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ATIVAN (lorazepam) Injection

Rx only
DESCRIPTION
Lorazepam, a benzodiazepine with antianxiety, sedative, and anticonvulsant effects, is
intended for the intramuscular or intravenous routes of administration. It has the
chemical formula: 7-chloro-5(2-chlorophenyl)-1,3-dihydro-3-hydroxy-2H-1,
4-benzodiazepin-2-one. The molecular weight is 321.16, and the C.A.S. No. is
[846-49-1]. The structural formula is:

Lorazepam is a nearly white powder almost insoluble in water. Each mL of sterile

injection contains either 2.0 or 4.0 mg of lorazepam, 0.18 mL polyethylene glycol 400 in
propylene glycol with 2.0% benzyl alcohol as preservative.
CLINICAL PHARMACOLOGY
Lorazepam interacts with the γ-aminobutyric acid (GABA)-benzodiazepine receptor
complex, which is widespread in the brain of humans as well as other species. This
interaction is presumed to be responsible for lorazepam’s mechanism of action.
Lorazepam exhibits relatively high and specific affinity for its recognition site but does
not displace GABA. Attachment to the specific binding site enhances the affinity of
GABA for its receptor site on the same receptor complex. The pharmacodynamic
consequences of benzodiazepine agonist actions include antianxiety effects, sedation, and
reduction of seizure activity. The intensity of action is directly related to the degree of
benzodiazepine receptor occupancy.
Effects in Pre-Operative Patients
Intravenous or intramuscular administration of the recommended dose of 2 mg to 4 mg of
ATIVAN Injection to adult patients is followed by dose-related effects of sedation
(sleepiness or drowsiness), relief of preoperative anxiety, and lack of recall of events
related to the day of surgery in the majority of patients. The clinical sedation (sleepiness
or drowsiness) thus noted is such that the majority of patients are able to respond to
simple instructions whether they give the appearance of being awake or asleep. The lack
of recall is relative rather than absolute, as determined under conditions of careful patient
questioning and testing, using props designed to enhance recall. The majority of patients
under these reinforced conditions had difficulty recalling perioperative events or
recognizing props from before surgery. The lack of recall and recognition was optimum
within 2 hours following intramuscular administration and 15 to 20 minutes after
intravenous injection.

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The intended effects of the recommended adult dose of ATIVAN Injection usually last 6
to 8 hours. In rare instances, and where patients received greater than the recommended
dose, excessive sleepiness and prolonged lack of recall were noted. As with other
benzodiazepines, unsteadiness, enhanced sensitivity to CNS-depressant effects of ethyl
alcohol and other drugs were noted in isolated and rare cases for greater than 24 hours.
Physiologic Effects in Healthy Adults
Studies in healthy adult volunteers reveal that intravenous lorazepam in doses up to
3.5 mg/70 kg does not alter sensitivity to the respiratory stimulating effect of carbon
dioxide and does not enhance the respiratory-depressant effects of doses of
meperidine up to 100 mg/70 kg (also determined by carbon dioxide challenge) as
long as patients remain sufficiently awake to undergo testing. Upper airway
obstruction has been observed in rare instances where the patient received greater
than the recommended dose and was excessively sleepy and difficult to arouse (see
WARNINGS and ADVERSE REACTIONS).
Clinically employed doses of ATIVAN Injection do not greatly affect the circulatory
system in the supine position or employing a 70-degree tilt test. Doses of 8 mg to 10 mg
of intravenous lorazepam (2 to 2-1/2 times the maximum recommended dosage) will
produce loss of lid reflexes within 15 minutes.
Studies in 6 healthy young adults who received lorazepam injection and no other drugs
revealed that visual tracking (the ability to keep a moving line centered) was impaired for
a mean of 8 hours following administration of 4 mg of intramuscular lorazepam and 4
hours following administration of 2 mg intramuscularly with considerable subject
variation. Similar findings were noted with pentobarbital, 150 and 75 mg. Although this
study showed that both lorazepam and pentobarbital interfered with eye-hand
coordination, the data are insufficient to predict when it would be safe to operate a motor
vehicle or engage in a hazardous occupation or sport.
Pharmacokinetics and Metabolism
Absorption
Intravenous
A 4-mg dose provides an initial concentration of approximately 70 ng/mL.
Intramuscular
Following intramuscular administration, lorazepam is completely and rapidly absorbed
reaching peak concentrations within 3 hours. A 4-mg dose provides a Cmax of
approximately 48 ng/mL. Following administration of 1.5 to 5.0 mg of lorazepam IM, the
amount of lorazepam delivered to the circulation is proportional to the dose administered.
Distribution/Metabolism/Elimination
At clinically relevant concentrations, lorazepam is 91±2% bound to plasma proteins; its
volume of distribution is approximately 1.3 L/kg. Unbound lorazepam penetrates the
blood/brain barrier freely by passive diffusion, a fact confirmed by CSF sampling.
Following parenteral administration, the terminal half-life and total clearance averaged
14±5 hours and 1.1±0.4 mL/min/kg, respectively.

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Lorazepam is extensively conjugated to the 3-O-phenolic glucuronide in the liver and is

known to undergo enterohepatic recirculation. Lorazepam glucuronide is an inactive
metabolite and is eliminated mainly by the kidneys.
Following a single 2-mg oral dose of 14C-lorazepam to 8 healthy subjects, 88±4% of the
administered dose was recovered in urine and 7±2% was recovered in feces. The percent
of administered dose recovered in urine as lorazepam glucuronide was 74±4%. Only
0.3% of the dose was recovered as unchanged lorazepam, and the remainder of the
radioactivity represented minor metabolites.
Special Populations
Effect of Age
Pediatrics
NEONATES (BIRTH TO 1 MONTH)
Following a single 0.05 mg/kg (n=4) or 0.1 mg/kg (n=6) intravenous dose of lorazepam,
mean total clearance normalized to body weight was reduced by 80% compared to
normal adults, terminal half-life was prolonged 3-fold, and volume of distribution was
decreased by 40% in neonates with asphyxia neonatorum compared to normal adults. All
neonates were of ≥37 weeks of gestational age.
INFANTS (1 MONTH UP TO 2 YEARS)
There is no information on the pharmacokinetic profile of lorazepam in infants in the age
range of 1 month to 2 years.
CHILDREN (2 YEARS TO 12 YEARS)
Total (bound and unbound) lorazepam had a 50% higher mean volume of distribution
(normalized to body-weight) and a 30% longer mean half-life in children with acute
lymphocytic leukemia in complete remission (2 to 12 years, n=37) compared to normal
adults (n=10). Unbound lorazepam clearance normalized to body-weight was comparable
in children and adults.
ADOLESCENTS (12 YEARS TO 18 YEARS)
Total (bound and unbound) lorazepam had a 50% higher mean volume of distribution
(normalized to body-weight) and a mean half-life that was two fold greater in adolescents
with acute lymphocytic leukemia in complete remission (12 to 18 years, n=13) compared
to normal adults (n=10). Unbound lorazepam clearance normalized to body-weight was
comparable in adolescents and adults.
Elderly
Following single intravenous doses of 1.5 to 3 mg of ATIVAN Injection, mean total body
clearance of lorazepam decreased by 20% in 15 elderly subjects of 60 to 84 years of age
compared to that in 15 younger subjects of 19 to 38 years of age. Consequently, no
dosage adjustment appears to be necessary in elderly subjects based solely on their age.
Effect of Gender
Gender has no effect on the pharmacokinetics of lorazepam.
Effect of Race
Young Americans (n=15) and Japanese subjects (n=7) had very comparable mean
total clearance value of 1.0 mL/min/kg. However, elderly Japanese subjects had a

