Lorazepam Administration
Oral Administration
- Tablets and oral solution concentrate are available to be administered orally. In some countries, a sublingual † dosage form is available; some published literature describes the effective sublingual administration † of available oral tablets, particularly in pre-operative use; chronic use of this administration route is not well-supported.
- Oral solution concentrate: The dose of the oral concentrate solution should be added to 30 ml or more of liquid (e.g., water, juices, carbonated, soda-like beverages) or to semi-solid foods (e.g., applesauce, pudding) prior to administration.
Parenteral Administration
- For intravenous or intramuscular administration only. Do not administer lorazepam injection by intra-arterial injection since arteriospasm can occur which may cause tissue damage and/or gangrene.
- Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit.
IM injection:
- No dilution necessary.
- Inject deeply into a large muscle mass. Aspirate prior to injection to avoid injection into a blood vessel.
IV injection:
- Dilute the parenteral injection with an equal volume of a compatible diluent such as NS, sterile water for injection, or D5W. Prefilled syringes (Tubex® ) may be diluted by extruding all of the air from the half-filled syringe and slowly aspirating an equal volume of diluent; pull the plunger back slightly to allow space for mixing. Mix the contents of the syringe thoroughly by gently inverting the syringe repeatedly until a homogenous solution is obtained; do not shake vigorously. Alternatively, withdraw the desired dose from a vial of lorazepam injection into an empty syringe and then follow the procedure above for mixing the prefilled syringe.
- Following dilution, inject directly into a vein or into the tubing of a freely-flowing compatible IV infusion. Rate of injection should not exceed 2 mg/minute. Direct IV injection should be made with repeated aspiration to ensure that none of the drug is injected intra-arterially and that perivascular extravasation does not occur.
Continuous IV infusion † :
- When PVC containers are used to administer lorazepam, significant drug losses (up to 29% within 24 hours) occur due to sorption. PVC administration sets can also be expected to contribute to sorption losses. Use of glass or polyolefin containers is recommended.
- Dilute lorazepam injection with a compatible diluent such as D5W (preferred) to a final concentration of up to 0.2 mg/ml. Lorazepam crystalline particle formation may occur when IV solution concentrations are > 0.08 mg/ml; however, manufacturers data and limited reports suggest that concentrations of 1 mg/ml are stable for up to 24 hours and may be used in fluid-restricted patients. Solutions should not be used if they appear discolored or contain a precipitate.
† non-FDA approved
[ Last revised: 1/21/2005 4:18:00 PM ]
References
. Volles DF, Boullata JI, Gelone SP, et al. More on usability of lorazepam admixtures for continuous infusion. Am J Health-Syst Pharm 1996;53:2753 - 54.
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