Benzodiazepine Pregnancy: D

Lorazepam (Elderly — Short-Term Use)

Brand names: Ativan

Adult dose

Dose: 0.5–1 mg once to twice daily (elderly); 1–2 mg (standard adult); IM/IV: 0.05–0.1 mg/kg for acute agitation

Route: oral, IM, IV

Frequency: once to twice daily (maximum 4 weeks oral)

Max: 4 mg/day

In elderly: start 0.5 mg; no active metabolites (preferred over diazepam in elderly); strict 2–4 week maximum for insomnia/anxiety

Dose: 0.05 mg/kg

Route: IV or IM

Frequency: single dose or repeat after 10 min

Max: 4 mg single dose

Concentration: 2 mg/mL or 4 mg/mL injection mg/ml

Status epilepticus: 0.1 mg/kg IV (max 4 mg); repeat once if no response at 10 min; dilute 1:1 with saline before IV administration

Renal

Use with caution; accumulation possible in renal failure

Hepatic

Reduce dose in severe hepatic impairment

Paediatric weight-based calculator

Patient weight (kg)

Status epilepticus: 0.1 mg/kg IV (max 4 mg); repeat once if no response at 10 min; dilute 1:1 with saline before IV administration

No hepatic metabolism to active metabolites — safer in hepatic impairment than diazepam
STOPP/START criteria and BEERS: avoid >4 weeks — risk of falls, cognitive impairment, dependence
Opioid + benzodiazepine combination: 3.86x increased risk of overdose death — FDA black box

Reference: BNFc; BNF 86; NICE NG11; STOPP/START version 3. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

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