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20% lower mean total clearance than elderly Americans, 0.59 mL/min/kg vs
0.77 mL/min/kg, respectively.
Patients With Renal Insufficiency
Because the kidney is the primary route of elimination of lorazepam glucuronide, renal
impairment would be expected to compromise its clearance. This should have no direct
effect on the glucuronidation (and inactivation) of lorazepam. There is a possibility that
the enterohepatic circulation of lorazepam glucuronide leads to a reduced efficiency of
the net clearance of lorazepam in this population.
Six normal subjects, six patients with renal impairment (Clcr of 22±9 mL/min), and four
patients on chronic maintenance hemodialysis were given single 1.5 to 3.0 mg
intravenous doses of lorazepam. Mean volume of distribution and terminal half-life
values of lorazepam were 40% and 25% higher, respectively, in renally impaired patients
than in normal subjects. Both parameters were 75% higher in patients undergoing
hemodialysis than in normal subjects. Overall, though, in this group of subjects the mean
total clearance of lorazepam did not change. About 8% of the administered intravenous
dose was removed as intact lorazepam during the 6-hour dialysis session.
The kinetics of lorazepam glucuronide were markedly affected by renal dysfunction. The
mean terminal half-life was prolonged by 55% and 125% in renally impaired patients and
patients under hemodialysis, respectively, as compared to normal subjects. The mean
metabolic clearance decreased by 75% and 90% in renally impaired patients and patients
under hemodialysis, respectively, as compared with normal subjects. About 40% of the
administered lorazepam intravenous dose was removed as glucuronide conjugate during
the 6-hour dialysis session.
Hepatic Disease
Because cytochrome oxidation is not involved with the metabolism of lorazepam, liver
disease would not be expected to have an effect on metabolic clearance. This prediction
is supported by the observation that following a single 2 mg intravenous dose of
lorazepam, cirrhotic male patients (n=13) and normal male subjects (n=11) exhibited no
substantive difference in their ability to clear lorazepam.
Effect of Smoking
Administration of a single 2 mg intravenous dose of lorazepam showed that there was no
difference in any of the pharmacokinetic parameters of lorazepam between cigarette
smokers (n=10, mean=31 cigarettes per day) and nonsmoking subjects (n=10) who were
matched for age, weight and gender.
Clinical Studies
The effectiveness of ATIVAN Injection in status epilepticus was established in two
multi-center controlled trials in 177 patients. With rare exceptions, patients were
between 18 and 65 years of age. More than half the patients in each study had
tonic-clonic status epilepticus; patients with simple partial and complex partial status
epilepticus comprised the rest of the population studied, along with a smaller number of
patients who had absence status.
One study (n=58) was a double-blind active-control trial comparing ATIVAN Injection
and diazepam. Patients were randomized to receive ATIVAN 2 mg IV (with an additional

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2 mg IV if needed) or diazepam 5 mg IV (with an additional 5 mg IV if needed). The

primary outcome measure was a comparison of the proportion of responders in each
treatment group, where a responder was defined as a patient whose seizures stopped
within 10 minutes after treatment and who continued seizure-free for at least an
additional 30 minutes. Twenty-four of the 30 (80%) patients were deemed responders to
ATIVAN and 16/28 (57%) patients were deemed responders to diazepam (p=0.04). Of
the 24 ATIVAN responders, 23 received both 2 mg infusions.
Non-responders to ATIVAN 4 mg were given an additional 2 to 4 mg ATIVAN;
non-responders to diazepam 10 mg were given an additional 5 to 10 mg diazepam. After
this additional dose administration, 28/30 (93%) of patients randomized to ATIVAN and
24/28 (86%) of patients randomized to diazepam were deemed responders, a difference
that was not statistically significant.
Although this study provides support for the efficacy of ATIVAN as the treatment for
status epilepticus, it cannot speak reliably or meaningfully to the comparative
performance of either diazepam (Valium) or lorazepam (ATIVAN Injection) under the
conditions of actual use.
A second study (n=119) was a double-blind dose-comparison trial with 3 doses of
ATIVAN Injection: 1 mg, 2 mg, and 4 mg. Patients were randomized to receive one of
the three doses of ATIVAN. The primary outcome and definition of responder were as in
the first study. Twenty-five of 41 patients (61%) responded to 1 mg ATIVAN; 21/37
patients (57%) responded to 2 mg ATIVAN; and 31/41 (76%) responded to 4 mg
ATIVAN. The p-value for a statistical test of the difference between the ATIVAN 4 mg
dose group and the ATIVAN 1-mg dose group was 0.08 (two-sided). Data from all
randomized patients were used in this test.
Although analyses failed to detect an effect of age, sex, or race on the effectiveness of
ATIVAN in status epilepticus, the numbers of patients evaluated were too few to allow a
definitive conclusion about the role these factors may play.
INDICATIONS AND USAGE
Status Epilepticus
ATIVAN Injection is indicated for the treatment of status epilepticus.
Preanesthetic
ATIVAN Injection is indicated in adult patients for preanesthetic medication, producing
sedation (sleepiness or drowsiness), relief of anxiety, and a decreased ability to recall
events related to the day of surgery. It is most useful in those patients who are anxious
about their surgical procedure and who would prefer to have diminished recall of the
events of the day of surgery (see PRECAUTIONS, Information for Patients).
CONTRAINDICATIONS
ATIVAN Injection is contraindicated in patients with a known sensitivity to
benzodiazepines or its vehicle (polyethylene glycol, propylene glycol, and benzyl
alcohol), in patients with acute narrow-angle glaucoma, or in patients with sleep
apnea syndrome. It is also contraindicated in patients with severe respiratory
insufficiency, except in those patients requiring relief of anxiety and/or diminished
recall of events while being mechanically ventilated. The use of ATIVAN Injection

