Ataxia lorazepam

Lorazepam (Ativan) 0.5-2 mg prior to chemotherapy Most common Sedation, amnesia Rare Respiratory depression, ataxia, blurred vision, hallucinations, paradoxical reactions (weeping, emotional reactions)... 

Long half-life BZDs may increase the risk of daytime sedation, lethargy, cognitive impairment, and delirium, as well as falls and hip fractures ( 309, 310 and 311). Long-term use of flurazepam (30 mg per day) has been associated with an increased incidence of ataxia and hallucinations ( 312). However, short half-life BZDs also may cause serious adverse effects. Ataxia, depression, confusion, amnestic syndromes, and oversedation have been reported in elderly lorazepam users, and there is some evidence that short-acting BZDs may also increase the risk of falls (313, 314, 315, 316 and 317). 

Caution has been recommended when starting clozapine in patients taking benzodiazepines (SEDA-19,55). Three cases of delirium associated with clozapine and benzodiazepines (244) have been reported. There have been several reports of synergistic reactions, resulting in increased sedation and ataxia, when lorazepam was begun in patients already taking clozapine (245). 

There are at least 6 other cases of severe hypotension, respiratory depression or loss of consciousness in patients taking clozapine and flurazepam, lorazepam or diazepam, - " as well as other cases of marked sedation, hypersalivation, ataxia and delirium in patients taking lorazepam and clozapine. Two of these reports are iiom the same group of workers and it is not clear whether they are about the same or different patients. 

Lorazepam has been used to treat anxiety symptoms occurring in patients with neoplasm (7 ). This group of patients might be expected to be particularly vulnerable to adverse effects, but although minor side effects of dizziness, drowsiness, asthenia, and ataxia were frequently recorded, their clinical significance was considered to be negligible the side effects disappeared during the first week of treatment. 

There have been several clinical trials comparing lorazepam with diazepam or me-dazepam(13, 30, 52, 50 ). Side effects noted include drowsiness, dizziness, ataxia, weakness, gastrointestinal upset, dreams, blurred vision, sweating and heachache. 

Fifty acutely anxious and/or agitated patients were treated with intravenous lorazepam in a dose of 5—10 mg (16 ). Since sedation was required it was not considered a side effect in this situation. While the patients were sedated, hypotonia and ataxia were noted. Local toleration of the injections was good. When lorazepam was used intramuscularly as premedication there was impaired memory of cards presented pre-operatively. Over half the patients rated the injection as uncomfortable (23 ). Other clinical studies have paid little attention to the question of side effects (51, 4 ). 

---