pms-Lorazepam Dosage/Direction for Use

Dosing Considerations: pms-LORAZEPAM should always be prescribed at the lowest effective dose for the shortest duration possible.
pms-LORAZEPAM can produce withdrawal signs and symptoms or rebound phenomena following abrupt discontinuation or rapid dose reduction (see Withdrawal under Warnings; Dependence/Tolerance under Precautions). Abrupt discontinuation should be avoided and treatment - even if only of short duration - should be terminated by gradually tapering the dosage schedule under close monitoring. Withdrawal symptoms (e.g., rebound insomnia) can appear following cessation of recommended doses after as little as one week of therapy.
Tapering should be tailored to the specific patient. Special attention should be given to patients with a history of seizure.
If a patient experiences withdrawal signs and symptoms, consider postponing the taper or raising the benzodiazepine to the previous dosage prior to proceeding with a gradual taper.
Symptoms reported following discontinuation of benzodiazepines include: headache, anxiety, tension, depression, insomnia, restlessness, confusion, irritability, sweating, rebound phenomena, dysphoria, dizziness, derealization, depersonalization, hyperacusis, numbness/tingling of extremities, hypersensitivity to light, noise and physical contact/perceptual changes, involuntary movements, nausea, vomiting, diarrhea, loss of appetite, hallucinations/delirium, convulsions/seizures, tremor, abdominal cramps, myalgia, agitation, palpitations, tachycardia, panic attacks, vertigo, hyperreflexia, short-term memory loss, and hyperthermia. Convulsions/seizures may be more common in patients with pre-existing seizure disorders or who are taking other drugs that lower the convulsive threshold, such as antidepressants.
Renal or hepatic disease: The dose should be titrated should pms-LORAZEPAM be used in patients with mild to moderate hepatic or renal disease. In patients for whom prolonged therapy with pms-LORAZEPAM is indicated, periodic blood counts and liver function tests should be carried out.
When lorazepam is used in patients with mild to moderate hepatic or renal disease, the lowest effective dose should be considered since drug effect may be prolonged. (See Renal under Precautions.)
Geriatrics: For elderly and debilitated patients reduce the initial dose by approximately 50% and adjust the dosage as needed and tolerated. Geriatric patients in particular may be more sensitive to benzodiazepines (see Neurologic: Falls and Fractures under Precautions). Long-term use of pms-LORAZEPAM should be avoided in geriatric patients. Enhanced monitoring is recommended. (See Use in the Elderly under Precautions.)
Recommended Dose and Dosage Adjustment: The dosage and duration of therapy of pms-LORAZEPAM must be individualized and carefully titrated in order to avoid excessive sedation or mental and motor impairment.
As with other anxiolytic sedatives, short courses of treatment should usually be the rule for the symptomatic relief of disabling anxiety in psychoneurotic patients and the initial course of treatment should not last longer than one week without reassessment of the need for a limited extension.
Initially, not more than one week's supply of the drug should be provided, and automatic prescription renewals should not be allowed. Subsequent prescriptions, when required, should be limited to short courses of therapy. (See Withdrawal under Warnings; Dependence/Tolerance under Precautions.)
Generalized Anxiety Disorder: The recommended initial adult daily oral dosage is 2 mg in divided doses of 0.5, 0.5 and 1 mg, or of 1 mg and 1 mg. The daily dosage should be carefully increased or decreased by 0.5 mg depending upon tolerance and response. The usual daily dosage is 2 to 3 mg. However, the optimal dosage may range from 1 to 4 mg daily in individual patients. Usually, a daily dosage of 6 mg should not be exceeded.
In elderly and debilitated patients, the initial daily dose should not exceed 0.5 mg and should be very carefully and gradually adjusted, depending upon tolerance and response.
Excessive Anxiety Prior to Surgical Procedures: Adults: As with all premedicant drugs, the dose should be individualized. Doses of other central nervous system depressant drugs should be ordinarily reduced.
Health Canada has not authorized an indication for pediatric use.
Missed Dose: Patients who miss taking a dose should contact their healthcare provider for instructions.