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intra-arterially is contraindicated because, as with other injectable benzodiazepines,

inadvertent intra-arterial injection may produce arteriospasm resulting in gangrene
which may require amputation (see WARNINGS).
WARNINGS
Use in Status Epilepticus
Management of Status Epilepticus
Status epilepticus is a potentially life-threatening condition associated with a high risk of
permanent neurological impairment, if inadequately treated. The treatment of status,
however, requires far more than the administration of an anticonvulsant agent. It involves
observation and management of all parameters critical to maintaining vital function and
the capacity to provide support of those functions as required. Ventilatory support must
be readily available. The use of benzodiazepines, like ATIVAN Injection, is ordinarily
only one step of a complex and sustained intervention which may require additional
interventions (e.g., concomitant intravenous administration of phenytoin). Because status
epilepticus may result from a correctable acute cause such as hypoglycemia,
hyponatremia, or other metabolic or toxic derangement, such an abnormality must be
immediately sought and corrected. Furthermore, patients who are susceptible to further
seizure episodes should receive adequate maintenance antiepileptic therapy.
Any health care professional who intends to treat a patient with status epilepticus should
be familiar with this package insert and the pertinent medical literature concerning
current concepts for the treatment of status epilepticus. A comprehensive review of the
considerations critical to the informed and prudent management of status epilepticus
cannot be provided in drug product labeling. The archival medical literature contains
many informative references on the management of status epilepticus, among them the
report of the working group on status epilepticus of the Epilepsy Foundation of America
“Treatment of Convulsive Status Epilepticus” (JAMA 1993; 270:854-859). As noted in
the report just cited, it may be useful to consult with a neurologist if a patient fails to
respond (e.g., fails to regain consciousness).
For the treatment of status epilepticus, the usual recommended dose of ATIVAN
Injection is 4 mg given slowly (2 mg/min) for patients 18 years and older. If seizures
cease, no additional ATIVAN Injection is required. If seizures continue or recur after a
10- to 15- minute observation period, an additional 4 mg intravenous dose may be slowly
administered. Experience with further doses of ATIVAN is very limited. The usual
precautions in treating status epilepticus should be employed. An intravenous infusion
should be started, vital signs should be monitored, an unobstructed airway should be
maintained, and artificial ventilation equipment should be available.
Respiratory Depression
The most important risk associated with the use of ATIVAN Injection in status
epilepticus is respiratory depression. Accordingly, airway patency must be assured and
respiration monitored closely. Ventilatory support should be given as required.
Excessive Sedation
Because of its prolonged duration of action, the prescriber should be alert to the
possibility, especially when multiple doses have been given, that the sedative effects of
lorazepam may add to the impairment of consciousness seen in the post-ictal state.

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Preanesthetic Use
AIRWAY OBSTRUCTION MAY OCCUR IN HEAVILY SEDATED PATIENTS.
INTRAVENOUS LORAZEPAM AT ANY DOSE, WHEN GIVEN EITHER ALONE
OR IN COMBINATION WITH OTHER DRUGS ADMINISTERED DURING
ANESTHESIA, MAY PRODUCE HEAVY SEDATION; THEREFORE, EQUIPMENT
NECESSARY TO MAINTAIN A PATENT AIRWAY AND TO SUPPORT
RESPIRATION/VENTILATION SHOULD BE AVAILABLE.
As is true of similar CNS-acting drugs, the decision as to when patients who have
received injectable lorazepam, particularly on an outpatient basis, may again operate
machinery, drive a motor vehicle, or engage in hazardous or other activities requiring
attention and coordination must be individualized. It is recommended that no patient
engage in such activities for a period of 24 to 48 hours or until the effects of the drug,
such as drowsiness, have subsided, whichever is longer. Impairment of performance may
persist for greater intervals because of extremes of age, concomitant use of other drugs,
stress of surgery, or the general condition of the patient.
Clinical trials have shown that patients over the age of 50 years may have a more
profound and prolonged sedation with intravenous lorazepam (see also DOSAGE AND
ADMINISTRATION, Preanesthetic).
As with all central-nervous-system-depressant drugs, care should be exercised in patients
given injectable lorazepam as premature ambulation may result in injury from falling.
There is no added beneficial effect from the addition of scopolamine to injectable
lorazepam, and their combined effect may result in an increased incidence of sedation,
hallucination and irrational behavior.
General (All Uses)
PRIOR TO INTRAVENOUS USE, ATIVAN INJECTION MUST BE DILUTED WITH
AN EQUAL AMOUNT OF COMPATIBLE DILUENT (see DOSAGE AND
ADMINISTRATION). INTRAVENOUS INJECTION SHOULD BE MADE SLOWLY
AND WITH REPEATED ASPIRATION. CARE SHOULD BE TAKEN TO
DETERMINE THAT ANY INJECTION WILL NOT BE INTRA-ARTERIAL AND
THAT PERIVASCULAR EXTRAVASATION WILL NOT TAKE PLACE. IN THE
EVENT THAT A PATIENT COMPLAINS OF PAIN DURING INTENDED
INTRAVENOUS INJECTION OF ATIVAN INJECTION, THE INJECTION SHOULD
BE STOPPED IMMEDIATELY TO DETERMINE IF INTRA-ARTERIAL INJECTION
OR PERIVASCULAR EXTRAVASATION HAS TAKEN PLACE.
Since the liver is the most likely site of conjugation of lorazepam and since excretion of
conjugated lorazepam (glucuronide) is a renal function, this drug is not recommended for
use in patients with hepatic and/or renal failure. ATIVAN should be used with caution in
patients with mild-to-moderate hepatic or renal disease (see DOSAGE AND
ADMINISTRATION).
Pregnancy
ATIVAN MAY CAUSE FETAL DAMAGE WHEN ADMINISTERED TO
PREGNANT WOMEN. Ordinarily, ATIVAN Injection should not be used during
pregnancy except in serious or life-threatening conditions where safer drugs

