Parenteral Manual

LORazepam

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
ATIVAN®
Classification: 
Anxiolytic, anticonvulsant, hypnotic, sedative, antiemetic
Original Date: 
August 2005
Revised Date: 
September 2011
Indications: 
  • Management of acute anxiety states
  • Alleviation of symptoms of acute alcohol withdrawal
  • Temporary control of prolonged severe recurrent seizures (status epilepticus)
  • Premedication for relief of anxiety before surgery (sedation and amnesia)
Reconstitution and Stability: 
  • Available as a 4 mg/mL solution
  • Refrigerate, stable for up to 60 days at room temperature
  • Protect from light
  • DO NOT administer if solution is discoloured or a precipitate forms
Compatibility: 

- Solutions Compatible: D5W, NS, ringer's lactate, Sterile Water for Injection

- Additives/Above Cassette Compatible: haloperidol, hydromorphone

- Y-site Compatible: albumin, amikacin, bumetanide, cefotaxime, ciprofloxacin, co-trimoxazole, dexamethasone, erythromycin, fentanyl, fluconazole, furosemide, gentamicin, heparin, hydrocortisone, KCl, meperidine, metronidazole, morphine, piperacillin, ranitidine, tacrolimus, tazocin, vancomycin, vecuronium, amino acids and dextrose

- Incompatible: aldesleukin, caffeine, imipenem-cilastatin, idarubicin, lipids, ondansetron

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM YES, undiluted
IV Direct YES, DO NOT administer into small veins.   Max 4 mg IV direct
Usual dilution: 2 mg/mL
Infusion time: 2-5 minutes   
Infusion rate: do not exceed 0.025 mg/kg/minute or 2 mg/minute
IV Intermittent Infusion NO
IV Continuous Infusion YES, DO NOT administer into small veins
Usual dilution: 0.2 mg/mL in D5W or NS
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Pediatric:
- Anxiety and sedation: 0.05 mg/kg/dose IV Q4-8H  (range: 0.02-0.1 mg/kg) (Max 2 mg/dose)

- Preoperative:

  • 0.05 mg/kg IM/IV (range: 0.02-0.09 mg/kg); repeat Q 20 minutes PRN
  • May use smaller doses 0.01-0.03 mg/kg IV

- Status epilepticus: 0.1 mg/kg IV, may repeat second dose of 0.05 mg/kg IV in 10-15 minutes Maximum: 4 mg/single dose

- Continuous IV infusion: 0.025 mg/kg/hr (Maximum of 2 mg/kg/hr).  Toxicity may result with continuous infusion due to the propylene glycol.

- Adjunct to antiemetic therapy:

  • Single dose: 0.04-0.08 mg/kg/dose IV prior to chemotherapy (Maximum: 4 mg)
  • Multiple doses: 0.02-0.05 mg/kg/dose IV Q 6 hours PRN (Maximum: 2 mg)

Adolescent/Adult:
- Preoperative:                        

  • 0.05 mg/kg IM 2 hours before surgery (Maximum: 4 mg/dose)
  • 0.044 mg/kg IV 15-20 minutes before surgery (Maximum: 2 mg/dose)

- Status epilepticus: 0.07 mg/kg IV (Maximum: 4 mg/dose); may repeat in 10-15 minutes

- Adjunct to antiemetic therapy: 0.5-2 mg IV Q 4-6 hours PRN

Potential hazards of parenteral administration: 
  • Thrombophlebitis, pain, risk of tissue damage at higher doses
  • Hypotension or hypertension, sedation
  • Respiratory depression, apnea
  • Hangover effect, confusion, CNS depression
  • Intra-arterial injection may result in arteriospasm and gangrene
Notes: 
  • DO NOT administer to patients in shock or coma, severe hypotension, or severe uncontrolled pain
  • Monitor respiratory rate, blood pressure, heart rate
  • Administer IV using repeated aspiration to make sure the injection is not intra-arterial and that extravasation has not occurred.
  • Use with caution in severe renal or hepatic failure
  • Additive depressant effects if given concomitantly with other psychotropic agents or CNS depressants
  • Onset: 15-30 minutes, duration: 8-12 hours

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