Lorazepam

Provider Level

AEMT/RN/Paramedic

Class

Benzodiazepine, Anticonvulsant, Sedative-Hypnotic

Mechanism of Action

Enhances the inhibitory effects of gamma-aminobutyric acid (GABA) at the GABA-A receptor, producing generalized central nervous system depression, sedation, anxiolysis, amnesia, and suppression of seizure activity.

Indications

Status epilepticus, severe anxiety, chemical restraint for severe agitation, sedation prior to procedures such as transcutaneous pacing or synchronized cardioversion.

Contraindications

Known hypersensitivity to benzodiazepines, acute narrow-angle glaucoma, severe respiratory depression, shock, or coma (unless seizing).

Routes

IV, IM, IO

Onset / Duration

Onset: 1 to 5 minutes (IV/IO), 15 to 30 minutes (IM). Duration: 6 to 8 hours.

Adverse Effects

Respiratory depression, apnea, hypotension, bradycardia, drowsiness, confusion, ataxia, paradoxical agitation, and injection site reaction.

Precautions & Interactions

Use caution in elderly patients, patients with renal or hepatic impairment, and those who have ingested alcohol or other CNS depressants. Continuous monitoring of airway, respiratory status, and hemodynamics is required.

Special Considerations

Authorized for AEMT, RN, and Paramedic levels. Always maintain immediate access to advanced airway equipment and ventilation support. Flumazenil may be considered for reversal but is rarely used in prehospital seizure management. Medication typically requires refrigeration but may be kept at room temperature for specified limited periods according to manufacturer and agency guidelines.