Ativan 2mg

1. Drug Overview

• Generic Name: Lorazepam

• Brand Name: Ativan®

• Strength: 2mg per tablet

• Drug Class: Benzodiazepine (Anxiolytic/Sedative-Hypnotic)

• Schedule: C-IV Controlled Substance (Risk of Abuse/Dependence)

• Manufacturer: Bausch Health Companies Inc.

2. Therapeutic Indications

✔ Anxiety Disorders: Short-term relief of anxiety symptoms (GAD, panic disorder)
✔ Insomnia: Management of sleep disturbances (short-term use only)
✔ Preoperative Sedation: Anxiolysis before surgery/procedures
✔ Status Epilepticus: IV form used for acute seizures (tablet not for this use)

3. Dosage & Administration

• Adults (Anxiety):

  • Initial dose: 2–3 mg/day in divided doses (e.g., 0.5–1mg 2–3x daily)

  • Max dose: 10 mg/day (rarely needed)

• Elderly/Debilitated Patients:

  • Start with 0.5–1 mg/day (increased sensitivity)

• Administration:

  • Take orally with/without food

  • Avoid abrupt discontinuation (taper to prevent withdrawal)

4. Mechanism of Action

• GABA-A Receptor Potentiation: Enhances inhibitory neurotransmitter effects → sedation, anxiolysis, muscle relaxation

• Peak Effect: 2 hours (oral)

• Half-Life: 10–20 hours

• Duration: 6–8 hours (acute dosing)

5. Contraindications

❌ Acute narrow-angle glaucoma
❌ Severe respiratory depression (e.g., COPD, sleep apnea)
❌ Pregnancy (Risk of fetal harm, esp. 1st trimester)
❌ Hypersensitivity to benzodiazepines
❌ Concurrent use with opioids (increased respiratory depression risk)

6. Warnings & Precautions

⚠ Risk of Dependence/Addiction:

• Limit to short-term use (2–4 weeks)

• Taper dose to avoid withdrawal (seizures, rebound anxiety)
  ⚠ CNS Depression:

• Avoid alcohol, opioids, other sedatives

• Impaired driving/alertness
  ⚠ Paradoxical Reactions:

• Agitation, aggression, hallucinations (esp. in elderly)
  ⚠ Suicidal Ideation: Monitor in depression/anxiety patients

7. Adverse Effects

Common (≥1%):

• Sedation, dizziness, weakness

• Ataxia, confusion (elderly)

• Memory impairment (“benzodiazepine amnesia”)

Serious (Seek Medical Help):
❗ Respiratory depression (esp. with opioids)
❗ Severe hypotension
❗ Dependence/withdrawal seizures
❗ Suicidal behavior

8. Drug Interactions

🚫 Opioids (fentanyl, oxycodone): ↑ Respiratory depression (potentially fatal)
🚫 Alcohol: ↑ Sedation/overdose risk
🚫 CNS Depressants (antihistamines, barbiturates): Additive effects
🚫 Probenecid/Valproate: ↑ Lorazepam levels

9. Special Populations

• Hepatic Impairment: Reduce dose (lorazepam is hepatically metabolized)

• Elderly: Start low (0.5mg), ↑ fall risk

• Pregnancy: Category D (avoid; risk of neonatal withdrawal/floppy infant syndrome)

• Breastfeeding: Excreted in milk (avoid or monitor infant for sedation)

10. Overdose Management

• Symptoms: Extreme drowsiness, coma, respiratory arrest

• Treatment:

  • Flumazenil (Romazicon®) for reversal (caution in benzo-dependent patients)

  • Supportive care (airway management)

11. Storage & Handling

• Temperature: 20–25°C (68–77°F)

• Packaging: Blister packs or bottles (light-resistant)

• DEA Requirements: Secure storage (C-IV controlled substance)

12. Patient Counseling Points

✔ Do not stop suddenly (taper under medical supervision)
✔ Avoid alcohol
✔ Report worsening anxiety/suicidal thoughts
✔ Do not drive/operate machinery until effects known

Prescribing Reminder: Short-term use only (reevaluate after 2–4 weeks). Consider non-pharmacologic therapies (CBT) for chronic anxiety.