Ativan (Lorazepam) - Summary

ATIVAN SUMMARY

ATIVAN (lorazepam) Injection
CIV
Rx only

Lorazepam, a benzodiazepine with antianxiety, sedative, and anticonvulsant effects, is intended for the intramuscular or intravenous routes of administration. It has the chemical formula: 7-chloro-5(2-chlorophenyl)-1,3-dihydro-3-hydroxy-2 H -1, 4-benzodiazepin-2-one.

Status Epilepticus

ATIVAN Injection is indicated for the treatment of status epilepticus.

Preanesthetic

ATIVAN Injection is indicated in adult patients for preanesthetic medication, producing sedation (sleepiness or drowsiness), relief of anxiety, and a decreased ability to recall events related to the day of surgery. It is most useful in those patients who are anxious about their surgical procedure and who would prefer to have diminished recall of the events of the day of surgery (see PRECAUTIONS, Information for Patients).

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NEWS HIGHLIGHTS

Published Studies Related to Ativan (Lorazepam)

The pharmacokinetic and pharmacodynamic effects of SL65.1498, a GABA-A alpha2,3 selective agonist, in comparison with lorazepam in healthy volunteers. [2009.08]
Benzodiazepines are effective short-term treatments for anxiety disorders, but their use is limited by undesirable side effects related to Central Nervous System impairment and tolerance development. SL65.1498 is a new compound that acts in vitro as a full agonist at the gamma-aminobutyric acid(A) 2 and 3 receptor and as a partial agonist at the 1 and 5 receptor subtypes...

A randomized, double-blind comparison of lorazepam and chlordiazepoxide in patients with uncomplicated alcohol withdrawal. [2009.05]
CONCLUSIONS: With the treatment schedule used in this study, lorazepam is as effective as the more traditional drug chlordiazepoxide in attenuating uncomplicated alcohol withdrawal. Lorazepam, therefore, could be used with confidence when liver disease or the inability to determine liver function status renders chlordiazepoxide therapy problematic. The absence of clinically significant withdrawal complications with lorazepam in this large study contrasts with findings from previously published studies and suggests that higher doses of lorazepam than those formerly used may be necessary during alcohol withdrawal.

Lorazepam versus diazepam-phenytoin combination in the treatment of convulsive status epilepticus in children: A randomized controlled trial. [2009.03.16]
BACKGROUND: Convulsive status epilepticus demands urgent and appropriate management with anticonvulsants. Intravenous diazepam is an established drug in the management of convulsive status epilepticus in adults as well as in children. The efficacy of intravenous lorazepam has not been well established in children. OBJECTIVE: To determine whether intravenous lorazepam is as efficacious as diazepam-phenytoin combination in the treatment of convulsive status epilepticus in children. STUDY DESIGN: Randomized controlled trial... CONCLUSION: Lorazepam is as efficacious and safe as diazepam-phenytoin combination. We recommend use of lorazepam as a single drug to replace the two drug combination of diazepam-phenytoin combination to control the initial seizure in pediatric convulsive status epilepticus.

The apolipoprotein E epsilon4 allele and memory performance in HIV-1 seropositive subjects: differences at baseline but not after acute oral lorazepam challenge. [2008.11]
RATIONALE: The APOE epsilon4 allele, an established genetic risk factor for late-onset Alzheimer's disease, has been linked to an increased risk for dementia especially in older individuals with HIV-1 infection. This allele has also been associated with increased memory impairment following oral lorazepam challenge in healthy elderly. Lorazepam and other benzodiazepines are widely prescribed in individuals with HIV-1 infection who are at increased risk for cognitive impairment. OBJECTIVE: The aim of this study was to examine if the epsilon4 allele influences lorazepam-induced memory deficits in this population... CONCLUSION: Future studies should clarify the role of epsilon4 in the modulation of drug-induced cognitive toxicity and baseline performance and their relationship to progressive decline, especially in older individuals with HIV-1 infection, a group at increased risk for dementia.

Economic evaluation of propofol and lorazepam for critically ill patients undergoing mechanical ventilation. [2008.03]
OBJECTIVE: The economic implications of sedative choice in the management of patients receiving mechanical ventilation are unclear because of differences in costs and clinical outcomes associated with specific sedatives. Therefore, we aimed to determine the cost-effectiveness of the most commonly used sedatives prescribed for mechanically ventilated critically ill patients... CONCLUSION: Propofol has superior value compared with lorazepam when used for sedation among the critically ill who require mechanical ventilation when used in the setting of daily sedative interruption.

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Clinical Trials Related to Ativan (Lorazepam)

Fasting Study of Lorazepam Tablets 2 mg and Ativan Tablets 2 mg [Completed]
The objective of this study was to investigate the bioequivalence of Mylan's lorazepam 2 mg tablets to Wyeth's Ativan 2 mg tablets following a single, oral 2 mg (1 x 2 mg) dose administered under fasting conditions.

