Management of Acute Agitation in Adults

Medication Dosage and Administration

The American Academy of Pediatrics recommends an initial intramuscular (IM) dose of lorazepam of 2 mg for acute agitation in adults, which can be repeated every 10-15 minutes as needed, with a maximum single dose of 4 mg 1
For elderly patients, consider starting with lower doses (0.5-1 mg) of lorazepam due to increased sensitivity to benzodiazepines 1
Patients with hepatic impairment should receive lower doses of lorazepam as metabolism may be impaired 1

Monitor vital signs, particularly respiratory status, after administration of lorazepam, and be prepared to provide respiratory support as benzodiazepines can cause respiratory depression 1
Assess level of sedation after administration of lorazepam and monitor oxygen saturation continuously 1

Combination therapy with an antipsychotic and benzodiazepine may be more effective than either agent alone for acute agitation in adults, according to the American College of Emergency Physicians 2
The combination of a benzodiazepine with an antipsychotic may produce more rapid sedation in severely agitated patients, as recommended by the American College of Emergency Physicians 2

Flumazenil may be administered to reverse life-threatening respiratory depression caused by lorazepam, but it will also counteract the anticonvulsant effects and may precipitate seizures in patients with a seizure history 1

Assess severity of agitation and need for immediate intervention, and attempt verbal de-escalation techniques first when possible, as recommended by the American College of Emergency Physicians 2
For severe agitation requiring rapid control, proceed with IM lorazepam 2 mg, and reassess after 10-15 minutes 1