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cannot be used or are ineffective. Status epilepticus may represent such a serious
and life-threatening condition.
An increased risk of congenital malformations associated with the use of minor
tranquilizers (chlordiazepoxide, diazepam and meprobamate) during the first trimester of
pregnancy has been suggested in several studies. In humans, blood levels obtained from
umbilical cord blood indicate placental transfer of lorazepam and lorazepam glucuronide.
Reproductive studies in animals were performed in mice, rats, and two strains of rabbits.
Occasional anomalies (reduction of tarsals, tibia, metatarsals, malrotated limbs,
gastroschisis, malformed skull, and microphthalmia) were seen in drug-treated rabbits
without relationship to dosage. Although all of these anomalies were not present in the
concurrent control group, they have been reported to occur randomly in historical
controls. At doses of 40 mg/kg orally or 4 mg/kg intravenously and higher, there was
evidence of fetal resorption and increased fetal loss in rabbits which was not seen at
lower doses.
The possibility that a woman of childbearing potential may be pregnant at the time of
therapy should be considered.
There are insufficient data regarding obstetrical safety of parenteral lorazepam, including
use in cesarean section. Such use, therefore, is not recommended.
Endoscopic Procedures
There are insufficient data to support the use of ATIVAN Injection for outpatient
endoscopic procedures. Inpatient endoscopic procedures require adequate recovery room
observation time.
When ATIVAN Injection is used for peroral endoscopic procedures; adequate topical
or regional anesthesia is recommended to minimize reflex activity associated with
such procedures.
PRECAUTIONS
General
The additive central-nervous-system effects of other drugs, such as phenothiazines,
narcotic analgesics, barbiturates, antidepressants, scopolamine, and monoamine-oxidase
inhibitors, should be borne in mind when these other drugs are used concomitantly with
or during the period of recovery from ATIVAN Injection (see CLINICAL
PHARMACOLOGY and WARNINGS).
Extreme caution must be used when administering ATIVAN Injection to elderly patients,
very ill patients, or to patients with limited pulmonary reserve because of the possibility
that hypoventilation and/or hypoxic cardiac arrest may occur. Resuscitative equipment
for ventilatory support should be readily available (see WARNINGS and DOSAGE
AND ADMINISTRATION).
When lorazepam injection is used IV as the premedicant prior to regional or local
anesthesia, the possibility of excessive sleepiness or drowsiness may interfere with
patient cooperation in determining levels of anesthesia. This is most likely to occur when
greater than 0.05 mg/kg is given and when narcotic analgesics are used concomitantly
with the recommended dose (see ADVERSE REACTIONS).

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As with all benzodiazepines, paradoxical reactions may occur in rare instances and in an
unpredictable fashion (see ADVERSE REACTIONS). In these instances, further use of
the drug in these patients should be considered with caution.
There have been reports of possible propylene glycol toxicity (e.g., lactic acidosis,
hyperosmolality, hypotension) and possible polyethylene glycol toxicity (e.g.,
acute tubular necrosis) during administration of ATIVAN Injection at higher than
recommended doses. Symptoms may be more likely to develop in patients with
renal impairment.
Information for Patients
Patients should be informed of the pharmacological effects of the drug, including
sedation, relief of anxiety, and lack of recall, the duration of these effects (about 8 hours),
and be apprised of the risks as well as the benefits of therapy.
Patients who receive ATIVAN Injection as a premedicant should be cautioned that
driving a motor vehicle, operating machinery, or engaging in hazardous or other activities
requiring attention and coordination, should be delayed for 24 to 48 hours following the
injection or until the effects of the drug, such as drowsiness, have subsided, whichever is
longer. Sedatives, tranquilizers and narcotic analgesics may produce a more prolonged
and profound effect when administered along with injectable ATIVAN. This effect may
take the form of excessive sleepiness or drowsiness and, on rare occasions, interfere with
recall and recognition of events of the day of surgery and the day after.
Patients should be advised that getting out of bed unassisted may result in falling and
injury if undertaken within 8 hours of receiving lorazepam injection. Since tolerance for
CNS depressants will be diminished in the presence of ATIVAN Injection, these
substances should either be avoided or taken in reduced dosage. Alcoholic beverages
should not be consumed for at least 24 to 48 hours after receiving lorazepam injectable
due to the additive effects on central-nervous-system depression seen with
benzodiazepines in general. Elderly patients should be told that ATIVAN Injection may
make them very sleepy for a period longer than 6 to 8 hours following surgery.
Laboratory Tests
In clinical trials, no laboratory test abnormalities were identified with either single or
multiple doses of ATIVAN Injection. These tests included: CBC, urinalysis, SGOT,
SGPT, bilirubin, alkaline phosphatase, LDH, cholesterol, uric acid, BUN, glucose,
calcium, phosphorus, and total proteins.
Drug Interactions
ATIVAN Injection, like other injectable benzodiazepines, produces additive depression
of the central nervous system when administered with other CNS depressants such as
ethyl alcohol, phenothiazines, barbiturates, MAO inhibitors, and other antidepressants.
When scopolamine is used concomitantly with injectable lorazepam, an increased
incidence of sedation, hallucinations and irrational behavior has been observed.
There have been rare reports of significant respiratory depression, stupor and/or
hypotension with the concomitant use of loxapine and lorazepam.
Marked sedation, excessive salivation, ataxia, and, rarely, death have been reported with
the concomitant use of clozapine and lorazepam.

