Learning Objective Summarize the safety and treatment-escalation outcomes associated with reduced-dose lorazepam in adult patients with status epilepticus (SE) at an academic medical center.
Background Guideline recommended dosing of intravenous (IV) lorazepam for SE is 0.1 mg/kg (max 4 mg). A reduced dose of 2 mg is sometimes used to mitigate safety concerns. The objective was to evaluate the efficacy and safety of reduced dose lorazepam for SE management.
Methods This single-center, retrospective analysis was conducted at a tertiary academic medical center. Adult patients were included if they were diagnosed with SE and treated with at least one dose of IV lorazepam during admission between January 2020 to March 2025. Patients were excluded for pregnancy, IV access issues, unclear seizure diagnosis, or seizing out of the hospital. The primary outcome was the percentage of patients that required more than one dose of lorazepam for SE within 20 minutes. Secondary outcomes included the percentage of patients who required second- or third-line agents, total lorazepam doses within 40 minutes of initial treatment, time between first and second dose, and rates of adverse events associated with uncontrolled SE, including incidence of intubation, aspiration events, or cardiac arrhythmias, within 24 hours of initial lorazepam dose. Descriptive statistics were used to analyze baseline characteristics and outcomes.
Results Of 287 patients identified, 80 and 6 patients were included in the 2 mg and 4 mg groups, respectively. The primary outcome was observed in 10 (12.5%) in the 2 mg group and 3 (50%) in the 4 mg group. 32.5% in the 2 mg and 66.7% in the 4 mg group required additional agents. The median number of lorazepam doses within 40 minutes of initial dose was 1 in the 2 mg group and 1.5 in the 4 mg group. If initial dose failed, time between first and second doses of lorazepam was 7.5 minutes in the 2 mg group and 4.7 minutes in the 4 mg group. Rates of intubation, aspiration events, and cardiac arrhythmias were 13.8%, 11.3%, and 0% in the 2 mg group and 33.3%, 0%, and 0% in the 4 mg group, respectively.
Conclusions This study characterizes the institutional prescribing patterns and assesses the efficacy and safety of reduced dose lorazepam for the initial management of SE at an academic medical center.
Self-Assessment Question True or False – Patients in the 2 mg group required more lorazepam doses in the first 40 minutes compared to those in the 4 mg group.
