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Ativan Drug Study

Lorazepam (Ativan) Overview

Lorazepam (Ativan) is a widely-used benzodiazepine known for its potent anxiolytic, sedative-hypnotic, and muscle relaxant properties. It is most effective due to its action on the central nervous system through the neurotransmitter GABA.

Generic Name:

Lorazepam (lor-a´ze-pam)

Brand Name:

Ativan

Classifications:

  • Central nervous system agent
  • Anxiolytic
  • Sedative-hypnotic
  • Benzodiazepine

Pregnancy Category:

D

Availability:

  • 0.5 mg, 1 mg, 2 mg tablets
  • 2 mg/mL oral solution
  • 2 mg/mL, 4 mg/mL injection

Actions:

Most potent of the available benzodiazepines. Effects (anxiolytic, sedative, hypnotic, and skeletal muscle relaxant) are mediated by the inhibitory neurotransmitter GABA. Action sites: thalamic, hypothalamic, and limbic levels of CNS.

Therapeutic Effects:

An antianxiety agent that also causes mild suppression of REM sleep, while increasing total sleep time.

Uses:

  • Management of anxiety disorders
  • Short-term relief of symptoms of anxiety
  • Preanesthetic medication to produce sedation and reduce anxiety and recall of events related to surgery
  • Management of status epilepticus

Contraindications:

  • Known sensitivity to benzodiazepines
  • Acute narrow-angle glaucoma
  • Primary depressive disorders or psychosis
  • Children under 12 years (PO preparation)
  • Coma, shock, acute alcohol intoxication
  • Pregnancy (category D), and lactation

Cautious Use:

  • Renal or hepatic impairment
  • Organic brain syndrome
  • Myasthenia gravis
  • Narrow-angle glaucoma
  • Suicidal tendency
  • GI disorders
  • Older adult and debilitated patients
  • Limited pulmonary reserve

Route & Dosage:

Antianxiety:

  • Adults: PO 2–6 mg/d in divided doses (max: 10 mg/d)
  • Geriatric: PO 0.5–1 mg/d (max: 2 mg/d)
  • Children: PO/IV 0.05 mg/kg q4–8h (max: 2 mg/dose)

Insomnia:

  • Adults: PO 2–4 mg at bedtime
  • Geriatric: PO 0.5–1 mg h.s.

Premedication:

  • Adults: IM 2–4 mg (0.05 mg/kg) at least 2 h before surgery; IV 0.044 mg/kg up to 2 mg 15–20 min before surgery
  • Children: PO/IV/IM 0.05 mg/kg (range: 0.02–0.09 mg/kg)

Status Epilepticus:

  • Adults: IV 4 mg injected slowly at 2 mg/min, may repeat dose once if inadequate response after 10 min
  • Children: IV 0.1 mg/kg slow IV over 2–5 min (max: 4 mg/dose), may repeat with 0.05 mg in 10–15 min if needed
  • Neonate: IV 0.05 mg/kg over 2–5 min, may repeat in 10–15 min

Administration:

Oral:

  • Increase the evening dose when a higher oral dosage is required, before increasing daytime doses.

Intramuscular:

  • Injected undiluted, deep into a large muscle mass.

Intravenous:

  • IV administration to neonates, infants, children: Verify the correct IV concentration and rate of infusion with the physician.
  • Patients >50 years old may have more profound and prolonged sedation with IV lorazepam (usual max: initial dose of 2 mg).

Preparation (Direct):

  • Prepare lorazepam immediately before use. Dilute with an equal volume of sterile water, D5W, or NS.
  • Administration (Direct): Inject directly into the vein or into IV infusion tubing at a rate not to exceed 2 mg/min and with repeated aspiration to confirm IV entry. Take extreme precautions to prevent intraarterial injection and perivascular extravasation.
  • Incompatibilities (Y-site): Idarubicin, Omeprazole, Ondansetron, Sargramostim, Sufentanil, TPN with Albumin.

Storage:

  • Keep parenteral preparation in the refrigerator; do not freeze.
  • Do not use a discolored solution or one with a precipitate.

Adverse Effects:

  • Body Whole: Usually disappears with continued medication or with reduced dosage.
  • CNS: Anterograde amnesia, drowsiness, sedation, dizziness, weakness, unsteadiness, disorientation, depression, sleep disturbance, restlessness, confusion, hallucinations.
  • CV: Hypertension or hypotension.
  • Spec Senses: Blurred vision, diplopia; depressed hearing.
  • GI: Nausea, vomiting, abdominal discomfort, anorexia.

Nursing Implications:

Assessment & Drug Effects:

  • Have equipment for maintaining a patent airway immediately available before starting IV administration.
  • IM or IV lorazepam injection of 2–4 mg is usually followed by a depth of drowsiness or sleepiness that permits the patient to respond to simple instructions whether the patient appears to be asleep or awake.
  • Supervise ambulation of older adult patients for at least 8 hours after lorazepam injection to prevent falling and injury.
  • Lab tests: Assess CBC and liver function tests periodically for patients on long-term therapy.
  • Supervise patient who exhibits depression with anxiety closely; the possibility of suicide exists, particularly when there is apparent improvement in mood.

Patient & Family Education:

  • Do not drive or engage in other hazardous activities for at least 24–48 hours after receiving an IM injection of lorazepam.
  • Do not drink large volumes of coffee. Anxiolytic effects of lorazepam can significantly be altered by caffeine.
  • Do not consume alcoholic beverages for at least 24–48 hours after an injection and avoid when taking an oral regimen.
  • Notify the physician if daytime psychomotor function is impaired; a change in regimen or drug may be needed.
  • Terminate the regimen gradually over a period of several days. Do not stop long-term therapy abruptly; withdrawal may be induced by feelings of panic, tonic-clonic seizures, tremors, abdominal and muscle cramps, sweating, and vomiting.
  • Do not self-medicate with OTC drugs; seek physician guidance.
  • Discuss discontinuation of the drug with the physician if you wish to become pregnant.
  • Do not breastfeed while taking this drug.

References

  1. Wong, E. K., Dunn, T. E., Beaver, B. P., Neronha, Z. J., & Chuu, A. (2023). Current Evidence Surrounding the Use of Lorazepam in the Critically Ill Patient. Current Emergency and Hospital Medicine Reports, 11, 26-34. Retrieved from https://link.springer.com/article/10.1007/s40138-023-00260-9
  2. Grgic, J., Grgic, I., Del Coso, J., Schoenfeld, B. J., & Pedisic, Z. (2021). Effects of Lorazepam Supplementation on Exercise Performance: An Umbrella Review. Journal of the International Society of Sports Nutrition, 18, 71. Retrieved from https://jissn.biomedcentral.com/articles/10.1186/s12970-021-00469-7
  3. SciTechDaily. (2023). Lorazepam Saves the World: New Additive in Medication Mix Could Revolutionize Anxiety Treatment. Retrieved from https://scitechdaily.com/lorazepam-saves-the-world-new-additive-in-medication-mix-could-revolutionize-anxiety-treatment/
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