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Apnea, coma, bradycardia, arrhythmia, heart arrest, and death have been reported with
the concomitant use of haloperidol and lorazepam.
The risk of using lorazepam in combination with scopolamine, loxapine, clozapine,
haloperidol, or other CNS-depressant drugs has not been systematically evaluated.
Therefore, caution is advised if the concomitant administration of lorazepam and these
drugs is required.
Concurrent administration of any of the following drugs with lorazepam had no effect on
the pharmacokinetics of lorazepam: metoprolol, cimetidine, ranitidine, disulfiram,
propranolol, metronidazole, and propoxyphene. No change in ATIVAN dosage is
necessary when concomitantly given with any of these drugs.
Lorazepam-Valproate Interaction
Concurrent administration of lorazepam (2 mg intravenously) with valproate (250 mg
twice daily orally for 3 days) to 6 healthy male subjects resulted in decreased total
clearance of lorazepam by 40% and decreased formation rate of lorazepam glucuronide
by 55%, as compared with lorazepam administered alone. Accordingly, lorazepam
plasma concentrations were about two-fold higher for at least 12 hours post-dose
administration during valproate treatment. Lorazepam dosage should be reduced to 50%
of the normal adult dose when this drug combination is prescribed in patients (see also
DOSAGE AND ADMINISTRATION).
Lorazepam-Oral Contraceptive Steroids Interaction
Coadministration of lorazepam (2 mg intravenously) with oral contraceptive steroids
(norethindrone acetate, 1 mg, and ethinyl estradiol, 50 μg, for at least 6 months) to
healthy females (n=7) was associated with a 55% decrease in half-life, a 50% increase in
the volume of distribution, thereby resulting in an almost 3.7-fold increase in total
clearance of lorazepam as compared with control healthy females (n=8). It may be
necessary to increase the dose of ATIVAN in female patients who are concomitantly
taking oral contraceptives (see also DOSAGE AND ADMINISTRATION).
Lorazepam-Probenecid Interaction
Concurrent administration of lorazepam (2 mg intravenously) with probenecid (500 mg
orally every 6 hours) to 9 healthy volunteers resulted in a prolongation of lorazepam
half-life by 130% and a decrease in its total clearance by 45%. No change in volume of
distribution was noted during probenecid co-treatment. ATIVAN dosage needs to be
reduced by 50% when coadministered with probenecid (see also DOSAGE AND
ADMINISTRATION).
Drug/Laboratory Test Interactions
No laboratory test abnormalities were identified when lorazepam was given alone or
concomitantly with another drug, such as narcotic analgesics, inhalation anesthetics,
scopolamine, atropine, and a variety of tranquilizing agents.
Carcinogenesis, Mutagenesis, Impairment of Fertility
No evidence of carcinogenic potential emerged in rats and mice during an 18-month
study with oral lorazepam. No studies regarding mutagenesis have been performed. The
results of a preimplantation study in rats, in which the oral lorazepam dose was 20 mg/kg,
showed no impairment of fertility.

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Pregnancy
Teratogenic Effects—Pregnancy Category D (See WARNINGS.)
Labor and Delivery
There are insufficient data to support the use of ATIVAN (lorazepam) Injection during
labor and delivery, including cesarean section; therefore, its use in this clinical
circumstance is not recommended.
Nursing Mothers
Lorazepam has been detected in human breast milk. Therefore, lorazepam should not be
administered to nursing mothers because, like other benzodiazepines, the possibility
exists that lorazepam may sedate or otherwise adversely affect the infant.
Pediatric Use
Status Epilepticus
The safety of ATIVAN in pediatric patients with status epilepticus has not been
systematically evaluated. Open-label studies described in the medical literature included
273 pediatric/adolescent patients; the age range was from a few hours old to 18 years of
age. Paradoxical excitation was observed in 10% to 30% of the pediatric patients under 8
years of age and was characterized by tremors, agitation, euphoria, logorrhea, and brief
episodes of visual hallucinations. Paradoxical excitation in pediatric patients also has
been reported with other benzodiazepines when used for status epilepticus, as an
anesthesia, or for pre-chemotherapy treatment.
Pediatric patients (as well as adults) with atypical petit mal status epilepticus have
developed brief tonic-clonic seizures shortly after ATIVAN was given. This
“paradoxical” effect was also reported for diazepam and clonazepam. Nevertheless, the
development of seizures after treatment with benzodiazepines is probably rare, based on
the incidence in the uncontrolled treatment series reported (i.e., seizures were not
observed for 112 pediatric patients and 18 adults or during approximately 400 doses).
Preanesthetic
There are insufficient data to support the efficacy of injectable lorazepam as a
preanesthetic agent in patients less than 18 years of age.
General
Seizure activity and myoclonus have been reported to occur following administration of
ATIVAN Injection, especially in very low birth weight neonates.
Pediatric patients may exhibit a sensitivity to benzyl alcohol, polyethylene glycol and
propylene glycol, components of ATIVAN Injection (see also
CONTRAINDICATIONS). The “gasping syndrome”, characterized by central nervous
system depression, metabolic acidosis, gasping respirations, and high levels of benzyl
alcohol and its metabolites found in the blood and urine, has been associated with the
administration of intravenous solutions containing the preservative benzyl alcohol in
neonates. Additional symptoms may include gradual neurological deterioration, seizures,
intracranial hemorrhage, hematologic abnormalities, skin breakdown, hepatic and renal
failure, hypotension, bradycardia, and cardiovascular collapse. Central nervous system
toxicity, including seizures and intraventricular hemorrhage, as well as unresponsiveness,
tachypnea, tachycardia, and diaphoresis have been associated with propylene glycol

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toxicity. Although normal therapeutic doses of ATIVAN Injection contain very small
amounts of these compounds, premature and low-birth-weight infants as well as pediatric
patients receiving high doses may be more susceptible to their effects.
Geriatric Use
Clinical studies of ATIVAN generally were not adequate to determine whether subjects
aged 65 and over respond differently than younger subjects; however, age over 65 may
be associated with a greater incidence of central nervous system depression and more
respiratory depression (see WARNINGS–Preanesthetic Use, PRECAUTIONS–
General and ADVERSE REACTIONS–Preanesthetic).
Age does not appear to have a clinically significant effect on lorazepam kinetics (see
CLINICAL PHARMACOLOGY).
Clinical circumstances, some of which may be more common in the elderly, such as
hepatic or renal impairment, should be considered. Greater sensitivity (e.g., sedation) of
some older individuals cannot be ruled out. In general, dose selection for an elderly
patient should be cautious, usually starting at the low end of the dosing range (see
DOSAGE AND ADMINISTRATION).
ADVERSE REACTIONS
Status Epilepticus
The most important adverse clinical event caused by the use of ATIVAN Injection is
respiratory depression (see WARNINGS).
The adverse clinical events most commonly observed with the use of ATIVAN Injection
in clinical trials evaluating its use in status epilepticus were hypotension, somnolence,
and respiratory failure.
Incidence in Controlled Clinical Trials
All adverse events were recorded during the trials by the clinical investigators using
terminology of their own choosing. Similar types of events were grouped into
standardized categories using modified COSTART dictionary terminology. These
categories are used in the table and listings below with the frequencies representing the
proportion of individuals exposed to ATIVAN Injection or to comparative therapy.
The prescriber should be aware that these figures cannot be used to predict the frequency
of adverse events in the course of usual medical practice where patient characteristics and
other factors may differ from those prevailing during clinical studies. Similarly, the cited
frequencies cannot be directly compared with figures obtained from other clinical
investigators involving different treatment, uses, or investigators. An inspection of these
frequencies, however, does provide the prescribing physician with one basis to estimate
the relative contribution of drug and nondrug factors to the adverse event incidences in
the population studied.
Commonly Observed Adverse Events in a Controlled Dose-Comparison Clinical
Trial
Table 1 lists the treatment-emergent adverse events that occurred in the patients treated
with ATIVAN Injection in a dose-comparison trial of ATIVAN 1 mg, 2 mg, and 4 mg.
TABLE 1. NUMBER (%) OF STUDY EVENTS IN A
DOSE COMPARISON CLINICAL TRIAL

