Lorazepam Administration in Emergency Settings

Dosage and Administration

For pediatric patients with status epilepticus, the American Academy of Pediatrics recommends an IV dose of 0.1 mg/kg every 10-15 minutes (maximum 4 mg per dose) 1
For adult patients with status epilepticus, the National Comprehensive Cancer Network recommends an IV dose of 0.1-0.3 mg/kg every 5-10 minutes (maximum 10 mg per dose) 2
For pediatric patients with status epilepticus, an alternative IV dose of 0.05-0.10 mg/kg (maximum 4 mg per dose) may be used, repeated every 10-15 minutes 1
For pediatric patients with status epilepticus, an IM dose of 0.2 mg/kg (maximum 6 mg per dose) may be used when IV administration is not available, repeated every 10-15 minutes 1
For patients with severe delirium in palliative care, the National Comprehensive Cancer Network recommends an initial dose of 0.5-2 mg every 4-6 hours as an adjunct to neuroleptics 2

When converting pediatric patients from IV midazolam to lorazepam, the calculated lorazepam dose should be divided by 4 and given every 6 hours, with a weaning rate of 10-20% per day 3

The American Academy of Pediatrics recommends continuous oxygen saturation monitoring when administering lorazepam, with respiratory support immediately available 1
The use of flumazenil as a reversal agent may precipitate seizures and counteract anticonvulsant effects, according to the Pediatrics journal 4, 1
Post-seizure management should include monitoring for seizure recurrence for at least 2 hours after initial administration, and avoiding oral lorazepam administration immediately post-seizure due to aspiration risk 1