Lorazepam dosage
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Lorazepam Dosage: Insights from Recent Research
Intravenous Lorazepam Dosage and Effects
Low and High Dose Comparison
A study involving six healthy volunteers compared the effects of low-dose (0.0225 mg/kg) and high-dose (0.045 mg/kg) intravenous lorazepam. Both doses showed similar distribution volumes and elimination half-lives, but the higher dose had a slightly reduced clearance rate . The onset of EEG effects was slow, peaking 30 minutes post-infusion, with prolonged action lasting up to 8 hours for the higher dose .
Comparison with Diazepam
In a companion study, the EEG effects of diazepam (0.15 mg/kg) were shorter and more immediate compared to lorazepam, likely due to faster plasma concentration decline . This suggests that lorazepam's slower brain entry contributes to its delayed onset of action .
Continuous Infusion for Sedation in Critically Ill Patients
Efficacy and Safety
A randomized study compared continuous infusions of lorazepam, midazolam, and propofol in critically ill trauma/surgery patients. Initial boluses and infusion rates were lorazepam 0.05 mg/kg followed by 0.007 mg/kg/hr, midazolam 0.05 mg/kg followed by 0.003 mg/kg/hr, and propofol 0.25 mg/kg followed by 0.06 mg/kg/hr 23. Maintenance doses achieved desired sedation levels 68% of the time for lorazepam, with oversedation occurring in 14% of assessments 23.
Cost-Effectiveness
Lorazepam was found to be the most cost-effective sedative, with sedation costs per patient day significantly lower than midazolam and propofol 23. However, oversedation was more frequent with lorazepam, indicating a need for careful monitoring 23.
Oral Lorazepam for Anxiety Treatment
Dosage and Efficacy
In a four-week double-blind study, lorazepam administered at an average daily dose of 3.1 mg (b.i.d.) was significantly more effective than placebo in treating neurotic anxiety 46. Patients showed greater improvement on various anxiety scales without significant changes in vital signs or laboratory values 46.
Comparison with Other Benzodiazepines
A study comparing single oral doses of lorazepam (2 mg), alprazolam (1 mg), and prazepam (20 mg) found that lorazepam had a slower onset but longer duration of sedative effects compared to alprazolam . Both lorazepam and alprazolam significantly impaired memory recall 24 hours post-dosage .
Lorazepam in Special Populations
Cardiovascular Patients
Lorazepam (3 mg/day) was effective in reducing anxiety in patients with cardiovascular symptoms, showing significant improvement over placebo in a four-week study . Adverse reactions were minimal and transient .
Preoperative Sedation
In a study of patients undergoing surgery, lorazepam (3 mg) provided effective premedication with better anterograde amnesia compared to heptabarbitone and diazepam, with fewer preoperative side effects .
Conclusion
Lorazepam is a versatile benzodiazepine with applications ranging from anxiety treatment to sedation in critically ill patients. Its dosage and administration need careful consideration to balance efficacy and safety. While it is cost-effective for sedation, the risk of oversedation requires vigilant monitoring. For anxiety, lorazepam shows significant benefits over placebo and other benzodiazepines, with manageable side effects.
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