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Body System ATIVAN Injection

Event (n=130)a
b
Any Study Event (1 or more) 16 (12.3%)
Body as a whole
Infection 1 ( <1%)
Cardiovascular system
Hypotension 2 (1.5%)
Digestive system
Liver function tests abnormal 1 ( <1%)
Nausea 1 ( <1%)
Vomiting 1 ( <1%)
Metabolic and Nutritional
Acidosis 1 ( <1%)
Nervous system
Brain edema 1 ( <1%)
Coma 1 ( <1%)
Convulsion 1 ( <1%)
Somnolence 2 (1.5%)
Thinking abnormal 1 ( <1%)
Respiratory system
Hyperventilation 1 ( <1%)
Hypoventilation 1 ( <1%)
Respiratory failure 2 (1.5%)
Terms not classifiable
Injection site reaction 1 ( <1%)
Urogenital system
Cystitis 1 ( <1%)
a: One hundred and thirty (130) patients received ATIVAN Injection.
b: Totals are not necessarily the sum of the individual study events because a patient may
report two or more different study events in the same body system.
Commonly Observed Adverse Events in Active-Controlled Clinical Trials
In two studies, patients who completed the course of treatment for status epilepticus were
permitted to be reenrolled and to receive treatment for a second status episode, given that
there was a sufficient interval between the two episodes. Safety was determined from all
treatment episodes for all intent-to-treat patients, i.e., from all “patient-episodes.” Table 2
lists the treatment-emergent adverse events that occurred in at least 1% of the patient-
episodes in which ATIVAN Injection or diazepam was given. The table represents the
pooling of results from the two controlled trials.
TABLE 2. NUMBER (%) OF STUDY EVENTS IN ACTIVE CONTROLLED
CLINICAL TRIAL
Body System ATIVAN Injection Diazepam
a
Event (n=85) (n=80)a
b
Any Study Event (1 or more) 14 (16.5%) 11 (13.8%)
Body as a whole
Headache 1 ( 1.2%) 1 (1.3%)

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Cardiovascular system
Hypotension 2 (2.4%) 0
Hemic and lymphatic system
Hypochromic anemia 0 1 (1.3%)
Leukocytosis 0 1 (1.3%)
Thrombocythemia 0 1 (1.3%)
Nervous system
Coma 1 (1.2 %) 1 (1.3%)
Somnolence 3 (3.5%) 3 (3.8%)
Stupor 1 (1.2%) 0
Respiratory system
Hypoventilation 1 (1.2%) 2 (2.5%)
Apnea 1 (1.2%) 1 (1.3%)
Respiratory failure 2 (2.4%) 1 (1.3%)
Respiratory disorder 1 (1.2%) 0
a: The number indicates the number of “patient-episodes.” Patient-episodes were used
rather than “patients” because a total of 7 patients were reenrolled for the treatment of a
second episode of status: 5 patients received ATIVAN Injection on two occasions that
were far enough apart to establish the diagnosis of status epilepticus for each episode,
and, using the same time criterion, 2 patients received diazepam on two occasions.
b: Totals are not necessarily the sum of the individual study events because a patient may
report two or more different study events in the same body system.
These trials were not designed or intended to demonstrate the comparative safety of the
two treatments.
The overall adverse experience profile for ATIVAN was similar between women and
men. There are insufficient data to support a statement regarding the distribution of
adverse events by race. Generally, age greater than 65 years may be associated with a
greater incidence of central-nervous-system depression and more respiratory depression.
Other Events Observed During the Pre-Marketing Evaluation of Ativan Injection
for the Treatment of Status Epilepticus
ATIVAN Injection, active comparators, and ATIVAN Injection in combination with a
comparator were administered to 488 individuals during controlled and open-label
clinical trials. Because of reenrollments, these 488 patients participated in a total of 521
patient-episodes. ATIVAN Injection alone was given in 69% of these patient-episodes
(n=360). The safety information below is based on data available from 326 of these
patient-episodes in which ATIVAN Injection was given alone.
All adverse events that were seen once are listed, except those already included in
previous listings (Table 1 and Table 2).
Study events were classified by body system in descending frequency by using the
following definitions: frequent adverse events were those that occurred in at least 1/100
individuals; infrequent study events were those that occurred in 1/100 to 1/1000
individuals.

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Frequent and Infrequent Study Events

Body as a Whole - Infrequent: asthenia, chills, headache,
infection.
Digestive System - Infrequent: abnormal liver function test,
increased salivation, nausea, vomiting.
Metabolic and Nutritional - Infrequent: acidosis, alkaline phosphatase
increased.
Nervous System - Infrequent: agitation, ataxia, brain edema,
coma, confusion, convulsion, hallucinations,
myoclonus, stupor, thinking abnormal, tremor.
Respiratory System - Frequent: apnea; Infrequent: hyperventilation,
hypoventilation, respiratory disorder.
Terms Not Classifiable - Infrequent: injection site reaction.
Urogenital System - Infrequent: cystitis.

