Ativan

Ativan. Ativan withdrawal side effects, withdrawal warnings, withdrawal precautions, withdrawal adverse effects, overdose, withdrawal symptoms and Ativan natural alternatives. Before you begin the spiral down with Ativan, try giving your body what it really wants.

Ativan

Ativan Withdrawal

The common Ativan side effects of anxiety, insomnia or unwanted head feelings can usually be handled quickly.

Whether you want to taper completely off Ativan or just eliminate the existing side effects caused by the medication, there is an answer and a solution.

Has Ativan caused you to have an inability to sleep? Daytime anxiety is non-stop? The anxiety tends to be first thing in the morning, fade away a little before noon and then return again with full force in the early afternoon?

You can make it and become Ativan free as well.

Note: You need to watch your calcium intake when you are taking Ativan.

Pharmacology

Anxiolytic - Sedative

Ativan is a benzodiazepine with CNS depressant, anxiolytic and sedative properties. Peak serum concentrations of free Ativan after oral administration are reached in 1 to 6 hours. Peak concentrations are reached in 60 to 90 minutes after i.m. administration and in 60 minutes after sublingual administration. Ativan is 85% bound to plasma proteins. Ativan is rapidly conjugated to an inactive glucuronide. Very small amounts of other metabolites have also been isolated in man. The serum half-life of Ativan is approximately 12 to 15 hours while the half-life of the conjugate is 16 to 20 hours. Ninety-five percent of the drug was excreted within 120 hours, 88% in the urine and 6.6% in the stool.

Anterograde amnesia, decreased or lack of recall of events during period of drug action, has been reported after administration of Ativan and appears to be dose-related.

Indications

Anxiety and tension associated with the stresses of everyday life usually do not require treatment with anxiolytic drugs.

Injectable Ativan is useful as an initial anticonvulsant medication for the control of status epilepticus.

Back to top of page 

Contraindications

Ativan should not be injected intra-arterially and care should be taken to prevent its extravasation into tissue adjacent to an artery because of the danger of producing arteriospasm resulting in gangrene which may require amputation.

Warnings

Occupational Hazards:
Excessive sedation has been observed with Ativan at standard therapeutic doses. Therefore, patients should be warned against engaging in hazardous activities requiring mental alertness and motor coordination, such as operating dangerous machinery or driving motor vehicles.

Prior to i.v. use, Ativan injection should be diluted with an equal amount of compatible diluent (see Dosage). I.V. injection should be made slowly and with repeated aspiration. Care should be taken to determine that any injection will not be intraarterial and that perivascular extravasation will not take place. Partial airway obstruction may occur in heavily sedated patients. I.V. Ativan, when given alone in greater than the recommended dose, or at the recommended dose and accompanied by other drugs used during the administration of anesthesia, may produce heavy sedation; therefore, equipment necessary to maintain a patent airway and to support respiration/ventilation should be available.

As with any premedicant, extreme care must be used in administering Ativan injection to elderly or very ill patients and to those with limited pulmonary reserve, because of the possibility that apnea and/or cardiac arrest may occur. Because of the lack of sufficient clinical experience Ativan injection is not recommended for use in patients less than 18 years of age.

Clinical trials have shown that patients over the age of 50 years may have a more profound and prolonged sedation with i.v. Ativan. Ordinarily an initial dose of 2 mg may be adequate, unless a greater degree of lack of recall is desired.

There is no evidence to support the use of Ativan injection in coma, shock or acute alcohol intoxication at this time. When Ativan injection is used in patients with mild to moderate hepatic or renal disease, the lowest effective dose should be considered since drug effect may be prolonged.

As is true of other similar CNS acting drugs, patients receiving injectable Ativan should not operate machinery or engage in hazardous occupations or drive a motor vehicle for a period of 24 to 48 hours. Impairment of performance may persist for greater intervals because of extremes of age, concomitant use of other drugs, stress of surgery or the general condition of the patient.

The addition of scopolamine to injectable Ativan is not recommended, since their combined effect may result in increased incidence of sedation, hallucination and irrational behaviour.

Care should be exercised when administering Ativan to patients with status epilepticus, especially when the patient has received other CNS depressants or is severely ill. The possibility that respiratory arrest may occur or that the patient may have partial airway obstruction should be considered. Proper resuscitation equipment should be available.

Back to top of page 

Pregnancy:
The safety of the use of Ativan in pregnancy has not been established. Therefore, it is not recommended for use during pregnancy or lactation. Several studies have suggested an increased risk of congenital malformations associated with the use of the benzodiazepines, chlordiazepoxide and diazepam, and meprobamate, during the first trimester of pregnancy. Since Ativan is also a benzodiazepine derivative, its administration is rarely justified in women of childbearing potential. If the drug is prescribed to a woman of childbearing potential, she should be warned to contact her physician regarding discontinuation of the drug if she intends to become or suspects that she is pregnant.

