Lorazepam aggression

Brief Severe Agitation. Acute management of severe agitation with physical aggression requires more definitive treatment. The first choice is haloperidol given in low doses (0.25-1 mg) as needed. Lorazepam can also be helpful if used briefly. Risperidone, olanzapine, quetiapine, or trazodone can also be used but are not available in injectable forms. 

Benzodiazepines. Benzodiazepines have not been well studied in patients with Clnster B personality disorders however, they do appear to be used on a relatively common basis. There are two scenarios in which benzodiazepines have been used to treat BPD. First, they have been used on an as-needed basis in the inpatient setting to manage severe agitation and aggression. Lorazepam (Ativan) is often preferred because it can be administered either orally or by injection. Usually, 0.5-2mg of lorazepam can help to cahn an agitated patient with BPD. This can then be repeated as needed every 2-A hours, though care should be taken not to overly sedate the patient. 

FIGURE 50.3 Childhood aggression or agitation pharmacological approach. DPH, diphenhydramine CLON, clonidine LZP, lorazepam CLZ, clonazepam HAL, haloperidol DRO, droperidol. 

Lorazepam. Lorazepam has been increasingly studied for control of psychotic aggressivity ( 157,158, 159,160, 161,162, 163,164, 165,166 and 167). One reason is that, of all the BZDs available in parenteral form, lorazepam has a pharmacokinetic profile (quick, reliable absorption) that makes it particularly suitable for this type of use. Open, retrospective, and controlled studies indicate that oral or parenteral lorazepam added to an antipsychotic controls disruptive behavior safely and effectively for most patients. The combination may also permit an overall reduction of the antipsychotic dose, although this assumption requires further study ( 162, 164, 166). 

Short-term aggressive dosing with BZDs may preclude the need for antipsychotics. Thus, lorazepam (1 to 2 mg) given every 2 to 4 hours, with doses up to 12 mg/day, has shown promise alternatively, clonazepam may also be used. 

Similarly, BZDs are used for insomnia but are best reserved for short-term use. They are also used to assist withdrawal from alcohol, where a long elimination half-life drug is best. In acute psychotic states short-term use of a high-potency drug, such as lorazepam, can be helpful in managing acute agitation or aggression. 

S.E. File, Effects of neonatal administration of diazepam and lorazepam on performance of adolescent rats in tests of anxiety, aggression, learning and convulsions, Neurobehav. Toxicol. Teratol., 8(3) (1986) 301-306. 

TCAs, together with neuroleptics should be avoided as they may aggravate psychotic symptoms and potentiate any anticholinergic side effects. In the case of the very aggressive patient, parenteral administration of lorazepam or diazepam will usually be sufficient to enable the patient to be managed. 

Bond A, Lader M. Differential effects of oxazepam and lorazepam on aggressive responding. Psychopharmacology (Berl) 1988 95(3) 369-73. 

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 disinhibits aggression more than its chemically and kinetically similar analogue oxazepam (8). 

The anxiolytic effects of lorazepam and possibly chlordiazepoxide may be opposed by alcohol. Alprazolam and alcohol together may possibly increase behavioural aggression. Similarly, flunitrazepam abuse can cause violent behaviour, impulsive decision-making and anterograde amnesia a report looking at violent crimes committed by abusers of flunitrazepam found that alcohol was almost always also present. Alcoholic drinks also enhance the effects of flunitrazepam when it is used as a date rape drug. ... 

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