Ativan


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Ativan

 [at´ĭ-van]
trademark for preparations of lorazepam, an antianxiety agent, sedative, and anticonvulsant.

lorazepam

Apo-Lorazepam (CA), Ativan, Dom-Lorazepam (CA), Novo-Lorazem (CA), Nu-Loraz (CA), PHL-Lorazepam (CA), PMS-Lorazepam (CA), Pro-Lorazepam (CA)

Pharmacologic class: Benzodiazepine

Therapeutic class: Anxiolytic

Controlled substance schedule IV

Pregnancy risk category D

Action

Unknown. Thought to depress CNS at limbic system and disrupt neurotransmission in reticular activating system.

Availability

Injection: 2 mg/ml, 4 mg/ml

Solution (concentrated): 2 mg/ml

Tablets: 0.5 mg, 1 mg, 2 mg

Indications and dosages

Anxiety

Adults: 2 to 3 mg P.O. daily in two or three divided doses. Maximum dosage is 10 mg daily.

Insomnia

Adults: 2 to 4 mg P.O. at bedtime

Premedication before surgery (as antianxiety agent, sedative-hypnotic, or amnestic)

Adults: 0.05 mg/kg (not to exceed 4 mg) deep I.M. injection at least 2 hours before surgery, or 0.044 mg/kg (not to exceed 2 mg) I.V. 15 to 20 minutes before surgery. For greater amnestic effect, give up to 0.05 mg/kg (not to exceed 4 mg) I.V. 15 to 20 minutes before surgery.

Status epilepticus

Adults: 4 mg I.V. given slowly (no faster than 2 mg/minute). If seizures continue or recur after 10 to 15 minutes, repeat dose. If seizure control isn't established after second dose, other measures should be used. Don't exceed 8 mg in 12 hours.

Dosage adjustment

• Elderly or debilitated patients

Off-label uses

• Acute alcohol withdrawal syndrome

Contraindications

• Hypersensitivity to drug, other benzodiazepines, polyethylene or propylene glycol, or benzyl alcohol
• Acute angle-closure glaucoma
• Coma or CNS depression
• Hepatic or renal failure

Precautions

Use cautiously in:
• hepatic or renal impairment
• history of suicide attempt, drug abuse, depressive disorder, or psychosis
• elderly patients
• pregnant or breastfeeding patients.

Administration

• For I.V. use, dilute with equal volume of compatible diluent, such as normal saline solution or dextrose 5% in water. Keep resuscitation equipment and oxygen at hand.

Give each 2 mg of I.V. dose slowly, over 2 to 5 minutes. Don't exceed rate of 2 mg/minute.
• Don't give parenteral form to children younger than age 18.

Adverse reactions

CNS: amnesia, agitation, ataxia, depression, disorientation, dizziness, drowsiness, headache, incoordination, asthenia

CV (with too rapid I.V. administration): hypotension, bradycardia, tachycardia, apnea, cardiac arrest, cardiovascular collapse

EENT: blurred vision, diplopia, nystagmus

GI: nausea, abdominal discomfort

Other: increased or decreased appetite

Interactions

Drug-drug.CNS depressants (including antidepressants, antihistamines, benzodiazepines, sedative-hypnotics): additive CNS depression

Hormonal contraceptives: increased lorazepam clearance

Drug-herbs.Chamomile, hops, kava, skullcap, valerian: increased CNS depression

Drug-behaviors.Alcohol use: increased CNS depression

Smoking: increased metabolism and decreased efficacy of lorazepam

Patient monitoring

During I.V. administration, monitor ECG and cardiovascular and respiratory status.
• Monitor vital signs closely.
• Evaluate for amnesia.
• Watch closely for CNS depression. Institute safety precautions as needed to prevent injury.

Monitor for signs and symptoms of overdose (such as confusion, hypotension, coma, and labored breathing).
• Assess liver function tests and CBC.

Patient teaching

• Tell patient and family about drug's possible CNS effects. Recommend appropriate safety precautions.
• Explain that with long-term use, drug must be discontinued slowly (typically over 8 to 12 weeks).
• Instruct patient to avoid alcohol, because it increases drowsiness and other CNS effects.
• Caution patient to avoid smoking, because it speeds drug breakdown in body.
• Advise female patient to inform prescriber if she is pregnant or breastfeeding.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, herbs, and behaviors mentioned above.

Ativan

(ăt′ə-văn′)
A trademark for the drug lorazepam.

Ativan

a trademark for a benzodiazepine antianxiety agent (lorazepam).

Ativan®

Lorazepam, see there.

Ativan

A brand name for LORAZEPAM.
References in periodicals archive ?
from the only a second ativan can begin to smudge the incriminating
He was still seizing in the emergency room and was given four doses of IV Ativan and then sedated for a long time.
He too was started on both methadone and Ativan at the same dosages as his son and has experienced similar symptomatic relief of RLS without any side effects for the last 2 years.
It and Ativan were among a host of other prescription drugs found in the blood of American pop star Michael Jackson when he died in June last year.
Officials have since ruled that his heart stopped due to an overdose of the powerful anesthetic propofol, which is utilized in surgery, as well as the sedative lorazepam, often used to treat anxiety and sold under brand names Ativan and Temesta.
In the early hours of June 25, Murray also gave Jackson doses of anti-anxiety medications Valium and Ativan and sedative Versed, the filing said.
She also accused the playboy of abusing Ativan, Valium, marijuana and sleeping pills.
Roozrokh to oversee care for the patient and said he ordered excessive amounts of morphine and the sedative Ativan.
A gastrointestinal (GI) cocktail of Nitropaste and Toradol didn't relieve the pain, nor did Ativan.
Mankato, Minnesota: You report side effects after switching from Ativan to a generic version and have heard that drug manufacturers can reduce the strength of generics by 40 percent.
by willfully causing and permitting Ruben Navarro [the patient] to be placed in a situation in which his health was endangered by the prescription of excessive amounts of morphine and Ativan, and/or by the introduction of Betadine into his stomach.
Q I am looking for educational information on the administration of Diprivan, Morphine, Ativan, Levophed, Dopamine and Epinephrine, specifically the indications for titration of these medications; i.