Preanesthetic
Central Nervous System
The most frequent adverse drug event reported with injectable lorazepam is central-
nervous-system depression. The incidence varied from one study to another, depending
on the dosage, route of administration, use of other central-nervous-system depressants,
and the investigator’s opinion concerning the degree and duration of desired sedation.
Excessive sleepiness and drowsiness were the most common consequences of CNS
depression. This interfered with patient cooperation in approximately 6% (25/446) of
patients undergoing regional anesthesia, causing difficulty in assessing levels of
anesthesia. Patients over 50 years of age had a higher incidence of excessive sleepiness
or drowsiness when compared with those under 50 (21/106 versus 24/245) when
lorazepam was given intravenously (see DOSAGE AND ADMINISTRATION). On
rare occasion (3/1580) the patient was unable to give personal identification in the
operating room on arrival, and one patient fell when attempting premature ambulation in
the postoperative period.
Symptoms such as restlessness, confusion, depression, crying, sobbing, and delirium
occurred in about 1.3% (20/1580). One patient injured himself by picking at his incision
during the immediate postoperative period.
Hallucinations were present in about 1% (14/1580) of patients and were visual and
self-limiting.
An occasional patient complained of dizziness, diplopia and/or blurred vision. Depressed
hearing was infrequently reported during the peak-effect period.
An occasional patient had a prolonged recovery room stay, either because of excessive
sleepiness or because of some form of inappropriate behavior. The latter was seen most
commonly when scopolamine was given concomitantly as a premedicant. Limited
information derived from patients who were discharged the day after receiving injectable

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lorazepam showed one patient complained of some unsteadiness of gait and a reduced
ability to perform complex mental functions. Enhanced sensitivity to alcoholic beverages
has been reported more than 24 hours after receiving injectable lorazepam, similar to
experience with other benzodiazepines.
Local Effects
Intramuscular injection of lorazepam has resulted in pain at the injection site, a sensation
of burning, or observed redness in the same area in a very variable incidence from one
study to another. The overall incidence of pain and burning in patients was about 17%
(146/859) in the immediate postinjection period and about 1.4% (12/859) at the 24-hour
observation time. Reactions at the injection site (redness) occurred in approximately 2%
(17/859) in the immediate postinjection period and were present 24 hours later in about
0.8% (7/859).
Intravenous administration of lorazepam resulted in painful responses in 13/771 patients
or approximately 1.6% in the immediate postinjection period, and 24 hours later 4/771
patients or about 0.5% still complained of pain. Redness did not occur immediately
following intravenous injection but was noted in 19/771 patients at the 24-hour
observation period. This incidence is similar to that observed with an intravenous
infusion before lorazepam is given. Intra-arterial injection may produce arteriospasm
resulting in gangrene which may require amputation (see CONTRAINDICATIONS).
Cardiovascular System
Hypertension (0.1%) and hypotension (0.1%) have occasionally been observed after
patients have received injectable lorazepam.
Respiratory System
Five patients (5/446) who underwent regional anesthesia were observed to have airway
obstruction. This was believed due to excessive sleepiness at the time of the procedure
and resulted in temporary hypoventilation. In this instance, appropriate airway
management may become necessary (see also CLINICAL PHARMACOLOGY,
WARNINGS and PRECAUTIONS).
Other Adverse Experiences
Skin rash, nausea and vomiting have occasionally been noted in patients who have
received injectable lorazepam combined with other drugs during anesthesia and surgery.
Paradoxical Reactions
As with all benzodiazepines, paradoxical reactions such as stimulation, mania,
irritability, restlessness, agitation, aggression, psychosis, hostility, rage, or
hallucinations may occur in rare instances and in an unpredictable fashion. In these
instances, further use of the drug in these patients should be considered with caution
(see PRECAUTIONS, General).
Postmarketing Reports
Voluntary reports of other adverse events temporally associated with the use of ATIVAN
(lorazepam) Injection that have been received since market introduction and that may
have no causal relationship with the use of ATIVAN Injection include the following:
acute brain syndrome, aggravation of pheochromocytoma, amnesia, apnea/respiratory
arrest, arrhythmia, bradycardia, brain edema, coagulation disorder, coma, convulsion,

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gastrointestinal hemorrhage, heart arrest/failure, heart block, liver damage, lung edema,
lung hemorrhage, nervousness, neuroleptic malignant syndrome, paralysis, pericardial
effusion, pneumothorax, pulmonary hypertension, tachycardia, thrombocytopenia,
urinary incontinence, ventricular arrhythmia.
Fatalities also have been reported, usually in patients on concomitant medications
(e.g., respiratory depressants) and/or with other medical conditions (e.g., obstructive
sleep apnea).
DRUG ABUSE AND DEPENDENCE
Controlled Substance Class
Lorazepam is a controlled substance in Schedule IV.
Abuse and Physical and Psychological Dependence
As with other benzodiazepines, ATIVAN Injection has a potential for abuse and may
lead to dependence. Physicians should be aware that repeated doses over a prolonged
period of time may result in physical and psychological dependence and withdrawal
symptoms, following abrupt discontinuance, similar in character to those noted with
barbiturates and alcohol.
OVERDOSAGE
Symptoms
Overdosage of benzodiazepines is usually manifested by varying degrees of central-
nervous-system depression, ranging from drowsiness to coma. In mild cases symptoms
include drowsiness, mental confusion and lethargy. In more serious examples, symptoms
may include ataxia, hypotonia, hypotension, hypnosis, stages one (1) to three (3) coma,
and, very rarely, death.
Treatment
Treatment of overdosage is mainly supportive until the drug is eliminated from the body.
Vital signs and fluid balance should be carefully monitored in conjunction with close
observation of the patient. An adequate airway should be maintained and assisted
respiration used as needed. With normally functioning kidneys, forced diuresis with
intravenous fluids and electrolytes may accelerate elimination of benzodiazepines from
the body. In addition, osmotic diuretics, such as mannitol, may be effective as adjunctive
measures. In more critical situations, renal dialysis and exchange blood transfusions may
be indicated. Lorazepam does not appear to be removed in significant quantities by
dialysis, although lorazepam glucuronide may be highly dialyzable. The value of dialysis
has not been adequately determined for lorazepam.
The benzodiazepine antagonist flumazenil may be used in hospitalized patients as an
adjunct to, not as a substitute for, proper management of benzodiazepine overdose. The
prescriber should be aware of a risk of seizure in association with flumazenil
treatment, particularly in long-term benzodiazepine users and in cyclic
antidepressant overdose. The complete flumazenil package insert including
CONTRAINDICATIONS, WARNINGS and PRECAUTIONS should be consulted
prior to use.

