One of the most popular effective and safe medicines for reducing the intensity of epileptic seizures or anxiety treatment is Ativan. This tranquilizer (or anxiolytic) of benzodiazepines class contains the active ingredient Lorazepam. Ativan is available in three dosage forms: oral and sublingual tablets and injections.
In medicine, Ativan is prescribed for:
- controlling epileptic seizures,
- accelerating sleep onset in strong anxiety or stress,
- short-term symptoms relief in acute mania, anxiety or excitement,
- premedication in prolonged surgical or diagnostic procedures (including endoscopy, bronchoscopy or arteriography).
Ativan has a powerful anxiolytic, sedative, anticonvulsant, muscle relaxant and hypnotic effects. The action mechanism of this tranquilizer is linked to the inhibition of GABA receptors (GABA), which leads to an inhibition in the CNS.
Due to increased GABA transport in the body, Ativan reduces the neuronal activity in limbic structures, cerebral cortex and thalamus. This action of the drug leads to suppression of pain or epileptic seizures and to their intensity lowering.
The average duration of the therapeutic Ativan action may reach one to six hours. The start and duration of the drug effect depend on the dosage form:
- Oral Ativan pills take effect within 15-17 minutes after ingestion.
- The therapeutic effect of sublingual tablets occurs in about 5-10 minutes after they dissolve under the tongue.
- The action duration of Ativan intramuscular injection is about 15-20 minutes, of intravenous - about 2 hours.
This medicine may interact with other tranquilizers, such as Bromazepam (Lexotan), Alprazolam (Alprax) or Triazolam (Halcion). Therefore, simultaneous use of these drugs requires reducing Ativan dosesby about 50%.
If opioid analgesics (including Endocet, Oramorph, Actiq)are usedfor the premedication, patient should be prescribed the minimum effective Ativan dose.
Overdose with Ativan may result in mild or moderate adverse events. The most common unwanted effects are loss of balance, blurred vision, drowsiness, dizziness, nausea, or vomiting.
The risk of Ativan side effects reduces, when itis used in lower therapeutic doses. It is recommended to strictly observe the assigned dosing regimen and recommendations for use of this tranquilizer:
- In premedication, sublingual Ativan dose of 0.05 mg/kg is administered about one to two hours before the start of the diagnostic or surgical procedure.
- The initial dose of intravenous or intramuscular Ativan injections is 4 mg. Injections must be introduced slowly, with a rate of about 2 mg per minute. If patient's response to the dose of 4 mg is insufficient, it should be repeated no earlier than 10-15 minutes after the first administration.
- Daily doses of oral Ativan for the treatment of anxiety disorders and epileptic seizures may range from 1 mg to 10 mg, divided into two or three doses.
- To reduce agitation or anxiety that cause sleep problems, it is recommended to take 1-2 mg of Ativan orally 10-20 minutes before the anticipated sleep.
Ativan sublingual tablet dissolves in about 30-60 minutes. Before use, place itbehind the cheek on the inner side of the lower lip.
To achieve the maximum clinical effect of Ativan, its therapeutic dose should be adjusted individually for each patient. The dose of tranquilizer is calculated according to several criteria, including:
- patient's age,
- clinical response to Ativan,
- type and intensity of the disease symptoms,
- history of benzodiazepine derivatives use.
Elderly patients with involutional changes or slow creatine clearance should start to treat acute anxiety disorders or seizures with the smallest Ativan doses.
One of Ativan advantages over other benzodiazepines is that it has a potent anxiolytic effect and very rarely causes serious side effects.