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2. Injectable Benzodiazepines: Focus on Lorazepam
Michael D. Jibson, MD, PhD
Professor of Psychiatry
Director of Residency Education
Associate Chair for Education and Academic Affairs
University of Michigan

3. Advantages of IM Administration
Rapid onset and time to peak concentration (compared to oral)
Battaglia J, Pharmacological Management of Acute Agitation, J. Drugs (2005) 65: 1207; doi: /
Wilson MP, et al. The Psychopharmacology of Agitation: Consensus Statement of the American Association for Emergency Psychiatry Project BETA Psychopharmacology Workgroup, West J Emerg Med (2012) 13: 26;

4. Advantages of IM Administration
Rapid onset and time to peak concentration (compared to oral)
Ease of administration (compared to IV)
Relative safety (compared to IV)
Battaglia J, Pharmacological Management of Acute Agitation, J. Drugs (2005) 65: 1207; doi: /
Wilson MP, et al. The Psychopharmacology of Agitation: Consensus Statement of the American Association for Emergency Psychiatry Project BETA Psychopharmacology Workgroup, West J Emerg Med (2012) 13: 26;

5. Disadvantages of IM Administration
Poor patient acceptance
Question of safety with injectable olanzapine
Battaglia J, Pharmacological Management of Acute Agitation, J. Drugs (2005) 65: 1207; doi: /
Wilson MP, et al. The Psychopharmacology of Agitation: Consensus Statement of the American Association for Emergency Psychiatry Project BETA Psychopharmacology Workgroup, West J Emerg Med (2012) 13: 26;

6. LRZ Lorazepam Only BZ available for IM administration
Not FDA approved for acute agitation
LRZ
Battaglia J, Pharmacological Management of Acute Agitation, J. Drugs (2005) 65: 1207; doi: /
Wilson MP, et al. The Psychopharmacology of Agitation: Consensus Statement of the American Association for Emergency Psychiatry Project BETA Psychopharmacology Workgroup, West J Emerg Med (2012) 13: 26;

7. LRZ Lorazepam Only BZ available for IM administration
Not FDA approved for acute agitation
Dose range: 1-2 mg q 30 min - 2 hrs.
Average dose: 2-6 mg/day
Maximum recommended dose: 12 mg/12 hrs.
LRZ
Battaglia J, Pharmacological Management of Acute Agitation, J. Drugs (2005) 65: 1207; doi: /
Wilson MP, et al. The Psychopharmacology of Agitation: Consensus Statement of the American Association for Emergency Psychiatry Project BETA Psychopharmacology Workgroup, West J Emerg Med (2012) 13: 26;

8. LRZ Lorazepam Only BZ available for IM administration
Not FDA approved for acute agitation
Dose range: 1-2 mg q 30 min - 2 hrs.
Average dose: 2-6 mg/day
Maximum recommended dose: 12 mg/12 hrs.
Time to peak concentration: 30 min
LRZ
Battaglia J, Pharmacological Management of Acute Agitation, J. Drugs (2005) 65: 1207; doi: /
Wilson MP, et al. The Psychopharmacology of Agitation: Consensus Statement of the American Association for Emergency Psychiatry Project BETA Psychopharmacology Workgroup, West J Emerg Med (2012) 13: 26;

9. Key Points
IM lorazepam

10. Key Points IM lorazepam
The only benzodiazepine available for IM administration
Don’t combine it with IM olanzapine

11. Key Points IM lorazepam
The only benzodiazepine available for IM administration
Don’t combine it with IM olanzapine
Dose range: 1-2 mg q 30 min - 2 hrs.
Maximum recommended dose: 12 mg/12 hrs.

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