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Anxiety Ativan
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Ativan is a benzodiazepine with CNS depressant, anxiolytic and sedative properties. Peak serum concentrations of free lorazepam 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. |
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| Ativan 1 mg (30 tablets) |
1 mg |
30 tablets |
$ |
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| Ativan 1 mg (60 tablets) |
1 mg |
60 tablets |
$ |
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| Ativan 1 mg (90 tablets) |
1 mg |
90 tablets |
$ |
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| Ativan 2 mg (30 tablets) |
2 mg |
30 tablets |
$ |
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| Ativan 2 mg (60 tablets) |
2 mg |
60 tablets |
$ |
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| Ativan 2 mg (90 tablets) |
2 mg |
90 tablets |
$ |
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| USES |
| Indications
The short-term relief of manifestations of excessive anxiety in patients with anxiety neurosis. Adjunct for the relief of excessive anxiety that might be present prior to surgical procedures. 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.
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| HOW TO TAKE THIS MEDICATION |
| The short-term relief of manifestations of excessive anxiety in patients with anxiety neurosis. Adjunct for the relief of excessive anxiety that might be present prior to surgical procedures.
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.
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| SIDE EFFECTS |
| Adverse Effects
Drowsiness is the most frequently reported adverse effect. Other reported adverse effects are dizziness, weakness, fatigue and lethargy, disorientation, ataxia, anterograde amnesia, nausea, change in appetite, change in weight, depression, blurred vision and diplopia, psychomotor agitation, sleep disturbance, vomiting, sexual disturbance, headache, skin rashes, gastrointestinal, ear, nose and throat, musculoskeletal and respiratory disturbances.
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. |
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| PRECAUTIONS |
| Precautions
Elderly and debilitated patients, or those with organic brain syndrome, have been found to be prone to CNS depression after even low doses of benzodiazepines. Therefore, medication should be initiated in these patients with very low initial doses, and increments should be made gradually, depending on the patient's response, in order to avoid oversedation or neurological impairment. Extreme care must be used in administering ativan injection to elderly patients, very ill patients, and to patients with limited pulmonary reserve, because of the possibility that underventilation and/or hypoxic cardiac arrest may occur. Resuscitative equipment for ventilatory support should be readily available.
Ativan should not be administered to individuals prone to drug abuse.
Observe caution in patients who are considered to have potential for psychological dependence. Ativan should be withdrawn gradually if it has been used in high dosage.
As with other benzodiazepines, lorazepam 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, lorazepam 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 lorazepam 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.
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.
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| DRUG INTERACTIONS |
| 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.
Ativan 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 behaviour 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.
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| OVERDOSE |
| Symptoms:
With benzodiazepines, including valiun, symptoms of mild overdosage include drowsiness, mental confusion and lethargy. In more serious overdosage, symptoms may include ataxia, hypotonia, hypotension, hypnosis, stages I to III coma and, very rarely, death.
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.
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| STORAGE |
| Store at room temperature away from moisture and heat. Keep this and all medications out of the reach of children. |
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