1. Wean midazolam drip as tolerated (Preferably to 0.05-0.1 mg/kg/hr)

2. Begin lorazepam at 0.1-0.15 mg/kg Q8H PO

3. Discontinue versed drip over 48-72 hours

• After 2 doses of lorazepam have been given, reduce the midazolam infusion by 25% every 12 hours

• Try to maintain the same level of sedation

  • If patient appears under sedated when midazolam is decreased: increase lorazepam dose by 25% and continue to wean midazolam at 12 hour intervals as tolerated

  • If patient appears overly sedated: decrease midazolam infusion by 50% at q12h intervals

4. Order PRN dose of lorazepam at 1/2 scheduled dose when midazolam infusion is discontinued.

5. Daily calculate total lorazepam required (scheduled doses + all prn doses), divide this amount by 3 to get new scheduled lorazepam dose.

6. Keep q8h interval but decrease dose by 20% every 2-3 days as tolerated.

 When decreasing scheduled doses remember that lorazepam solution is 2 mg/ml so try to decrease by an amount that is measurable.  Alternate days between methadone and lorazepam if your patient is tapering from both agents.  This will allow you to assess from which agent the patient may be experiencing withdrawal symptoms.

 

Equivalent IV Midazolam and PO or IV Lorazepam Dose for Benzodiazepine Weaning Midazolam Drip Dose Starting Lorazepam Dose 0.05 mg/kg/hr 0.08 mg/kg q8h 0.075 mg/kg/hr 0.12 mg/kg q8h 0.1 mg/kg/hr 0.16 mg/kg q8h 0.125 mg/kg/hr 0.2 mg/kg q8h 0.15 mg/kg/hr 0.24 mg/kg q8h 0.2mg/kg/hr 0.32 mg/kg q8h

Calculations: ____mg/kg/hr x 24 hours x 0.2 (conversion factor for midazolam to lorazepam based on T ½)   ____mg/kg/day of lorazepam  ÷    3 doses/day  ____mg/kg q8h   (Weaning must be patient specific.  Some patients may tolerate a faster wean while others require a slower wean)