Lorazepam vomiting

Benzodiazepines, especially lorazepam, are used to prevent and treat CINV.5,10 Lorazepam is thought to prevent input from the cerebral cortex and limbic system from reaching the central vomiting center in the brain stem.10 Sedation and amnesia are common side effects. Respiratory depression can occur with high doses or when other central depressants such as alcohol are combined with benzodiazepines. 

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. 

Benzodiazepines such as lorazepam or diazepam are used before the initiation of chemotherapy to reduce anticipatory vomiting or vomiting caused by anxiety. The pharmacology of these agents is presented in Chapter 22. 

Lorazepam (Ativan, and others) is used as an adjunct to antiemetic regimens, particularly in patients with anticipatory vomiting. Alprazolam (Xanax) has also been used as an adjunct. Benzodiazepines can cause somnolence and amnesia lasting for several hours, which may be beneficial. 

Intravenous ondansetron combined with dexamethasone, with or without lorazepam, is the most effective treatment available for prevention of severe vomiting due to cancer chemotherapy and... 

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-... 

Benzodiazepines The antiemetic potency of lorazepam and alprazolam (see p. 89) is low. Their beneficial effects may be due to their sedative, anxiolytic and amnesic properties. These same properties make benzodiazepines useful in treating anticipatory vomiting. 

Moreno I, RoseU R, Abad-Esteve A, Barnadas A, Carles J, Ribelles N. Randomized trial for the control of acute vomiting in cisplatin-treated patients high-dose metoclopramide with dexamethasone and lorazepam as adjuncts versus high-dose alizapride plus dexamethasone and lorazepam. Study of the incidence of delayed emesis. Oncology 1991 48(5) 397-402. 

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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