A member of DOCS Education writes:
I am sedating a highly anxious 32-year-old female who is ASA 1. I prescribed her 5 mg diazepam to take the night before the appointment. The patient weighs 145lbs. Please confirm that her max dose of lorazepam is 5.8 mg.
Since I am practicing a single-dose protocol, should I administer 5 mg when she gets to the office? Is that sublingually or orally? The appointment is 4.5 hours long.
Dr. Anthony Feck, Dean of DOCS Education Faculty, writes:
Lorazepam is administered in the office the same way triazolam is—crushed up sublingually. Compared to triazolam, the onset is slightly longer; the duration of action is approximately three times longer; the amnesia slightly less; the potency is approximately one-fourth; and the efficacy is less. Lorazepam has an outstanding track record. In the DOCS Education sedation protocols the drug is well-suited for single-dose protocols that require three hours of sedation or more, sedation in 12- to 18-year-olds, and patients who take medications that have significant interactions with triazolam.
A member of DOCS Education writes:
This is my first time using lorazepam; is there anything I should keep in mind?
Dr. Anthony Feck, Dean of DOCS Education Faculty, adds:
Given your patient's weight, age and ASA status, the TOP Dose for lorazepam is 5.8 mg. TOP Dose only refers to the incremental protocol. Since you are doing a single-dose protocol, you must adhere to the maximum doses of that protocol, which would be 3 mg of lorazepam in a single dose. This maximum dose of lorazepam in a single dose would only be reserved for highly anxious patients, patients with a high degree of body fat, and patients with a known history of hyporesponse. Please refer to the doses and regimen for single-dose protocols listed in your OSD workbook.