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Lorazepam tolerance

First, optimize current mood stabilizer or initiate mood-stabilizing medication lithium,0 valproate,0 or carba-mazepine0 Consider adding a benzodiazepine (lorazepam or clonazepam) for short-term adjunctive treatment of agitation or insomnia if needed Alternative medication treatment options carbam-azepine0 if patient does not respond or tolerate, consider atypical antipsychotic (e.g., olanzapine, quetiapine, risperidone) or oxcarbazepine. [Pg.777]

Benzodiazepines. Like the barbiturates, benzodiazepines bind to the GABA receptor and are therefore cross-tolerant with alcohol. As a result, they also make suitable replacement medications for alcohol and are widely used for alcohol detoxification. Theoretically, any benzodiazepine can be used to treat alcohol withdrawal. However, short-acting benzodiazepines such as alprazolam (Xanax) are often avoided because breakthrough withdrawal may occur between doses. Intermediate to long-acting benzodiazepines including chlordiazepoxide (Librium), diazepam (Valium), oxazepam (Serax), lorazepam (Ativan), and clonazepam (Klonopin) are more commonly utilized. [Pg.193]

Benzodiazepines should be used with caution in dementia patients. Used improperly, they can disinhibit patients and worsen behavior, or they can accumulate and lead to a state of intoxication. To minimize the risk of accumulation, benzodiazepines that are easily metabolized are preferred for elderly patients. Specifically, lorazepam (Ativan) and oxazepam (Serax) are easier for elderly patients to tolerate than other benzodiazepines. [Pg.302]

Anxiety. Like psychosis, choosing a medication to treat anxiety in demented patients depends in large part on whether the anxiety is acute or longstanding. Acute severe anxiety requires rapid relief. For this, we recommend a benzodiazepine. Our first choice is lorazepam (Ativan) that is given as needed at 0.25-0.5 mg per dose. We prefer lorazepam because elderly patients tolerate it well (i.e., they metabolize it easily), and it is available in both oral and injectable forms. Oxazepam (Serax) is another benzodiazepine that older patients metabolize easily, but it is only available in oral form. When using benzodiazepines, be careful that your patients do not become overly sedated or delirious. [Pg.309]

The BZs are all metabolized in the liver via the hepatic cytochrome P450 (CYP) enzymes through one or both of the following pathways phase I oxidation and dealkylation, and/or phase II conjugation to glucuron-ides, sulfates, and acetylated compounds. Diazepam, chlordiazepoxide, and flurazepam all undergo both phase 1 and phase 11 metabolism. Lorazepam, lorme-tazepam, oxazepam, and temazepam are all metabolized by phase 11 alone and are better tolerated by patients with liver impairment. [Pg.343]

Fieve RR, Platman SR, Plutchik RR The use of lithium in affective disorders, I acute endogenous depression. Am J Psychiatry 125 79-83, 1968 Fieve RR, Kumbaraci T, Dunner DL Lithium prophylaxis of depression in bipolar I, bipolar II, and unipolar patients. Am J Psychiatry 133 925-930, 1976 File SE Rapid development of tolerance to the sedative effects of lorazepam and triazolam in rats. Psychopharmacology 73 240-245, 1981... [Pg.635]

There are several studies that combined lithium with other treatments such as antipsychotics, anticonvulsants (e.g., CBZ, VPA), calcium channel blockers (e.g., verapamil), or BZDs (e.g., lorazepam). Generally, in partial responders, the addition of these medications was beneficial and well tolerated. [Pg.195]

In the management of anxiety, the cumulative effects of longer half-life BZDs often result in excessive sleepiness, apathetic states, and confusion (with or without paradoxical agitation). Thus, short- and intermediate-acting agents such as oxazepam, lorazepam, and alprazolam are preferable. Lower doses (e g., 0.5 to 1.0 mg of lorazepam 0.25 to 0.5 mg of alprazolam) are preferable. Agents with very short half-lives, such as midazolam and triazolam, are not well tolerated, especially in those with more severe neurocognitive disruption. In this context, low-dose antipsychotics were found more effective than lorazepam in the treatment of AIDS-related delirium (495). [Pg.302]

