Lorazepam is a widely used benzodiazepine with anxiolytic, sedative, and anticonvulsant properties, commonly prescribed for anxiety disorders, insomnia, and status epilepticus. Its potential for dependence and serious side effects, such as respiratory depression, necessitates careful nursing oversight. This guide outlines lorazepam’s key details and provides practical nursing considerations to ensure patient safety and therapeutic efficacy.
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Drug Name and Classification
- Generic Name: Lorazepam
- Brand Names: Ativan, Lorazepam Intensol, Loreev XR
- Classification: Benzodiazepine, Anxiolytic, Sedative-Hypnotic, Anticonvulsant
Lorazepam enhances the activity of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter, to calm the central nervous system.
Dosage and Route
Lorazepam is available in multiple forms, allowing flexibility in administration:
Dosage Forms
- Oral Tablets: 0.5 mg, 1 mg, 2 mg
- Oral Solution: 2 mg/mL
- Injectable Solution: 2 mg/mL, 4 mg/mL
- Sublingual Tablets: 0.5 mg, 1 mg, 2 mg
Recommended Dosages
Adults
- Anxiety Disorders: 1–3 mg orally, 2–3 times daily
- Insomnia: 2–4 mg orally at bedtime
- Status Epilepticus: 4 mg IV as a single dose, repeatable after 10–15 minutes if needed
- Preoperative Sedation: 0.05 mg/kg IM (max 4 mg)
Pediatric Patients
- Weight-based; consult specific guidelines.
Administration
- Oral: With or without food.
- IV: Administer slowly (over 2–5 minutes) to prevent respiratory depression.
- IM: Inject deeply into a large muscle.
- Sublingual: Place under the tongue for rapid absorption.
Nurses must verify the dosage and route, especially in acute settings.
Therapeutic Actions
Lorazepam works by:
- Enhancing GABA activity to reduce neuronal excitability.
- Providing anxiolytic, sedative-hypnotic, and anticonvulsant effects.
These actions make it effective for anxiety, sleep disturbances, and seizures but also increase the risk of dependence.
Indications
- Anxiety Disorders: Generalized anxiety and panic disorders.
- Insomnia: Short-term sleep issues.
- Status Epilepticus: Acute seizure management.
- Preoperative Sedation: Anxiety reduction and amnesia before surgery.
- Alcohol Withdrawal: Symptom management and delirium tremens prevention.
Adverse Effects
Common
- Drowsiness, dizziness, weakness, confusion, blurred vision.
Serious
- Respiratory Depression: Especially with IV use or combined with other CNS depressants.
- Dependence/Withdrawal: Risk with prolonged use; symptoms include anxiety and seizures.
- Paradoxical Reactions: Agitation or aggression, more common in elderly or pediatric patients.
- Amnesia: Anterograde amnesia at higher doses.
Nurses should monitor closely, especially during initial therapy or dose changes.
Contraindications
- Hypersensitivity: To lorazepam or benzodiazepines.
- Severe Respiratory Insufficiency: Risk of worsening respiratory depression.
- Narrow-Angle Glaucoma: May exacerbate the condition.
- Pregnancy: Risk of congenital malformations, especially in the first trimester.
Precautions
- Elderly: Increased sensitivity; use lower doses.
- Hepatic/Renal Impairment: May need dose adjustments.
- Substance Abuse History: Higher dependence risk.
Nursing Considerations
Assessment
- Mental Status: Assess anxiety, sedation, and cognition.
- Respiratory Status: Monitor rate and depth, especially with IV use.
- Vital Signs: Check for hypotension or bradycardia.
- Substance Abuse History: Evaluate dependence risk.
Interventions
- Monitor Respiratory Depression: Keep resuscitation equipment ready.
- Fall Prevention: Use safety measures for sedated patients.
- Tapering: Gradually discontinue to avoid withdrawal.
- Avoid CNS Depressants: Prevent additive effects with alcohol or other sedatives.
Teaching Points
- Adherence: Take as prescribed; do not adjust dose independently.
- Side Effects: Report severe or persistent symptoms.
- Avoid Driving: Until effects are known.
- Dependence Risk: Do not stop abruptly; discuss with provider.
- Pregnancy/Breastfeeding: Use contraception; discuss risks.
Special Considerations
- Elderly: Start at 0.5 mg; monitor for sedation and falls.
- Pediatric: Use cautiously; watch for paradoxical reactions.
- Drug Interactions: Avoid with CNS depressants; adjust for CYP3A4 inhibitors.
Conclusion
Lorazepam is effective for anxiety, insomnia, and seizures but requires vigilant nursing management. Through thorough assessment, targeted interventions, and patient education, nurses can optimize outcomes while minimizing risks.
