Ativan (Lorazepam)

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Ativan (Lorazepam) is a medication that belongs to the class known as the benzodiazepines. Lorazepam is a Schedule IV drug. It is a benzodiazepine with CNS depressant activity and is also classified as an anxiolytic drug. Lorazepam does have sedative properties.
Ativan is manufactured by Wyeth-Ayerst Pharmaceuticals. The generic form (Lorazepam) is manufactured by various pharmaceutical companies.
Lorazepam's primary use is for the treatment of acute (excessive) anxiety disorder. Lorazepam can be used as the initial drug for the control of status epilepticus and it is also utilized to control belligerent elderly patients. Lorazepam can also be utilized for pre-surgical, excessive anxiety.
Off-label use of Lorazepam is to control withdrawal symptoms of alcohol dependency and other substance use disorders. Lorazepam is frequently administered intravenously in patients in delirium tremens (DTs.)
According to Lejoyeux, Solomon, and Ades (1998) and Ott, Tarter, and Ammerman (1999), Benzodiazepines (BZDs) are the preferred pharmacologic agents for the treatment of acute alcohol withdrawal states. The author's further state that mild to moderate withdrawal symptoms can be treated with BZDs on an outpatient basis, whereas severe withdrawal states require inpatient admission. Lejoyeux, Solomon, and Ades (1998) state that BZDs do not improve abstinence rates and in most circumstances are not indicated for long-term use. A variety of BZDs can be utilized for successful detoxification.
Librium is the gold standard for treatment of alcohol withdrawal states. Lorazepam has also been utilized with success and is oftentimes the preferred treatment in the acute care hospital setting as Lorazepam can be administered intravenously as well as orally. One of the problems with use of the BZDs is their long half-life. In some cases of patients with liver failure secondary to cirrhosis and alcoholism, BZDs given orally are not processed quickly enough by the failing liver. Serax as an alternative BZD has been found to be more effective in these cases.
Phillips, Haycock, and Boyle (2006) designed a process improvement project that developed an Alcohol Withdrawal Syndrome (AWS) management protocol for the acute care hospital setting. The design of this project included a work team that was comprised of physicians, pharmacists, and nurses led by a behavioral health clinical nurse specialist.
The outcome of this project was the development and integration of a safe and effective treatment protocol that effectively managed AWS. This project was facilitated by collaborative, evidence-based decision making. The authors addressed three key components of care: 1. the identification of high-risk patients; 2. the initiation of prophylactic treatment; and 3. the initiation of effective and timely pharmacologic interventions in an effort to prevent medical complications in AWS that could lead to death. The authors also concluded from their review that BZDs are the mainstay of primary pharmacologic therapy in patients in AWS. Their preferred medication in the acute care setting was Valium (Diazepam).
Peak plasma concentrations of free lorazepam after oral administration are achieved in approximately 2 hours (the range is 1 to 6 hours). Peak concentrations are achieved in 60 to 90 minutes after intramuscular injection. Sublingual administration of Lorazepam achieves peak concentration in 60 minutes. Lorazepam is 85% bound to plasma proteins. The renal system is the primary mechanism for excretion of Lorazepam.
The serum half-life of lorazepam is approximately 12 to 15 hours.
The vast majority of the drug (88%) is excreted in the urine with 75% excreted as glucuronide.
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