In women, blood levels obtained from umbilical cord blood indicate placental transfer of Ativan and Ativan glucuronide. Ativan injection should not be used during pregnancy. There are insufficient data regarding obstetrical safety of parenteral Ativan including use in cesarean section. Such use, therefore, is not recommended.

Precautions

Lorazepam should not be administered to individuals prone to drug abuse.

Observe caution in patients who are considered to have potential for psychological dependence. Lorazepam should be withdrawn gradually if it has been used in high dosage.

As with other benzodiazepines, Ativan injection has a low potential for abuse and may lead to limited dependence. Although there are no clinical data available for injectable Ativan in this respect, physicians should be aware that repeated doses over a prolonged period of time may result in limited physical and psychological dependence.

Ativan is not recommended for the treatment of psychotic or depressed patients. Since excitement and other paradoxical reactions can result from the use of these drugs in psychotic patients, they should not be used in ambulatory patients suspected of having psychotic tendencies.

As with other anxiolytic-sedative drugs, Ativan should not be used in patients with nonpathological anxiety. These drugs are also not effective in patients with characterological and personality disorders or those with obsessive-compulsive neurosis.

When using Ativan, it should be recognized that suicidal tendencies may be present and that protective measures may be required.

Since the liver is the most likely site of conjugation of Ativan and since excretion of conjugated Ativan is a renal function, the usual precautions should be taken if Ativan is used in patients who may have some impairment of renal or hepatic function. In such cases, the dose should be very carefully titrated.

In patients for whom prolonged Ativan therapy is indicated, periodic blood counts and liver function tests should be carried out.

Back to top of page 

When injectable Ativan is used in patients with mild to moderate hepatic or renal disease, the lowest effective dose should be considered since drug effect may be prolonged.

While Ativan has been shown to control status epilepticus promptly, it is not recommended for maintenance treatment of epilepsy. After seizures are controlled, agents useful in the prevention of further seizures should be administered. In the treatment of status epilepticus due to acute reversible metabolic derangement (e.g., hypoglycemia, hypocalcemia, hyponatremia) immediate efforts should be made to correct the specific defect.

Drug Interactions:
If Ativan is to be combined with other drugs acting on the CNS, careful consideration should be given to the pharmacology of the agents to be employed because of the possible potentiation of drug effects. The benzodiazepines, including Ativan, produce CNS depressant effects when administered with such medications as barbiturates or alcohol.

Lorazepam injection, like other injectable benzodiazepines, also produces depression of the CNS when administered with ethyl alcohol, phenothiazines, barbiturates, MAO inhibitors and other antidepressants. When scopolamine is used concomitantly with injectable Ativan, an increased incidence of sedation, hallucinations and irrational behavior has been observed.

When Ativan injection is used i.v. as the premedicant prior to regional or local anesthesia, the possibility of excessive sleepiness or drowsiness may interfere with patient cooperation to determine levels of anesthesia. This is most likely to occur when a dose greater than 0.05 mg/kg is given and when narcotic analgesics are used concomitantly with the recommended dose.

Back to top of page 

Adverse Effects

Release of hostility and other paradoxical effects, such as irritability and excitability have occurred with benzodiazepines. In addition, hypotension, mental confusion, slurred speech, oversedation and abnormal liver and kidney function tests and hematocrit values have been reported with these drugs.

The most frequent adverse effects seen with injectable Ativan are an extension of the CNS depressant effects of the drug. Excessive sleepiness and drowsiness are the main side effects: the incidences reported depended on the dosage, route of administration, concomitant use of other CNS depressants and the investigators' expectations concerning the degree and duration of sedation.

When injectable Ativan was given i.v., patients over 50 years of age had a higher incidence of excessive sedation than patients under 50 years of age. Restlessness, confusion, depression, crying, sobbing, delerium, hallucinations, dizziness, diplopia have been reported. Hypertension and hypotension have occasionally been observed after injectable Ativan.

Respiratory depression and partial airway obstruction have been observed after injectable Ativan. Skin rash, nausea and vomiting have been noted occasionally in patients who have received injectable Ativan combined with other drugs during anesthesia and surgery.

Pain at the injection site, a sensation of burning, and redness in the same area have been reported after i.m. administration of injectable Ativan. Pain in the immediate postinjection period and redness at the 24 hour observation period also have been reported after i.v. administration of injectable Ativan.

