Management of Anxiety and Agitation with Lorazepam

Introduction to Lorazepam Use

The American Academy of Family Physicians recommends lorazepam for treatment of anxiety, agitation, or as an adjunct for symptom management in patients who can no longer take primidone 1, 2

For patients who can swallow, the British Medical Journal suggests starting with lorazepam 0.5-1 mg orally four times a day as needed, with a maximum of 4 mg in 24 hours 3
The British Medical Journal recommends reducing the dose to 0.25-0.5 mg in elderly or debilitated patients, with a maximum of 2 mg in 24 hours 3
For patients unable to swallow, the Annals of Oncology recommends lorazepam 1 mg subcutaneously or intravenously, up to 2 mg maximum 4

The American Academy of Family Physicians and the National Comprehensive Cancer Network recommend lorazepam for management of insomnia, anxiety, and agitation 1, 5
The National Comprehensive Cancer Network suggests that lorazepam can be particularly useful when symptoms are not adequately controlled with other medications 6
For dyspnea management, the National Comprehensive Cancer Network recommends adding lorazepam if dyspnea is not relieved by opioids and is associated with anxiety 5, 6

The American Academy of Family Physicians warns that regular use of lorazepam can lead to tolerance, addiction, depression, and cognitive impairment 1
The American Academy of Family Physicians notes that paradoxical agitation occurs in approximately 10% of patients treated with benzodiazepines 1

In elderly patients, the British Medical Journal recommends starting with lower doses of 0.25-0.5 mg 3
The Annals of Oncology notes that elderly patients have an increased risk of falls 4
The American Academy of Family Physicians warns that elderly patients have a higher risk of cognitive impairment 1
In patients with respiratory conditions, the Annals of Oncology recommends using caution in patients with severe pulmonary insufficiency 4
The Annals of Oncology suggests using lower doses in patients with COPD 4

The Annals of Oncology and the American Academy of Family Physicians recommend assessing for signs of sedation, respiratory depression, and paradoxical agitation, and evaluating the effectiveness of lorazepam in controlling target symptoms 1, 4, 5