Lorazepam (Lorazepam)
Also sold as: Ativan, Larpose, Calmore, Loram, Lorikem
Pregnancy
Cat D
Lactation
Avoid
Schedule
X
Forms
Tablets 0.5mg, 1mg, 2mg +2
Indications
- Anxiety disorders (short-term)
- Status epilepticus (IV — first-line along with diazepam)
- Pre-anaesthetic medication (IV/IM)
- Acute agitation (IV/IM — inpatient)
- Alcohol withdrawal syndrome (acute management)
- Chemotherapy-induced nausea and vomiting (IV — adjunct)
- Procedural sedation
Adult Dosing
Anxiety (oral)
0.5–2mg
Twice to three times daily; maximum 4mg/day oral
Use lowest effective dose; limit to short-term use (2–4 weeks)
Status epilepticus (IV — first-line)
4mg IV
Slow IV push over 2 minutes; may repeat once after 10–15 minutes if seizures persist
Maximum 8mg per episode. Preferred over diazepam for IV use due to no active metabolites. Monitor respiratory function — have resuscitation equipment ready.
Acute agitation (IM)
1–2mg IM
May repeat every 1–2 hours; maximum 8mg/day in acute setting
Pre-medication before procedures (IV/IM)
2–4mg
15–30 minutes before procedure
Alcohol withdrawal
1–2mg
Every 4–6 hours as needed (symptom-triggered protocol — CIWA-Ar score based)
Pediatric Dosing
Oral use in children <12 years: not established. IV lorazepam used for paediatric status epilepticus under specialist supervision. Neonatal lorazepam: use only if no alternative; benzyl alcohol content in some formulations toxic to neonates.
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| Renal impairment | Glucuronide metabolites may accumulate; use with caution in severe renal impairment. No active metabolites from lorazepam itself — preferred BZD in renal impairment (LOT mnemonic: Lorazepam, Oxazepam, Temazepam). |
Hepatic Adjustment
Preferred benzodiazepine in hepatic impairment — undergoes simple glucuronidation (not Phase I CYP450 metabolism). Start at lower doses and titrate. Avoid prolonged use even in liver disease.
Pregnancy & Lactation
Pregnancy: Category D
Category D — Fetal harm risk. Neonatal withdrawal, floppy infant syndrome when used near term. Injectable formulation contains propylene glycol and benzyl alcohol — additional neonatal risks. Avoid in pregnancy. Single acute use (e.g., status epilepticus IV) may be unavoidable and justified.
Lactation: Avoid
Excreted in breast milk. Can cause neonatal sedation and feeding difficulties. Avoid breastfeeding during regular use. After a single dose (procedural use), pumping and discarding milk for 12 hours is an option.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Opioids (morphine, fentanyl, codeine, tramadol) | FDA BLACK BOX WARNING: Profound respiratory depression, sedation, coma, death. Avoid combination. If essential, minimize doses of both drugs and monitor closely. | Major |
| Alcohol and CNS depressants | Additive CNS and respiratory depression — risk of respiratory arrest. Avoid alcohol completely. | Major |
| Clozapine | Combination of lorazepam IV + clozapine may cause cardiorespiratory collapse — severe hypotension, loss of consciousness. Avoid concurrent IV lorazepam in clozapine-treated patients. | Major |
| Valproate | Valproate displaces lorazepam from protein binding and may inhibit glucuronidation — increased lorazepam effects. Monitor sedation level. | Moderate |
| Probenecid | Inhibits glucuronidation of lorazepam — may double the half-life and increase sedation | Moderate |
DoctorScribe — AI Medical Scribe
Stop looking up Lorazepam — just speak the prescription
"Lorazepam as per dose, BD for 5 days." DoctorScribe writes the full prescription with brand, strength, frequency, and route — auto-applies pediatric weight-based dosing and renal adjustments. Try the live demo.
Side Effects
Common
- Sedation (most common)
- Dizziness and unsteadiness
- Amnesia (anterograde — may not remember procedure or event)
- Weakness and fatigue
- Confusion (especially elderly)
- Respiratory depression (dose-related)
Serious / Discontinue If
- Respiratory depression / apnoea (especially IV use and with opioid combination)
- Physical dependence and withdrawal syndrome (seizures, psychosis on abrupt discontinuation)
- Paradoxical disinhibition / aggression
- Cardiovascular depression (hypotension) with IV administration
- Thrombophlebitis at IV injection site (propylene glycol in formulation)
Contraindications
- Severe respiratory insufficiency (acute)
- Sleep apnoea syndrome
- Severe hepatic insufficiency
- Myasthenia gravis
- Hypersensitivity to lorazepam or any benzodiazepine
- Acute narrow-angle glaucoma
- Intra-arterial injection (injection formulation only)
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Ativan 1mg | Pfizer Ltd. | 10 tab ₹42 |
| Larpose 1mg | Cipla Ltd. | 10 tab ₹35 |
| Calmore 1mg | Sun Pharmaceutical Industries | 10 tab ₹28 |
| Loram 1mg | Intas Pharmaceuticals | 10 tab ₹30 |
| Ativan 2mg/ml Injection | Pfizer Ltd. | 2ml amp ₹85 |
Monitoring Required
- Respiratory rate and oxygen saturation — CRITICAL with IV use; resuscitation equipment must be available
- Level of consciousness (sedation scale)
- Blood pressure with IV use (cardiovascular depression risk)
- Signs of dependence — review at each prescription renewal
- CIWA-Ar score if used for alcohol withdrawal (symptom-triggered dosing)
- Fall risk assessment — especially in elderly outpatients
Patient Counseling Points
- DEPENDENCE WARNING: Can cause physical dependence with regular use. Do not increase your dose without doctor approval. Never stop abruptly.
- OPIOID/ALCOHOL WARNING: Do not mix with pain killers (opioids) or alcohol — this combination can stop your breathing.
- STATUS EPILEPTICUS (family/carer): If rectal or IM diazepam is prescribed for rescue use, call emergency services first, then administer — do not leave patient alone.
- SCHEDULE X CONTROLLED SUBSTANCE: Prescription cannot be refilled without a new prescription from your doctor.
- Do not drive, operate machinery, or make important decisions for 24 hours after IV/IM use
- Anterograde amnesia is expected with IV use — you may not remember events after the injection
Stop Googling drug references mid-consultation
EasyClinic auto-flags Lorazepam interactions, renal cutoffs, and pregnancy warnings the moment you write the prescription. Built-in safety net for every Indian doctor.
Clinically reviewed by: Dr. Krishnakumar Menon, MD DM Neurology — AIIMS New Delhi
Last reviewed: 2026-04-01
References
- Indian National Formulary (INF) 2023 — Lorazepam monograph
- CDSCO Schedule X Drug List — Lorazepam
- Epilepsy Foundation — Status Epilepticus Management Guidelines 2023
- FDA Black Box Warning — Benzodiazepines: CNS depression and respiratory depression with opioids 2020
- Goodman & Gilman's Pharmacological Basis of Therapeutics, 13th ed.
- Indian Academy of Neurology (IAN) Status Epilepticus Management Guidelines