Lorazepam for Psychosis: Role and Recommendations

Role in Psychosis Management

The American Academy of Pediatrics recommends lorazepam as an adjunctive treatment for psychosis with agitation at a dose of 0.05-0.15 mg/kg (maximum single dose: 5 mg) 1, 2
The Journal of the American Geriatrics Society suggests that lorazepam should not be used as a primary treatment for psychosis without agitation, as benzodiazepines are not indicated for treating the core symptoms of psychotic disorders 3
Lorazepam is specifically indicated for psychosis with agitation as noted in pediatric emergency guidelines, where it can help manage the acute agitation component 1, 2
The Journal of the American Geriatrics Society recommends that benzodiazepines like lorazepam should be employed only if behavioral interventions have failed or are not possible, and ongoing use should be evaluated daily 3

For psychosis with agitation: IM/IV dosing at 0.05-0.15 mg/kg, may repeat hourly as necessary with a maximum single dose of 5 mg 1, 2
The Journal of the American Geriatrics Society recommends that when used, lorazepam should be administered at the lowest effective dose for the shortest possible duration to minimize risks 3

The American Academy of Child and Adolescent Psychiatry recommends antipsychotic medications, not benzodiazepines, as the first-line treatment for the psychotic symptoms of schizophrenia 4
The Journal of the American Geriatrics Society suggests that in older adults with postoperative delirium, benzodiazepines should not be used as first-line treatment except when specifically indicated (e.g., alcohol or benzodiazepine withdrawal) 3