The effective dose is 0.05-0.10 mg/kg, administered intravenously in 0.05 mg/kg increments over several minutes. The onset of effect has been in 2-3 minutes, and the duration has extended to 24 hours.
43 It has been effective in treatment of neonatal clinical seizures, whether as a second drug (after phenobarbital) or as a third drug (after phenobarbital and phenytoin). Lorazepam has been investigated in the newborn in several studies. Moreover, lorazepam appears less likely to produce respiratory depression or hypotension than does diazepam. The duration of action for lorazepam is generally 6-24 hours (i.e., longer than diazepam). Of importance, however, lorazepam is less lipophilic than diazepam, and thus lorazepam does not redistribute from brain as rapidly as diazepam. Lorazepam enters the brain rapidly and produces a pronounced anticonvulsant effect in less than 5 minutes. Lorazepam is a benzodiazepine anticonvulsant medication of proven efficacy in older infants and children. Thus benzodiazepines share the mechanistic problems related to GABA activation and chloride levels (see prior discussion) and the adverse effects associated with phenobarbital, including respiratory and, more rarely, cardiovascular depression. Like barbiturates, benzodiazepines act on the GABA receptor and its chloride channel, thus hyperpolarizing the neuron. Martin MBBS, FRACP, in Fanaroff and Martin's Neonatal-Perinatal Medicine, 2020 Benzodiazepines (Lorazepam, Diazepam, Midazolam)Īpproximately 20% or more of newborns with electrographic seizures do not respond to the sequential administration of phenobarbital and phenytoin.
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