (e.g., 0.5–1 mg)
Sources: FDA label (DailyMed): ATIVAN (LORAZEPAM) TABLET [BAUSCH HEALTH US LLC]
Prescriber-oriented details; limited in this beta.
hepatic Adjustment
- Preferred benzodiazepine in hepatic impairment (no active metabolites).
geriatric
- Beers criteria: avoid in older adults when possible; lower doses.
discontinuation
- Taper gradually (e.g., 5–25% every 1–2 weeks, individualized).
Sources: FDA label (DailyMed): ATIVAN (LORAZEPAM) TABLET [BAUSCH HEALTH US LLC]
- Verified
- No – unverified beta
- Last reviewed
- 2026-10-29 (drafted; not clinician-reviewed)
- FDA label (DailyMed): ATIVAN (LORAZEPAM) TABLET [BAUSCH HEALTH US LLC]
- FDA Drug Safety Communication (Sept 2020): boxed warning update for benzodiazepines (abuse, misuse, addiction, dependence, withdrawal)
- General nursing drug reference conventions (e.g., Davis Drug Guide / Lexicomp nursing) - summarized from standard practice; NOT line-by-line verified