Lorazepam indications

Other sedative-hypnotic medications, such as barbiturates, may play a useful role in severe withdrawal from this group of drugs. For example, in a case series of GBL withdrawal, use of intravenous pentobarbital in the range of 1-2 mg/kg/hour lowered the total requirement for intravenous lorazepam (Sivilotti et al. 2001). Antipsychotic medications are often used to reduce psychotic agitation. However, because antipsychotic medications lower the seizure threshold and may contribute to loss of central control of temperature leading to hyperthermia or neuroleptic malignant syndrome (NMS), they are not indicated as first-line medications for GHB withdrawal delirium (Dyer and Roth 2001 McDaniel and Miotto 2001 Sharma et al. 2001). If anti-... 

With symptom-triggered therapy, medication is given only if symptoms emerge, resulting in shorter treatment duration, and avoidance of over sedation. A typical regimen would be lorazepam 2 mg administered every hour as needed when a structured assessment scale (e.g., Clinical Institute Withdrawal Assessment-Alcohol, Revised) indicates that symptoms are moderate to severe. Current guidelines recommend such individualized therapy over fixed-schedule therapy. 

Lorazepam The PK-PD modeling of the psychomotor and mnesic effects of a single 2 mg oral dose of lorazepam in healthy volunteers showed that the parameter values derived from PK/PD modeling, and especially the EC values, may provide sensitive indices that can be used, rather than the raw data derived from PD measurements, to compare CNS effects of benzodiazepines... 

The normal body temperature is 36.8°C. Babies under 6 months of age who have a higher temperature than 37.7°C should be referred on the same day. Babies over 6 months should be referred if their temperature is above 38.2°C. Babies who have had a temperature-related convulsion lasting 15 minutes or longer should receive pharmacotherapy in the form of either lorazepam, diazepam or clonazepam. Febrile convulsions in children usually cease spontaneously within 5-10 minutes and are rarely associated with significant sequelae and therefore long-term anticonvulsant prophylaxis is rarely indicated. Parents should be advised to seek professional advice when the child develops fever so as to prevent the occurrence of high body temperatures. 

All benzodiazepines are indicated in obsessive compulsive disorders. Diazepam and lorazepam are effective in status epilepticus, whereas chlordiazepoxide is indicated in alcohol withdrawal. 

Lorazepam is a short-acting benzodiazepine. Both short-acting and long-acting benzodiazepines, such as diazepam, may be indicated for short-term relief of severe anxiety. 

Lorazepam is a short-acting benzodiazepine indicated for use in relieving anxiety and insomnia. Lorazepam may also be administered perioperatively to alleviate pain and in status epilepticus. Imipramine is a tricyclic antidepressant, paroxetine is a selective serotonin re-uptake inhibitor, venlafaxine is a serotonin and adrenaline re-uptake inhibitor and moclobemide is a reversible monoamine oxidase inhibitor. Imipramine, paroxetine, venlafaxine and moclobemide are all classified as antidepressants. 

Other drugs are metabolised by Phase II synthetic reactions, catalysed typically by non-microsomal enzymes. Processes include acetylation, sulphation, glycine conjugation and methylation. Phase II reactions may be affected less frequently by ageing. Thus according to some studies, the elimination of isoniazid, rifampicin (rifampin), paracetamol (acetaminophen), valproic acid, salicylate, indomethacin, lorazepam, oxazepam, and temazepam is not altered with age. However, other studies have demonstrated a reduction in metabolism of lorazepam, paracetamol (acetaminophen), ketoprofen, naproxen, morphine, free valproic acid, and salicylate, indicating that the effect of age on conjugation reactions is variable. 

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). 

BZDs may exacerbate depression and possibly increase suicide risk. Case reports and clinical trials also indicate that BZD treatment of generalized anxiety and panic may result in emergence of depression (215, 216, 217, 218, 219, 220, 221, 222, 223, 224, 225 and 226). In some of these reports, depression is ill-defined, but in others, it met DSM-III criteria for a major depressive disorder, requiring treatment with an antidepressant ( 225, 226). Depression has been reported with a variety of BZDs (alprazolam, bromazepam, clonazepam, diazepam, lorazepam), but there is no evidence that one is more likely than another to cause or aggravate depressive illness. 

There is some evidence that higher than usual doses of lower potency BZDs may also be effective in treating PD ( 17, 25, 43, 81, 82, 83 and 84). For example, studies comparing alprazolam with lorazepam or diazepam indicate approximately equal efficacy ( 25, 43, 84, 85). In addition, there is evidence that higher than usual doses of diazepam, lorazepam, bromazepam, or clobazam may also block panic attacks. 

Whereas iithium has been the standard approach, increased complications in elderly patients, especially when there is compromise of the CNS, endocrine, or renal systems, makes this agent a less attractive choice. Lower doses (e.g., 150 to 300 mg) should be initiated, with many elderly patients achieving adequate response on total daily doses of lithium in the 450- to 600-mg range. If a more rapid response is necessary, low-dose high-potency antipsychotics can also be used in the early phases. Alternatively, a BZD, such as clonazepam or lorazepam, may be indicated (297). 