Lorazepam Sedation for Critically Ill Children [Suspended]
This clinical trial is being performed under the Best Pharmaceuticals for Children Act, signed into law in 2002 in order to improve pediatric labeling for off-patent drugs. The purpose of this study is to make sure that lorazepam, when given to children who are very sick in the Intensive Care Unit and who are on a breathing machine, is safe and works as well as a drug called midazolam. Midazolam is already approved by the FDA for this use, but lorazepam is not, even though both drugs are commonly used for sedation.

A Comparison of Lorazepam and Diazepam in the Treatment of Alcohol Withdrawal [Completed]
The purpose of this study is to compare the efficacy of two commonly used medications in the treatment of alcohol withdrawal, diazepam and lorazepam.

The Impact of Lorazepam on Cognition in APOE e4 Carriers [Completed]
We expect the results of this pilot study to justify a larger study that follows people to determine if certain tests of memory and attention, performed while sleepiness is induced by a single dose of lorazepam (a widely used anti-anxiety medication) could predict an individual's risk of developing AD. We plan to compare cognitively normal people who possess a common gene that increases risk for AD— the apolipoprotein E (APOE) e4 allele—to individuals without this gene. We hypothesize that a single 2 mg dose of lorazepam will cause more cognitive impairment in carriers of the APOE e4 allele than in noncarriers, and that the carriers will recover more slowly from these impairments than noncarriers.

Exploring the Effects of Diazepam and Lorazepam [Recruiting]
Aims :

- exploring lorazepam (0. 038 mg/kg)effects, after a single oral intake, in healthy

volunteers, on the neural correlates of encoding and retrieval of information during a word-stem completion task (implicit memory), using fMRI

- comparing lorazepam effects to diazepam (0. 3 mg/kg)effects

- exploring benzodiazepines effects, after a single oral intake, on the neural correlates

of successful encoding of information within explicit memory using fMRI

Hypothesis :

- both diazepam and lorazepam will impair explicit memory performance, but lorazepam only

will impair perceptual priming

- lorazepam and diazepam will modify the normal correlates of information encoding wthin

explicit memory

- lorazepam only will alter the neural corraltes of perceptual priming

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PATIENT REVIEWS / RATINGS / COMMENTS

Ativan review by 37 year old female patient
		Rating
Overall rating:
Effectiveness:		Highly Effective
Side effects:		No Side Effects
		Treatment Info
Condition / reason:		Anxiety
Dosage & duration:		2mg taken as needed for the period of as needed
Other conditions:		N/A
Other drugs taken:		None
		Reported Results
Benefits:		It really help me to cope with the anxiety
Side effects:		Make you tired.
Comments:		Had to take one when not feeling good. Or if anxiety issue to go to the doctor, take one, one hour prior apt

Ativan review by 30 year old female patient
		Rating
Overall rating:
Effectiveness:		Highly Effective
Side effects:		Severe Side Effects
		Treatment Info
Condition / reason:		anxiety
Dosage & duration:		1mg at night taken once a day for the period of one weeks
Other conditions:		None
Other drugs taken:		None
		Reported Results
Benefits:		It helped relieve anxiety because it made me sleep. I found that prior to taking this medication, I could not sleep and that I was not eating properly. My overall health was suffering.
Side effects:		It made me so sleepy and sluggish that I could not function properly the next day. While it did resolve sleep issues, it led to many other issues.
Comments:		moderate anxiety.

Ativan review by care giver of 43 year old male patient
		Rating
Overall rating:
Effectiveness:		Moderately Effective
Side effects:		Severe Side Effects
		Treatment Info
Condition / reason:		sleep problem
Dosage & duration:		1mg taken 4-5nights per week for the period of 1year
Other conditions:		dvt of leg
Other drugs taken:		syntrom
		Reported Results
Benefits:		At first, could actually sleep. The sleep issue has been life long and various natural things helped but not always. As stress increased, nothing helped,not even the Ativan.
Side effects:		Loss of energy. Huge increase in anger and irritability over seemingly non-issues. Personality changes to being more depressed and pessimistic. World view was negative, and everyone was an 'asshole'. Did not want to do anything or try anything or go out. Not even things normally that were turn ons ie. movies, dancing, sex, food After 6-8months on the drug, it helped not at all and sleep was down to 1-2 hours per nite.
Comments:		Very simple, just take drug at night before bed. Doctor prescribed for no more thatn 3 nights per week, but as sleep deprivation increased, so did the taking of the Ativan. Sublingual helped better than pill. Took drug up to 5 nights per week. Ran out of Ativan at some point and realized after a 3-4 days that was sleeping better and felt better mentally, emotionally and physically. Realized that the drug had severely affected his personality and motivation. sex drive and pleasure increased with each week off the Ativan. Swore to never use it again because the difference in how he felt was like night and day, once he got off the pills.