Ativan, also known by its generic name lorazepam, is a benzodiazepine medication used primarily for the treatment of anxiety and status epilepticus.
Other uses include perioperative sedation induction and anterograde amnesia. Intravenous it has
replaced intravenous diazepam as the drug of choice for the treatment of status epilepticus because it persists in the CSF longer than diazepam.
Some clinicians also prefer it over chlordiazepoxide or diazepam for controlling anxiety and agitation during ethanol withdrawal because Lorazepam is not metabolized to active metabolites.
Chemically Identification
Chemically Lorazepam is identified as 7-chloro-5- (o-chlorophenyl)-1, 3-dihydro-3-hydroxy-2H-1, 4 benzodiazepine 2one.
FDA APPROVAL
It was approved by the FDA in September 1977.
MECHANISAM OF ACTION
The action is mediated through the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). Lorazepam (Ativan) works by enhancing the inhibitory effects of GABA in the brain, leading to reduced neural activity. This results in its calming, sedative, anxiolytic, anticonvulsant, and muscle relaxant effects. These properties make it useful for treating anxiety disorders, providing sedation before procedures, managing seizures, and relieving muscle spasms.
USES
Lorazepam is primarily indicated in conditions like:
- Acute nausea and vomiting
- Acute panic attacks
- All forms of epilepsy
- Anxiety
- The Anxiety associated with obsessional states
- Anxiety associated with phobic states
- Convulsions
- Insomnia
- Myoclonus
- Pre-operative anxiety
- Psychotic illness
- Sedation with amnesia
- Status epilepticus
- It can also be given in adjunctive therapy as an alternative drug of choice in Premedication.
SIDE EFFECTS
Lorazepam produces potentially life-threatening effects which include:
- Acute anaphylactic reactions, which are responsible for the discontinuation of Lorazepam therapy.
The signs and symptoms that are produced after the acute overdosage of Lorazepam include:
- Drowsiness
- Ataxia
- CNS depression
- Dysarthria
The symptomatic adverse reactions produced by Lorazepam are more or less tolerable and if they become severe, they can be treated symptomatically, these include
- Dizziness
- Headache
- Drowsiness
- Nausea
- Blurred vision
- Confusion
CONTRAINDICATIONS
Lorazepam is contraindicated in conditions like Hypersensitivity.
WARNINGS
Perform periodic blood counts and liver function tests during long term therapy with lorazepam. It should be used with caution in patients if increased salivation cause respiratory difficulty, because it may produce an increase in salivation. Give least amount of drug to patients in whom depression accompanies anxiety and suicidal tendencies may be present. It should be used with caution (if it contains tartrazine)in patients with aspirin hypersensitivity because it may cause allergic reaction (including bronchial asthma).
High Risk Groups
- Drug should not be given to Paediatrics
- Pregnant Mothers
- patients suffering from Kidney dysfunction
- patients suffering from Liver Malfunction and Neonates
If prescribing authority justifies the benefits of the drug against the possible damages he/she should reevaluate them and consult the reference material and previous studies.
Administration Forms
- Oral Tablets: Taken by mouth with or without food.
- Intramuscular Injection (IM): Administered by a healthcare professional into a muscle.
- Intravenous Injection (IV): Administered by a healthcare professional into a vein.
- Oral Solution: Taken by mouth, usually measured with a special dose-measuring device.
DOSAGE
1. Anxiety Disorders
Adults:
- Oral Tablets:
- Typical initial dose: 2 to 3 mg per day, divided into 2 or 3 doses.
- Maintenance dose: 1 to 2 mg two to three times daily.
- Elderly or Debilitated Patients:
- Initial dose: 1 to 2 mg per day in divided doses, adjusted as needed.
2. Insomnia Due to Anxiety or Transient Situational Stress
Adults:
- Oral Tablets:
- Typical dose: 2 to 4 mg at bedtime.
3. Preoperative Sedation
Adults:
- Oral Tablets:
- 2 to 4 mg taken the night before surgery.
- 2 to 4 mg taken 1 to 2 hours before the procedure.
- Intramuscular Injection (IM):
- 0.05 mg/kg (not to exceed 4 mg) administered 2 hours before surgery.
4. Status Epilepticus
Adults:
- Intravenous Injection (IV):
- Initial dose: 4 mg given slowly (2 mg/min).
- If seizures persist after 10-15 minutes, a second dose of 4 mg may be administered.
INTERACTIONS
Lorazepam can interact with other medications, such as other CNS depressants, alcohol, and certain antidepressants. Always inform your healthcare provider about all the medications and supplements you are taking.
FAQS
Can Ativan be taken during pregnancy or breastfeeding?
Ativan should be used during pregnancy only if clearly needed and prescribed by a healthcare provider. It can pass into breast milk and may affect a nursing infant, so breastfeeding while taking Ativan is not recommended.
Can Ativan be addictive?
Yes, Ativan can cause physical and psychological dependence, especially with prolonged use or high doses. It should be used at the lowest effective dose for the shortest duration possible.
How should I stop taking Ativan?
Do not stop taking Ativan suddenly without consulting your healthcare provider. The dose should be gradually reduced under medical supervision to prevent withdrawal symptoms.
Are there any special precautions I should take while using Ativan?
- Avoid driving or operating heavy machinery until you know how Ativan affects you, as it can cause drowsiness and dizziness.
Can children take Ativan?
Ativan can be prescribed for children, particularly for managing seizures, but the dosage will be adjusted based on the child’s weight and specific condition. Always follow the healthcare provider’s instructions.
Can I drink alcohol while taking Ativan?
No, you should avoid alcohol while taking Ativan as it can increase the risk of severe side effects like drowsiness, dizziness, and respiratory depression.
Disclaimer
The information provided on this platform is for general informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health providers with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this platform.
