Lorazepam dosage

Most physicians felt these symptoms were a reflection of the patient s anxiety disorder and not a manifestation of dependence. Their opinions were reinforced when resumption of lorazepam therapy resulted in symptom amelioration, suggesting recontrol of the patient s anxiety disorder. Rarely were these patients considered dependent, mainly because they had not escalated lorazepam dosage, or manifested any signs or symptoms of drug-seeking behavior. They appeared to be typical medical users of prescribed medication. 

However, lorazepam and oxazepam are relatively safe for older adults when given in normal dosages. Buspirone (BuSpar) also is a safe choice for older adults with anxiety because it does not cause excessive sedation, and the risk of falling is not as great. Before bus-pirone therapy is begun, benzodiazepines and sedatives and hypnotics are gradually withdrawn. Buspirone, unlike most of the benzodiazepines, must be taken regularly and is not effective on an as-needed basis. 

The benzodiazepines currently available for clinical use vary substantially in pharmacokinetics, acute euphoriant effects, and frequency of reported dependence. It is likely, therefore, than not all benzodiazepines have the same potential for abuse. Diazepam, lorazepam, and alprazolam may have greater abuse potential than chlordiazepoxide and clorazepate (Wolf et al. 1990). Similarly, oxazepam has been reported to produce low levels of abuse (Eliding 1978). Jaffe et al. (1983) found that in recently detoxified alcoholic patients, halazepam produces minimal euphoria even at a supratherapeutic dosage. The development of partial agonist and mixed agonist/antagonist compounds at the benzodiazepine receptor complex may offer an advantage over approved benzodiazepines for use in alcoholic patients. 

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. 

Most of the minor tranquilizers in the BZD exhibit similar clinical effects they differ primarily in their duration of action and in the dosage required to achieve the same effect. The BZDs are classified as short- (triazolam [Halcion]), intermediate- (alprazolam [Xanax] and lorazepam [Ativan]), and long-acting (chlordiazepoxide [Librium] and diazepam [Valium]). Of the various BZDs available in the United States in 2002, those primarily prescribed as anxiolytics and hypnotics include the intermediate- and long-acting variety. 

Akathisia has been reported in 16% of patients taking olanzapine (SEDA-21, 56). Three patients developed severe akathisia during treatment with olanzapine (20-25 mg/day) (87). In two, the akathisia resolved after withdrawal of olanzapine and in one of those olanzapine was well tolerated when reintroduced in combination with lorazepam. In the third patient, the akathisia was controlled by dosage reduction. A 33-year-old man with AIDS and a prior history of extrapyramidal symptoms with both typical antipsychotic drugs and risperidone developed dose-dependent akathisia with olanzapine 15-19 mg/day the akathisia responded to dosage reduction and beta-blockade (88). 

Patients receiving intravenous benzodiazepines must be monitored for respiratory depression, which may demand artificial ventilation during intensive treatment. Diazepam may cause more respiratory depression than lorazepam at equieffective dosages (SEDA-20, 59) and is contraindicated in neonates for this reason and because it produces unacceptably prolonged sedation (9). 

In a study conducted on 13 patients with chronic psychiatric conditions who had received therapeutic dosage of benzodiazepines for several months, Sramek et al.3 were able to detect diazepam (0.2-1.6 ng/mg), but alprazolam and lorazepam were not detected. Inspection of diazepam results were not suggestive of a correlation between dosage and hair concentration. 

The incidence and severity of vomiting depends on the dosage and route of administration of antineoplastic agents. Intravenous ondansetron (Zof-ran) plus dexamethasone and lorazepam is the most effective treatment available for prevention of severe vomiting due to antineoplastic agents (see also Figure 73). 

In addition to pharmacokinetic drug-drug interactions, pharmacodynamic effects have been reported as well. Halothane increases the susceptibility to ventricular arrhythmias under theophylline therapy as a result of increased sensitivity of the myocardium to endogenous catecholamine release by theophylUne. Ketamine lowers the theophyUine seizure threshold. Benzodiazepines Uke midazolam, diazepam, lorazepam, and Uurazepam increase the central nervous system concentration of adenosine, a potent central nervous system depressant. As theophyUine also blocks adenosine receptors, it counteracts benzodiazepine-induced sedation, resulting in increased dosage requirements for these compounds. ... 

It is very difficult to assess and compare the results of the very many studies of this interaction because of the differences between the tests, their duration, the dosages of the benzodiazepines and alcohol, whether given chronically or acutely, and a number of other variables. However, the overall picture seems to be that benzodiazepines and related drugs including diazepam, " alprazolam,bromazepam, brotizolam, chlo-rdiazepoxide, " clobazam, dipotassium clorazepate, flunitrazepam, flurazepam, loprazolam, " lorazepam, lormetazepam, medazepam, midazolam, nitrazepam, " " oxazepam, temazepam, " triazolam, and zopiclone enhance the effects of alcohol i.e. cause increased drowsiness, impaired performance and driving skills. 

The interactions of nefazodone with alprazolam, midazolam, triazolam and zopiclone are established and clinically important. The practical consequences are that the effects of alprazolam, midazolam and triazolam are expected to be increased but the extent is uncertain. Be alert for any evidence of any psychomotor impairment, drowsiness etc. and reduce the benzodiazepine dosage if necessary. More study is needed. Lorazepam does not interact with nefazodone. There seems to be no direct information about other benzodiazepines and related drugs. 

Established interactions but of uncertain clinical importance. Be alert for increases in the effects (sedation, antegrade amnesia) of adinazolam, lorazepam and possibly nitrazepam. Reduee the dosage as necessary. Note that adinazolam is no longer available.There seems to be no direct information about other benzodiazepines, but those that are metabolised like lorazepam and nitrazepam (e.g. oxazepam) may also interact. Temazepam does not appear to interact with probenecid. 

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