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DOSAGE AND ADMINISTRATION

ATIVAN must never be used without individualization of dosage particularly when used
with other medications capable of producing central-nervous-system depression.
EQUIPMENT NECESSARY TO MAINTAIN A PATENT AIRWAY SHOULD BE
IMMEDIATELY AVAILABLE PRIOR TO INTRAVENOUS ADMINISTRATION OF
LORAZEPAM (see WARNINGS).
Status Epilepticus
General Advice
Status epilepticus is a potentially life-threatening condition associated with a high risk of
permanent neurological impairment, if inadequately treated. The treatment of status,
however, requires far more than the administration of an anticonvulsant agent. It involves
observation and management of all parameters critical to maintaining vital function and
the capacity to provide support of those functions as required. Ventilatory support must
be readily available. The use of benzodiazepines, like ATIVAN Injection, is ordinarily
only an initial step of a complex and sustained intervention which may require additional
interventions, (e.g., concomitant intravenous administration of phenytoin). Because status
epilepticus may result from a correctable acute cause such as hypoglycemia,
hyponatremia, or other metabolic or toxic derangement, such an abnormality must be
immediately sought and corrected. Furthermore, patients who are susceptible to further
seizure episodes should receive adequate maintenance antiepileptic therapy.
Any health care professional who intends to treat a patient with status epilepticus should
be familiar with this package insert and the pertinent medical literature concerning
current concepts for the treatment of status epilepticus. A comprehensive review of the
considerations critical to the informed and prudent management of status epilepticus
cannot be provided in drug product labeling. The archival medical literature contains
many informative references on the management of status epilepticus, among them the
report of the working group on status epilepticus of the Epilepsy Foundation of America
“Treatment of Convulsive Status Epilepticus” (JAMA 1993; 270:854-859). As noted in
the report just cited, it may be useful to consult with a neurologist if a patient fails to
respond (e.g., fails to regain consciousness).
Intravenous Injection
For the treatment of status epilepticus, the usual recommended dose of ATIVAN
Injection is 4 mg given slowly (2 mg/min) for patients 18 years and older. If seizures
cease, no additional ATIVAN Injection is required. If seizures continue or recur after a
10- to 15-minute observation period, an additional 4 mg intravenous dose may be slowly
administered. Experience with further doses of ATIVAN is very limited. The usual
precautions in treating status epilepticus should be employed. An intravenous infusion
should be started, vital signs should be monitored, an unobstructed airway should be
maintained, and artificial ventilation equipment should be available.
Intramuscular Injection
IM ATIVAN is not preferred in the treatment of status epilepticus because therapeutic
lorazepam levels may not be reached as quickly as with IV administration. However,
when an intravenous port is not available, the IM route may prove useful (see
CLINICAL PHARMACOLOGY, Pharmacokinetics and Metabolism).

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Pediatric
The safety of ATIVAN in pediatric patients has not been established.
Preanesthetic
Intramuscular Injection
For the designated indications as a premedicant, the usual recommended dose of
lorazepam for intramuscular injection is 0.05 mg/kg up to a maximum of 4 mg. As with
all premedicant drugs, the dose should be individualized (see also CLINICAL
PHARMACOLOGY, WARNINGS, PRECAUTIONS, and ADVERSE
REACTIONS). Doses of other central-nervous-system-depressant drugs ordinarily
should be reduced (see PRECAUTIONS). For optimum effect, measured as lack of
recall, intramuscular lorazepam should be administered at least 2 hours before the
anticipated operative procedure. Narcotic analgesics should be administered at their
usual preoperative time.
There are insufficient data to support efficacy or make dosage recommendations for
intramuscular lorazepam in patients less than 18 years of age; therefore, such use is
not recommended.
Intravenous Injection
For the primary purpose of sedation and relief of anxiety, the usual recommended initial
dose of lorazepam for intravenous injection is 2 mg total, or 0.02 mg/lb (0.044 mg/kg),
whichever is smaller. This dose will suffice for sedating most adult patients and
ordinarily should not be exceeded in patients over 50 years of age. In those patients in
whom a greater likelihood of lack of recall for perioperative events would be beneficial,
larger doses as high as 0.05 mg/kg up to a total of 4 mg may be administered (see
CLINICAL PHARMACOLOGY, WARNINGS, PRECAUTIONS, and ADVERSE
REACTIONS). Doses of other injectable central-nervous-system-depressant drugs
ordinarily should be reduced (see PRECAUTIONS). For optimum effect, measured as
lack of recall, intravenous lorazepam should be administered 15 to 20 minutes before the
anticipated operative procedure.
There are insufficient data to support efficacy or make dosage recommendations for
intravenous lorazepam in patients less than 18 years of age; therefore, such use is
not recommended.
Dose Administration in Special Populations
Elderly Patients and Patients With Hepatic Disease
No dosage adjustments are needed in elderly patients and in patients with hepatic disease.
Patients With Renal Disease
For acute dose administration, adjustment is not needed for patients with renal disease.
However, in patients with renal disease, caution should be exercised if frequent doses are
given over relatively short periods of time (see also CLINICAL PHARMACOLOGY).
Dose Adjustment Due to Drug Interactions
The dose of ATIVAN should be reduced by 50% when coadministered with probenecid
or valproate (see PRECAUTIONS, Drug Interactions).
It may be necessary to increase the dose of ATIVAN in female patients who are
concomitantly taking oral contraceptives.

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Administration
When given intramuscularly, ATIVAN Injection, undiluted, should be injected deep in
the muscle mass.
Injectable ATIVAN can be used with atropine sulfate, narcotic analgesics, other
parenterally used analgesics, commonly used anesthetics, and muscle relaxants.
Immediately prior to intravenous use, ATIVAN Injection must be diluted with an equal
volume of compatible solution. Contents should be mixed thoroughly by gently inverting
the container repeatedly until a homogenous solution results. Do not shake vigorously, as
this will result in air entrapment. When properly diluted, the drug may be injected
directly into a vein or into the tubing of an existing intravenous infusion. The rate of
injection should not exceed 2.0 mg per minute.
Parenteral drug products should be inspected visually for particulate matter and
discoloration prior to administration, whenever solution and container permit. Do not use
if solution is discolored or contains a precipitate.
ATIVAN Injection is compatible for dilution purposes with the following solutions:
Sterile Water for Injection, USP; Sodium Chloride Injection, USP; 5% Dextrose
Injection, USP.
HOW SUPPLIED
ATIVAN (lorazepam) Injection is available in the following dosage strengths in
single-dose and multiple-dose vials:
2 mg per mL, NDC 60977-112-01, 25 x 1 mL vial
NDC 60977-112-02, 10 x 10 mL vial
4 mg per mL, NDC 60977-113-01, 25 x 1 mL vial
NDC 60977-113-02, 10 x 10 mL vial
For IM or IV injection.
Store in a refrigerator.
PROTECT FROM LIGHT.
Use carton to protect contents from light.
ATIVAN is a trademark of Biovail Laboratories, Ltd.

Manufactured by
Baxter Healthcare Corporation
Deerfield, IL 60015 USA
For Product Inquiry 1 800 ANA DRUG (1-800-262-3784)

MLT-01086/1.0

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