Lorazepam nausea/vomiting

Chlorpromazine, prochlorperazine, promethazine, methylprednisolone, lorazepam, metoclopramide, dexamethasone, or dronabinol may be used for adult patients. Around the clock dosing should be considered. The choice of specific agent should based on patient specific factors, including potential for adverse drug reactions, and cost. SSRIs are effective for breakthrough nausea and vomiting but they are not superior to the less expensive antiemetics above. 

The other toxicities of carboplatin are generally milder and better tolerated than those of cisplatin. Nausea and vomiting, though frequent, is less severe, shorter in duration, and more easily controlled with standard antiemetics (for example compazine, dexamethasone, lorazepam) than that following cisplatin treatment. Renal impairment is infrequent, though alopecia is common, especially with the paclitaxel-containing combinations. Neu-... 

HT3 antagonists are effective for acute nausea, but are not effective for anticipatory nausea, and efficacy is low for delayed nausea. Lorazepam is very effective for anticipatory nausea. Other agents used in chemotherapy-induced emesis are dopamine antagonists, scopolamine, and dronabinol. Antihistamines are generally less effective for chemotherapy-induced nausea and vomiting. 

E Lorazepam is most effective for anticipatory nausea and vomiting, or emesis that oaurs prior to chemotherapy administration. The antiemetic effects may be related to the sedative and anxiolytic properties of lorazepam. 5-HT3 antagonists and dopamine antagonists are poor choices because efficacy has not been shown in anticipatory nausea and vomiting. 

Benzodiazepines indirectly control nausea and vomiting. Lorazepam (Ativan) is the choice drug in this category and may be given with metoclopramide. 

Animal studies suggest that the benzodiazepines may possibly increase the metabolic activation and the toxicity of high doses of cyclophosphamide and ifosfamide. However, diazepam did not alter the pharmacokinetics of high-dose cyclophosphamide in a clinical study. Note also that lorazepam is widely used for chemotherapy-induced nausea and vomiting. 

Lorazepam approved uses treatment of anxiety, panic attacks, insomnia, chemotherapy-induced nausea and vomiting, alcohol withdrawal, treatment of seizures. Non-approved muscle spasms. 

Case 4 Ms D, a 20-year-old Caucasian female, presented with 6 days of nausea and vomiting. Her symptoms were unresponsive to lorazepam, ondansetron or prochlorperazine. Physical examination and basic laboratory test results were unremarkable, except for low potassium. An extensive medical workup was negative, including CT scans of the head, chest, abdomen and pelvis an esophagogastroduodenoscopy and a colonoscopy. Because she took up to nine hot showers daily, staff had to repeatedly remove her from the bathroom and put her in bed due to safety concerns. A psychiatry consult was requested to evaluate her compulsive bathing habits. 

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