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Indications Other considerations
Excitatory symptoms
Anxiety/Agitation
Neuromuscular excitation
Seizures
Parenteral vs. PO administration based
on signs and symptom severity and
drug availability (eg, parenteral BZD
shortages). IM administration allows
for administration in agitated patients
without IV access.
Lorazepam has very slow IM onset
(15–30 min)
Midazolam has very rapid IV onset,
allowing for easy titration, and a relatively
fast IM onset
If psychosis is primary symptom,
antipsychotics should be considered
primarily or adjunctively
BZD shortages or contraindications
Patient not responding to escalating doses
of BZDs
Severe sympathomimetic intoxication
High oral bioavailability; PO dosing can
be similar to parenteral dosing
Onset of effects, while slower than IV, is
still fairly quick compared to other PO
medications
For critically ill patients in the intensive
care unit (ICU)
Severe sympathomimetic intoxication not
responding to other agents
Patients can be administered BZDs, PBO,
and/or propofol concomitantly
Intubation is almost always required for
propofol administration
Anxiety Useful medication adjunct to BZDs
Maintain hydration to avoid orthostatic
symptoms
For critically ill patients in the ED or ICU
as primary or secondary medication for
sedation
Useful medication adjunct to BZDs or
other sedation agents
Onset of effects generally 30–60 min
Sedation without impairments in
ventilation
