Benzodiazepine Pregnancy: Contraindicated in pregnancy unless there are compelling reasons, and when planning a pregnancy. Benzodiazepines should not be used during pregnancy, especially during the first and last trimesters, and may cause foetal damage; infants exposed chronically in later pregnancy may develop physical dependence, and neonates exposed late in pregnancy or at delivery have shown withdrawal symptoms, hypoactivity, hypotonia, hypothermia, respiratory depression, apnoea, feeding problems and impaired metabolic response to cold stress. Mothers who are breast-feeding should not take benzodiazepines — sedation and inability to suckle have occurred in neonates (§4.6).

Lorazepam (Elderly — Short-Term Use)

Brand names: Ativan

Used in: Delirium & Cognitive Impairment Seizures & Epilepsy

This page addresses short-term lorazepam use in older patients; it is a short-to-intermediate-acting benzodiazepine used briefly for severe anxiety, agitation or as an anxiolytic, where falls and confusion risks dominate.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Elderly and debilitated patients: reduce the initial dose by approximately 50% and adjust the dosage as needed and tolerated. The adult doses from which that reduction is made are: anxiety 1-4 mg daily in divided doses; insomnia 1-2 mg before retiring.

Route: Oral

Frequency: Anxiety: daily in divided doses. Insomnia: single dose before retiring.

eMC source: Lorazepam 0.5 mg tablets. No numeric maximum dose is stated for elderly patients in this SPC. Before starting, a discussion should be held with the patient to put in place a strategy for ending treatment, to minimise the risk of dependence, addiction and drug withdrawal syndrome. Treatment should be given under close medical supervision, at the lowest effective dose, for the shortest possible duration not exceeding 4 weeks, with doses individualised; extension of use should not take place without further clinical evaluation and chronic use is not recommended. (If used for epilepsy, the SPC states the medicine should be used for as long as the prescriber considers necessary.) When treatment is started the patient should be told that treatment will be of limited duration, that the dosage will be progressively decreased, and that rebound phenomena are possible; the drug should always be discontinued gradually. Other adult indication on this label: premedication before operative dentistry or general surgery — 2-3 mg the night before operation and 2-4 mg one to two hours before the procedure. Renal or hepatic impairment: lower doses may be sufficient, and patients should be monitored frequently with the dosage adjusted carefully according to response; the same precautions apply to elderly or debilitated patients and to patients with chronic respiratory insufficiency. Use in severe hepatic insufficiency is contraindicated. US labelling (DailyMed, cross-check only — verify against the UK SPC): usual range 2 to 6 mg/day in divided doses with the largest dose taken before bedtime, daily dosage varying from 1 to 10 mg/day; for elderly or debilitated patients an initial dosage of 1 to 2 mg/day in divided doses, adjusted as needed and tolerated, increasing the evening dose before the daytime doses when higher dosage is indicated.

Paediatric dose

Dose: 0.05 mg/kg

Route: Oral

Frequency: Single dose, not less than one hour before operation (premedication)

Max: 0.5-2.5 mg total, rounded to the nearest 0.5 mg according to weight

eMC §4.2 states, for children aged 5-13 years, premedication: 0.5-2.5 mg at 0.05 mg/kg to the nearest 0.5 mg according to weight, not less than one hour before operation. This is the only paediatric dose given in this SPC — no paediatric anxiety or insomnia dose is stated. Verify against a children's formulary.

Dose adjustments

Renal

Lower doses may be sufficient in patients with impaired renal or hepatic function; such patients should be monitored frequently and have their dosage adjusted carefully according to response (§4.2/§4.4). Use in severe hepatic insufficiency is contraindicated.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Paediatric weight-based calculator

Patient weight (kg)

Verify in a children's formulary

Contraindications

Hypersensitivity to benzodiazepines or to any of the other ingredients (§4.3)
Acute pulmonary insufficiency, respiratory depression, sleep apnoea (risk of further respiratory depression) (§4.3)
Severe hepatic insufficiency (may precipitate encephalopathy); myasthenia gravis (§4.3)
Obsessional states (inadequate evidence of safety and efficacy); benzodiazepines should not be used alone in depression or anxiety with depression, as this may precipitate suicide (§4.3)
Pregnancy, unless there are compelling reasons, and when planning a pregnancy (§4.3)

Side effects

Daytime drowsiness and sedation (very common)
Dizziness and ataxia (common)
Muscle weakness (common)
Asthenia and fatigue (common)
Confusion, depression and unmasking of depression, disinhibition, transient anterograde amnesia or memory impairment, hypotension, respiratory depression and apnoea (rare); paradoxical reactions such as restlessness, agitation, irritability, aggressiveness, rage, hallucinations and inappropriate behaviour occasionally reported; dependence and withdrawal symptoms (frequency not known). The incidence of sedation and unsteadiness increases with age (US labelling).

Interactions

Alcohol and other CNS depressants — tolerance is diminished; these substances should either be avoided or taken in reduced dosage (§4.4). Increased CNS-depressant effects occur with barbiturates, antipsychotics, sedatives/hypnotics, anxiolytics, antidepressants, narcotic analgesics, sedative antihistamines, anticonvulsants and anaesthetics (US labelling)
Opioids — concomitant use increases the risk of respiratory depression; limit the dosage and duration of concomitant use and monitor closely for respiratory depression and sedation (US labelling)
Valproate — increases plasma concentrations and reduces clearance of lorazepam; the lorazepam dose should be reduced to approximately 50% when co-administered (US labelling)
Clozapine — concomitant use may produce marked sedation, excessive salivation, hypotension, ataxia, delirium and respiratory arrest; probenecid may cause a more rapid onset or prolonged effect (US labelling). eMC §4.5 was not retrieved in this bundle.

Clinical monograph

How it works

It enhances the inhibitory action of GABA at the GABA-A receptor, increasing chloride conductance to produce anxiolytic, sedative and anticonvulsant effects.

Prescribing in practice

In older people benzodiazepines markedly increase the risk of sedation, confusion, cognitive impairment and falls, so use the lowest effective dose for the shortest possible time and avoid routine or prolonged use.
Tolerance and dependence develop with continued use, so plan a short course with a clear stopping strategy and gradual withdrawal if used beyond a brief period.
Additive central nervous system depression occurs with opioids, alcohol and other sedatives, raising the risk of excessive sedation and respiratory depression.

Monitoring

Monitor sedation, cognition, mobility and falls risk, and review the ongoing need at each opportunity to keep the course short.

Counselling the patient

This is intended only for short-term use to limit dependence and falls.
It can cause drowsiness and unsteadiness; take care moving about and avoid alcohol.
Do not stop abruptly after regular use, as withdrawal effects can occur.

Evidence & guidelines

Guidance on prescribing in older adults consistently identifies benzodiazepines as high-risk for falls and cognitive harm, supporting short-term use only with a planned withdrawal.

Reference: NICE NG11; STOPP/START version 3; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

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