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LORazepam

LORazepam
  • Restricted Medications Cardiac Monitor (IV)
Drug Name Form Strength Non-Formulary Restricted TX Sub Notes
Ativan SOLUTION, INJECTABLE 2 mg/1 mL; 20 mg/10 mL; 40 mg/ 20 mL      
Ativan TABLET, ORAL 0.5 mg; 1 mg      
Display Benzodiazepines Class : 282408
Medication comments:
Warning: Pump Care Area Special Med!

LORazepam should generally not be interrupted during procedures unless there is a specific physician order.
Refrigerated Products Stored At Room Temperature (RT) 
Medication Allowable time at room temp
LORazepam inj 90 days intact vial; 28 days once punctured, not past RT exp date
Adapted from Extended Stability for Parenteral Drugs, 7th Edition; 2023 & Lexi-Drugs. UpToDate LexiDrug. UpToDate Inc. https://online.lexi.com. Accessed September 2025.
Per policy, these medications require cardiac and/or special monitoring.
(KEY: "Y" = may be given as described on chart. "N" = may NOT be given except in Rapid Response/Code Blue situations or as otherwise described in Exceptions section of Policy.
generic (Brand) / Notes CCU, OR, PACU, CCL, ED PCU 2N (Tele) 1N (Tele), 3N (Tele) Med/Surg (1N w/o Tele, 3N w/o Tele, 4N, 5N) BirthPlace SNF ICS OPS
LORazepam (Ativan)
IV Push not for sedation		 Y Y Y Y Y Y Y Y Y
LORazepam (Ativan)
IV Push sedation / analgesia by non-ANES personnel Key: designated staff		 Y N N N N N N N N
LORazepam (Ativan)
IV Infusion		 Y N N N N N N N N
Iredell Memorial Hospital ICU Adult Infusion Guidelines  
The following orders are intended to provide a specific, safe, and effective means of initiating and titrating medications for critically ill patients. Physicians may modify doses and/or parameters as necessary pending patients' status.For all medications listed below, the responsible LIP is to be notified if unable to titrate or the maximum dose is reached and goals of therapy are not met.
Drug Name Onset Preparation Compatible fluids
LORazepam (Ativan) 1-3 min 50 mg/50mL NS (1 mg/mL) NS or D5W
Starting Dose for ICU Sedation Titration Guidelines (for increasing and decreasing doses) with Maximum dose
For agitation: Begin infusion at 0.01 mg/kg/hr. titrate by 0.5 mg/hr every 15 min to -2 RASS sedation score.Max dose =5 mg/hr. If oversedated, hold infusion x 30 min and restart at 75% prior rate. If patient still exceeds RASS of -2, discontinue drip and notify physician.
2023 American Geriatrics Society Beers Criteria® for potentially inappropriate medication use in older adults.
Medication: LORazepam (Ativan)
Criteria 1: Potentially inappropriate medication use in older adults. (Table 2)
Drug(s) benzodiazepines
Rationale The use of benzodiazepines exposes users to risks of abuse, misuse, and addiction. Concomitant use of opioids may result in profound sedation, respiratory depression, coma, and death.
Older adults have increased sensitivity to benzodiazepines and decreased metabolism of long-acting agents; the continued use of benzodiazepines may lead to clinically significant physical dependence. In general, all benzodiazepines increase the risk of cognitive impairment, delirium, falls, fractures, and motor vehicle crashes in older adults.
May be appropriate for seizure disorders, rapid eye movement sleep behavior disorder, benzodiazepine withdrawal, ethanol withdrawal, severe generalized anxiety disorder, and periprocedural anesthesia.
Recommendation Avoid
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 
Criteria 2: Potentially inappropriate medication use in older adults due to drug–disease or drug–syndrome interactions that may exacerbate the disease or syndrome. (Table 3)
Drug(s) ⇆ disease or syndrome benzodiazepines ⇄ Delirium
Rationale Avoid in older adults with or at high risk of delirium because of the potential of inducing or worsening delirium.
Recommendation Avoid
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 
Drug(s) ⇆ disease or syndrome benzodiazepines ⇄ Dementia or cognitive impairment
Rationale Avoid because of adverse CNS effects.
Recommendation Avoid
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 
Drug(s) ⇆ disease or syndrome antiepileptics ⇄ History of falls or fractures
Rationale May cause ataxia, impaired psychomotor function, syncope, or additional falls. If one of the drugs must be used, consider reducing the use of other CNS-active medications that increase the risk of falls and fractures. (i.e., anticholinergics, selected antidepressants, antiepileptics, antipsychotics, sedative/hypnotics including benzodiazepines and, Nonbenzodiazepine benzodiazepine receptor agonist hypnotics, opioids) and implement other strategies to reduce fall risk.
Recommendation Avoid except for seizures and mood disorders.
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug(s) ⇆ disease or syndrome benzodiazepines ⇄ History of falls or fractures
Rationale May cause ataxia, impaired psychomotor function, syncope, or additional falls.
Benzodiazepines: shorter-acting ones are not safer than long-acting ones.
If one of the drugs must be used, consider reducing the use of other CNS-active medications that increase the risk of falls and fractures. (i.e., anticholinergics, selected antidepressants, antiepileptics, antipsychotics, sedative/hypnotics including benzodiazepines and, Nonbenzodiazepine benzodiazepine receptor agonist hypnotics, opioids) and implement other strategies to reduce fall risk.
Recommendation Avoid unless safer alternatives are not available.
 Quality of evidence: High, Strength of Recommendation: Strong
 
Criteria 4: Potentially clinically important drug-drug interactions that should be avoided in older adults. (Table 5)
Interacting drug(s) or class(es) benzodiazepines ⇄ CNS-active agents
Risk Rationale Increased risk of falls and of fracture with the concurrent use of ≥3 CNS-active agents (antiepileptics including gabapentinoids, antidepressants, antipsychotics, benzodiazepines, Nonbenzodiazepine benzodiazepine receptor agonist hypnotics, opioids, and skeletal muscle relaxants).
Recommendation Avoid concurrent use of ≥3 CNS-active drugs Click for list; minimize the number of CNS-active drugs.
 Quality of evidence: High, Strength of Recommendation: Strong
 
Interacting drug(s) or class(es) antiepileptics (including gabapentinoids) ⇄ CNS-active agents
Risk Rationale Increased risk of falls and of fracture with the concurrent use of ≥3 CNS-active agents (antiepileptics including gabapentinoids, antidepressants, antipsychotics, benzodiazepines, Nonbenzodiazepine benzodiazepine receptor agonist hypnotics, opioids, and skeletal muscle relaxants).
Recommendation Avoid concurrent use of ≥3 CNS-active drugs Click for list; minimize the number of CNS-active drugs.
 Quality of evidence: High, Strength of Recommendation: Strong
Last updated: Nov. 3, 2025
UpToDate Lexidrug

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