Lorazepam Dosing for Seizures

Efficacy and Safety

Historical data from a multicenter trial showed 89% seizure control with lorazepam versus 76% with diazepam, in patients with status epilepticus, with lorazepam administered intravenously 1, 2, 3
The American Academy of Pediatrics recommends administering 0.05-0.10 mg/kg IV lorazepam (maximum 4 mg per dose) for pediatric patients with status epilepticus, which may be repeated every 10-15 minutes if seizures continue 4
The administration of lorazepam should be done over 2-3 minutes to avoid pain at the IV site, in pediatric patients with status epilepticus 4
Increased apnea risk is associated with combining lorazepam with other sedative agents, particularly in patients with compromised respiratory function 4
The American Academy of Pediatrics does not recommend rectal lorazepam, but instead suggests rectal diazepam (0.5 mg/kg up to 20 mg) as a preferred alternative when IV access is unavailable, although this is based on a guideline from Praxis Medical Insights, a less preferred source 5

Lorazepam must be followed immediately by a long-acting anticonvulsant due to rapid redistribution and potential seizure recurrence within 15-20 minutes, as recommended by the Praxis Medical Insights, although this is a less preferred source 5
Combining lorazepam with other sedatives dramatically increases apnea risk, and should be done with close monitoring of respiratory function 4