Back to top of page 

Overdose

Treatment:
In the case of an oral overdose, if vomiting has not occurred spontaneously and the patient is fully awake, it may be induced with 20 to 30 mL of ipecac syrup USP. Institute gastric lavage as soon as possible, and introduce 50 to 100 g of activated charcoal to the stomach and allow it to remain there. Institute general supportive therapy as indicated. Vital signs and fluid balance should be carefully monitored. An adequate airway should be maintained and assisted respiration used as needed. With normally functioning kidneys, forced diuresis with i.v. fluids and electrolytes may accelerate elimination of benzodiazepines from the body. In addition, osmotic diuretics such as mannitol may be effective as adjunctive measures. In more critical situations, renal dialysis and exchange blood transfusions may be indicated. Published reports indicate that i.v. infusion of 0.5 to 4 mg of physostigmine at the rate of 1 mg/minute may reverse symptoms and signs suggestive of central anticholinergic overdose (confusion, memory disturbance, visual disturbances, hallucinations, delirium); however, hazards associated with the use of physostigmine (i.e., induction of seizures) should be weighed against its possible clinical benefit.

Dosage

Generalized anxiety disorder:
The recommended initial adult daily oral dosage is 2 mg in divided doses of 0.5 mg, 0.5 mg and 1 mg, or of 1 mg and 1 mg. The daily dosage should be carefully increased or decreased by 0.5 mg depending upon tolerance and response. The usual daily dosage is 2 to 3 mg. However, the optimal dosage may range from 1 to 4 mg daily in individual patients. Usually, a daily dosage of 6 mg should not be exceeded.

The initial daily dose in elderly and debilitated patients should not exceed 0.5 mg and should be very carefully and gradually adjusted, depending upon tolerance and response.

Excessive anxiety prior to surgical procedures:
Adults:
Usually 50 mcg/kg to a maximum of 4 mg given sublingually (1 to 2 hours before surgery) or i.m. (2 to 3 hours before surgery). As with all premedicant drugs, the dose should be individualized. Doses of other CNS depressant drugs should ordinarily be reduced.

When a rapid onset of action is required, lorazepam may be given i.v., 15 to 20 minutes before surgery. The usual i.v. dose is 44 mcg/kg or 2.0 mg total, whichever is smaller.

I.V. doses in excess of 2 mg should be restricted to patients of unusual size. A dose of 2 mg should not ordinarily be exceeded in patients over 50 years of age. Doses of other CNS depressants should ordinarily be reduced.

Equipment necessary to maintain a patent airway should be immediately available prior to i.v. administration of lorazepam.

Status Epilepticus:
Adults:
The usual recommended initial dose of Ativan is 0.05 mg/kg up to a maximum of 4 mg given by slow i.v. injection. If seizures are terminated, no additional Ativan is required. If seizures continue or recur after a 10 to 15 minute observation period, an additional i.v. dose of 0.05 mg/kg may be administered. If the second dose does not result in seizure control after another 10 to 15 minute observation period, other measures to control status epilepticus should be employed. A maximum of 8 mg only, of Ativan, should be administered during a 12 hour period.

Back to top of page 

Administration:
The sublingual tablet, when placed under the tongue, will dissolve in approximately 20 seconds. The patients should not swallow for at least 2 minutes to allow sufficient time for absorption.

When given i.v., Ativan injection, undiluted, should be injected deep into a muscle mass.

Lorazepam injectable can be used with atropine sulfate, narcotic analgesics, other parenterally used analgesics, commonly used anesthetics and muscle relaxants. The use of scopolamine with Ativan injection is not recommended since this combination has been associated with a higher incidence of adverse reactions.

Immediately prior to i.v. use, Ativan injection must be diluted with an equal volume of compatible solution. When properly diluted the drug may be injected directly into the vein or into the tubing of an existing i.v. infusion. The rate of injection should not exceed 2 mg/minute. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration. Do not use if solution is discolored or contains a precipitate.

Lorazepam injection is compatible for dilution purposes with the following solutions: Sterile Water for Injection, USP, Sodium Chloride Injection, USP, 5% Dextrose Injection, USP, Bacteriostatic Sodium Chloride Injection, USP with benzyl alcohol, Bacteriostatic Water for Injection, USP with parabens, Bacteriostatic Water for Injection, USP with benzyl alcohol.

Directions for dilution for i.v. use:
Aspirate the desired amount of Ativan injection into the syringe, then slowly aspirate the desired volume of diluent. Pull back slightly on the plunger to provide additional mixing space. Immediately mix contents thoroughly by gently inverting the syringe repeatedly until a homogenous solution results. Do not shake vigorously since this will result in air entrapment.

Back to top of page