Like reaction time tests, nearly all studies have reported that acute administration of benzodiazepines impair performance on the DSST. Lorazepam (1 to 9 mg),125,130,142,147-149 triazolam (0.25 to 0.75 mg),132,134,135,148,150-153 alprazolam (0.5 to 4 mg),129,147 temazepam (15 to 60 mg),119,150 diazepam (5 to 10 mg),147,154 clonazepam,155 and estazolam (1 to 4 mg)152 have been shown to impair response speed and/or accuracy on the DSST in a dose-related manner. However, Kelly et al.156 reported that diazepam (5 or 10 mg) had no effect on DSST performance. It is unlikely that low doses of diazepam accounted for the lack of effect, as suggested by Kelly et al.,156 because numerous studies have reported DSST impairment after 10 mg diazepam.7 In a test similar to the DSST symbol copying, Saano et al.125 reported no effect of diazepam (5 mg) and lorazepam (1 mg). Acute triazolam (0.375 mg) administration decreased the number of trials completed on the DSST task, but tolerance to this decrement developed with each of three subsequent doses.137... [Pg.75]

Several members of the benzodiazepine group are effective in treating epilepsy, but most are limited because of problems with sedation and tolerance. Some agents such as diazepam (Valium) and lorazepam (Ativan) are used in the acute treatment of status epilepti-cus (see Treatment of Status Epilepticus ), but only a few are used in the long-term treatment of epilepsy. Clonazepam (Klonopin) is recommended in specific forms of absence seizures (e.g., the Lennox-Gastaut variant) and may also be useful in minor generalized seizures such as akinetic spells and myoclonic jerks. Clorazepate (Tranxene) is another benzodiazepine that is occasionally used as an adjunct in certain partial seizures. [Pg.107]

Because benzodiazepines, as a class, are usually equally effective in treating anxiety (in combination with cognitive-behavioral theraphy), psychiatrists usually select which of these drugs to prescribe based on its side effect profile. This means that the physician will weigh all the individual factors of each patient, and decide which drug is best suited for the patient s individual needs based on which side effects that person can or cannot tolerate. For example, some of the benzodiazepines are more easily processed by the liver. This may be particularly useful in patients taking birth control pills, propranolol, disulfuram, ulcer medications, and other drugs that may affect liver function. In such cases, lorazepam (Ativan) may be chosen because it has less of an effect on the liver. [Pg.71]

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-... [Pg.57]

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). [Pg.308]

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. [Pg.391]

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. [Pg.414]

The antianxiety effects of chlordiazepoxide (165) were described in 1960 and this compound was followed by diazepam (135). These two drugs have captured 75% of the market for sedatives in the USA. Other benzodiazepines used as antianxiety agents include oxazepam (166 R = H), a metabolite of diazepam that is better tolerated, lorazepam (166 R = Cl) and potassium clorazepate (167). Prazepam is the iV-cyclopropylmethyl analogue of diazepam. The benzodiazepines have other therapeutic applications, many being used for inducing sleep, diazepam and nitrazepam are anticonvulsants and flurazepam (168) is both an antianxiety agent and a potent hypnotic. Thieno- and pyrazolo-1,4-diazepinones isosteric with diazepam have similar pharmacological properties (B-81 Ml 10604). [Pg.170]

If the peel is to be done without deep sedation, the patient should immediately be given premedication, as per the doctor s usual practice for example, one sublingual tablet of Temesta 2.5 mg (lorazepam) if the patient has not taken any that morning and 15 drops of tilidine (a major analgesic) or any other strong analgesic the doctor usually prescribes. It is best to use an analgesic that the patient can tolerate easily. [Pg.256]

The initial dose of lorazepam can be found in Table 55-3. Data suggest that a single dose produces adequate serum concentrations and provides seizure protection for 24 hours. A second dose may be given after 5 minutes, and if necessary, a third and final dose may be given after another 5 minutes. It is important to remember that patients chronically on a benzodiazepine (e.g., clonazepam) may have developed tolerance and could require large doses before response. [Pg.1055]


See other pages where Lorazepam tolerance is mentioned: [Pg.129]    [Pg.254]    [Pg.124]    [Pg.465]    [Pg.564]    [Pg.34]    [Pg.148]    [Pg.150]    [Pg.198]    [Pg.293]    [Pg.482]    [Pg.525]    [Pg.170]    [Pg.75]    [Pg.77]    [Pg.525]    [Pg.573]    [Pg.129]    [Pg.254]    [Pg.636]    [Pg.524]    [Pg.532]    [Pg.570]    [Pg.286]    [Pg.565]    [Pg.1055]    [Pg.1216]   
See also in sourсe #XX -- [ Pg.124 ]




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Lorazepam

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