Antipsychotic drugs are also indicated for schizoaffective disorders, which share characteristics of both schizophrenia and affective disorders. No fundamental difference between these two diagnoses has been reliably demonstrated. They are part of a continuum with bipolar psychotic disorder. The psychotic aspects of the illness require treatment with antipsychotic drugs, which may be used with other drugs such as antidepressants, lithium, or valproic acid. The manic phase in bipolar affective disorder often requires treatment with antipsychotic agents, although lithium or valproic acid supplemented with high-potency benzodiazepines (eg, lorazepam or clonazepam) may suffice in milder cases. Recent controlled trials support the efficacy of monotherapy with atypical antipsychotics in the acute phase (up to 4 weeks) of mania, and olanzapine and quetiapine has been approved for this indication. 

Diazepam, lorazepam, and midazolam are used in anesthetic procedures. The primary indication is for premedication because of their sedative and amnestic properties. (The basic pharmacology of benzodiazepines is discussed in Chapter 22 Sedative-Hypnotic Drugs.) Diazepam and lorazepam are not water-soluble, and their intravenous use necessitates nonaqueous vehicles, which may cause local irritation. Midazolam formulations are water-soluble and thus produce less irritation, but the drug becomes lipid-soluble at physiologic pH and readily crosses the blood-brain barrier. 

As well as compounds specifically indicated for the short-term treatment of insomnia, some benzodiazepines used primarily as anxiolytics have found extensive usage as symptomatic remedies for insomnia in anxious individuals. Examples include oxazepam, lorazepam, and diazepam. Patterns of use vary from country to country and at different times. 

Indications and use. Lithium carbonate is effective treatment in > 75% of episodes of acute mania or hypomania. Because its therapeutic action takes 2-3 weeks to develop, lithium is generally used in combination with a benzodiazepine such as lorazepam or diazepam (or with an antipsychotic agent where there are also psychotic features). 

When substances that themselves bind to specific sites on SA are added to the mobile phase, competitive displacements, that is, a lowering of k and a, are not the only possibilities. There is also the potential for an allosteric interaction to occur in which the affinity of the protein for the solute is increased by the addition of the modifier. For example, the addition of 10 jiM (S)-WAR to the mobile phase increased the k of the S-enantiomers of lorazepam and lorazepam hemisuccinate by 4 and 72%, respectively (113). The k s of the R-enantiomers were not affected and, therefore, the observed a s increased by 5 and 76%, respectively. These results not only increased the chromatographic separation of the respective enantiomers, but also indicated that there was an allosteric interaction between WAR and S)-Iorazepam and (S)-lorazepam hemisuccinate. 

The metabolism of lorazepam (e.g., Ativan), oxazepam (e.g., Serax), and temazepam (e.g., Restoril) are not likely to be affected, and one of these agents may be preferred when a benzodiazepine is indicated in a patient being treated with cimetidine. The experience with ranitidine (e.g., Zantac), famotidine (Pepcid), and nizatidine (Axid) suggests that these agents are not likely to inhibit hepatic enzyme systems, and these other histamine H2-receptor antagonists are less likely than cimetidine to interact with other drugs that are metabolized via these pathways. 

For ingestion of smaller amounts or if treatment has been delayed, activated charcoal and catharsis are indicated. Seizures can be treated with intravenous benzodiazepines (diazepam or lorazepam) phenytoin or phenobarbital may be helpful for recurrent seizures. No specific antidotes for pyrethroid-induced neurotoxic effects have been approved for use in humans. Spontaneous recovery usually occurs with mild or moderate intoxication. 

Exposed skin should be washed promptly with soap and water. Dermal application of vitamin E oil preparations may be used for both prophylaxis and treatment of paresthesia. Eor contact with eyes, eyes should be flushed immediately and for an extended period with generous amounts of clean water or saline. Gastric lavage is indicated if patient has ingested a large amount of pyrethroids and can be treated soon after exposure. Eor ingestion of smaller amounts or if treatment has been delayed, activated charcoal and catharsis are indicated. Seizures can be treated with intravenous benzodiazepines (diazepam or lorazepam) phenytoin or phenobarbital may be helpful for recurrent seizures. No specific antidotes for pyrethroid-induced neurotoxic effects have been approved for use in humans. Spontaneous recovery usually occurs with mild or moderate intoxication. 

Lorazepam (2 to 3 mg/day) is indicated for the management of anxiety disorders or for the short-term relief of the symptoms of anxiety or anxiety associated with depressive symptoms. In addition, it may be used as a preanesthetic medication producing sedation, relief of anxiety, and a decreased ability to recall events related to surgery. 

In treatment-resistant cases, benzodiazepines, either long-acting (diazepam, clonazepam, and chlordiazepoxide) or short-acting (alprazolam, oxazepam, and lorazepam) may be used when the patient does not have a history of addictive behavior. Also, they can be combined with SNRIs/SSRIs in the first weeks of treatment before the onset of the therapeutic effects of the latter. Benzodiazepines as monotherapy may not be as robust as assumed. Among patients responding to treatment, less than two-thirds will go into remission, and a number of studies have indicated, despite early improvements in anxiety symptoms, that the effect of benzodiazepines may not be different from placebo after 4-6 weeks of treatment. 

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