Lorazepam adverse effects

Pregabalin produced anxiolytic effects similar to lorazepam, alprazolam, and venlafaxine in acute trials. Sedation and dizziness were the most common adverse effects, and the dose should be tapered over 1 week upon discontinuation. 

Lorazepam Ativan Tablet 0.5, 1,2 mg Oral solution 2 rrig/rri Injection 2,4 mg/mL 2-40 mg/day in divided doses or one dose at bedtime. Dosage should be slowly adjusted up and down according to response and adverse effects. 

Although clozapine has been considered an alternate agent, as mentioned earlier there is also a risk with this agent ( 494, 495 and 496). An unusual adverse effect of clozapine, apparently unrelated to NMS, is hyperthermia in 10% to 15% of patients (usually 0.5°C to 1°C, but virtually never above 40°C [104°F]). This symptom usually occurs between the fifth and the fifteenth days of treatment, after which, temperature returns to normal. Benzodiazepines (e.g., lorazepam) have also been recommended to either avoid or at least minimize the dose of antipsychotic. 

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). 

Cimetidine can impair benzodiazepine metabolism and lead to adverse effects (SEDA-18, 43). In contrast, a few benzodiazepines are metabolized exclusively by glucuro-nide conjugation (lorazepam, oxazepam, temazepam), and are therefore unaffected by concomitant therapy with cimetidine and other oxidation inhibitors (123). 

Abecarnil is a partial agonist at the benzodiazepine -GABA receptor complex, and is used in generalized anxiety disorder. Its pharmacology suggests that it may be less likely to produce sedation and tolerance, but data thus far have not shown clear differences in its adverse effects from those of classical benzodiazepines, such as alprazolam, diazepam, and lorazepam. As expected, both acute adverse effects and tolerance are dose-related. 

Diazepam produces less sedation in cigarette smokers, and higher (not lower, as stated in SEDA-20) doses may be required for the same sedative or anxiolytic effect. Owing in part to its continued widespread use, several unusual adverse effects of diazepam continue to be reported. These include cases of urinary retention and compartment syndrome, which are not explicable by its pharmacology. On the other hand, accumulation of diazepam and attendant complications of obtundation and respiratory depression may be understood in terms of its long half-life, particularly in elderly people and medically ill patients. Caution about the intravenous use of diazepam comes from a study that showed cardiac dysrhythmias (mainly ventricular extra beats) in a quarter of oral surgery patients midazolam and lorazepam were much safer (1). 

In a multicenter, randomized, double-blind comparison of diazepam (0.15 mg/kg followed by phenytoin 18 mg/kg), lorazepam (0.1 mg/kg), phenobarbital (15 mg/kg), and phenytoin (18 mg/kg) in 518 patients with generalized convulsive status epilepticus, lorazepam was more effective than phenytoin and at least as effective as phenobarbital or diazepam plus phenytoin (1). Drug-related adverse effects did not differ significantly among the treatments and included hypoventilation (up to 17%), hypotension (up to 59%), and cardiac rhythm disturbances (up to 9%). 

Intramuscular lorazepam 4 mg has been compared with the combination of intramuscular haloperidol 10 mg + promethazine 50 mg in 200 emergency psychiatric patients with agitation, aggression, or violence (2). The treatments were comparably effective and well tolerated overall, but two patients who took lorazepam had moderate adverse effects one had worse bronchial asthma and one had nausea and dizziness. 

Lorazepam causes some rare adverse effects, including a manic-like reaction on withdrawal, delirium, and paradoxical precipitation of tonic seizures or myoclonus in children (SEDA-19, 35). It can both relieve and worsen behavioral disturbances in demented elderly patients (SEDA-20, 32). 

BZDs PROTEASE INHIBITORS t adverse effects, e.g. prolonged sedation Inhibition of CYP3A4-mediated metabolism of BZDs and buspirone Watch closely for t sedation 4 dose of sedative as necessaiy. Some recommend considering substituting long-acting for shorter-acting BZDs with less active metabolites (e.g. lorazepam for diazepam)... 

BZDs (NOT LORAZEPAM OR TEMAZEPAM) H2 RECEPTOR BLOCKERS -CIMETIDINE, RANITIDINE t efficacy and adverse effects of BZD, e.g. sedation Cimetidine is an inhibitor of CYP3A4, CYP2D6, CYP2C19 and CYP1A2 Not clinically significant for most patients. Conflicting information for some BZDs. Monitor more closely, and i dose if necessary... 

The antiemetic effect of combined intravenous ondansetron 8 mg, oral dexamethasone 20 mg, and oral lorazepam 0.5 mg was significantly better than that of intravenous metoclopramide 10 mg, dexamethasone 20 mg, and oral lorazepam 0.5 mg in 30 patients receiving chemotherapy for ovarian cancer in a randomized trial (23). All the antiemetics were given 30 minutes before and 6 hours after chemotherapy. Significantly more patients given metoclopramide (40% versus 13%) complained of adverse effects. The most frequent adverse effects with both regimens were sedation and headache. 

All narcotics are expected to have this problem. The most common side effects demonstrated with narcotics include decreased gastrointestinal motility and risk of hypotension. Lorazepam is the preferred sedative agent in the absence of pain owing to its fast onset of action, its lack of hemodynamic toxicities, and its low risk of metabolite accumulation in comparison with diazepam. Midazolam continuous infusion is a reasonable altemative, although more costly and requiring additional fluid, which may be detrimental in a patient predisposed to PDA. Muscle paralysis has been used to reduce ventilator fighting and the consequent comphcations. However, its role in RDS has diminished owing to adverse effects (e.g., edema and hypoventilation). If paralysis is induced, assessment of sedation and seizures is confounded. Consequently, concurrent phenobarbital serum concentrations of 40 mg/L are recommended. Independent of... 

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