Pharmacy Update: Lorazepam - Critical Shortage
We are unfortunately once again facing a critical shortage of IV/IM lorazepam (2mL vials) and down to a limited supply (~2 weeks). We will be implementing an EPIC alert but wanted to also notify you directly due to the far reaching nature of this shortage.
For clinical scenarios that require IV/IM lorazepam critically (e.g. status epilepticus): please proceed with order. Otherwise, some options for managing this shortage include:
- Utilize PO lorazepam whenever possible (dosing conversion is 1:1)
- For ED/CCU/procedural areas – consider utilizing midazolam if able.
- For med/surg areas, consider IV diazepam (avoid IM due to erratic absorption) if able.
NOTE: There are no direct dosage conversions between the benzodiazepines because each has a distinct pharmacokinetic profile that dictates the agent's therapeutic use and dosing. Below are conservative recommendations and information regarding the onset and duration.
|
Agent |
Onset of Action (min) – Intravenous |
Duration of Action (hours) – Intravenous |
Onset of Action (min) – Intramuscular |
Duration of Action (hours) - Intramuscular |
Half Life (hours) |
Conservative estimate on equivalent dose1 |
|
Lorazepam |
5 to 20 |
6 to 8 |
15 to 30 |
6 to 8 |
8 to 15 |
1mg |
|
Diazepam |
1 to 5 |
0.3 to 0.5 |
Erratic/slow |
Erratic/slow |
20 to 120 |
5mg |
|
Midazolam |
1 to 5 |
< 2 |
5 to 15 |
< 2 |
3 to 11 |
2mg |