Lorazepam may now be the preferred first-line drug for stopping status Epilepticus. Although it may have a slower onset of action, it carries a lower risk of cardiorespiratory depression (respiratory arrest, hypotension) than diazepam as it is less lipid soluble. Lorazepam also has a longer duration of anticonvulsant activity compared with diazepam (6–12 hours versus 15–30 min after a single bolus).
Uses
Termination of epileptic fit
Contraindications
Airway obstruction
Administration
• IV: 4 mg over 2 min, repeated after 10 min if no response
• IM: 4 mg, dilute with 1 ml of WFI or 0.9% sodium chloride
Ampoules stored in refrigerator between 0°C and 4°C
How not to use lorazepam
IM injection – painful and unpredictable absorption; only use when IV
route not possible
Adverse effects
Respiratory depression and apnoea
Drowsiness
Hypotension and bradycardia
Cautions
Airway obstruction with further neurological damage
Enhanced and prolonged sedative effect in the elderly
Additive effects with other CNS depressants
Organ failure
CNS: enhanced and prolonged sedative effect
Respiratory: respiratory depression
Hepatic: enhanced and prolonged sedative effect. Can precipitate coma
Renal: enhanced and prolonged sedative effect
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