NCTI- Pharmacology- Drug List J- Lorazepam

Ativan

• Benzodiazepine
• Sedative
• Anti-anxiety (anxiolytic)

Most potent of all Benzodiazepines; its effects (anxiolytic, sedative, hypnotic, and skeletal muscle relaxant) are all mediated by increasing the levels of the inhibitory neurotransmitter GABA. GABA works mostly at the hypothalamus, limbic system and thalamus in the brain.

• 1. status epilepticus
• 2. sedation prior to cardioversion/pacing
• 3. anxiety

• 1. pregnancy or nursing mothers
• 2. Use with caution in shock, coma, acute alcohol intoxication, suicidal patients and those with depressed respirations.

CNS: Anterograde amnesia, drowsiness, sedation, dizziness/disorientation, confusion, Hallucinations (found frequently in elderly patients), restlessness

Cardiovascular: hypertension or hypotension

GI: nausea/vomiting, abdominal discomfort

Other: depressed hearing

Use further care when administering Ativan to patients with renal or hepatic impairment; the elderly or debilitated; and those with psychosis

Alcohol, CNS depressants, and anticonvulsants may potentiate CNS depression; may also increase Dilantin levels; and smoking decreases sedative and anti-anxiety effects.

IV, IO, IM, PR

Onset is 1-5 min IV, 15-30 min IM; peak effects in 15-20 mins IV, 2 hrs IM; duration 6-8 hours.

• Sedation for Cardioversion:
• Adult: 2-4 mg IM, or 0.5-2 mg IV
• Pediatric: 0.03 mg-0.05 mg/kg IV/IM/PR max dose of 4mg

• Seizure Management:
• Adult: 2 mg slow IV (1mg/min) – repeat half dose if needed in 2-5 mins
• Pediatric: 0.1 mg/kg slow IV (over 2-5 mins); repeat half dose if needed in 2-5 minutes (Can be given PR to children if no IV obtained)

Riverside County Protocol: Not in Riverside County Protocol

Keep benzodiazepine antagonist (i.e. Romazicon) nearby; patient over 50 years of age have frequent incidents of psychosis with Ativan administration do exceed 2 mg initial dose