MedWorm: Ativan

Lorazepam/alcohol interaction: Fall leading to subdural haematoma in an elderly patient: case report

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All bath salts are not mephedrone

The Poison Review — Sat, 04 Feb 2012 05:56:41 +0100

2.5 out of 5 stars “Bath Salt” Ingestion Leading to Severe Intoxication Delirium: Two Cases and a Brief Review of the Emergence of Mephedrone Use. Kasick DP et al. Am J Drug Alcohol Abuse 2012 Jan 5 [Epub ahead of print] Abstract This paper from the Ohio State Department of Psychiatry is worth reading for vivid descriptions of acute toxic delirium in two patients after they used a product sold as “bath salts”: Patient A presented after ingesting “bath salts” sold under the label “Arctic Blast”. He was tachycardic (heart rate = 144.min), anxious and paranoid, and suffering visual hallucinations of snakes. For some bizarre reason he was given 2 mg naloxone in the field. At the hospital, he slowly improved after treatment with fluids, lorazep...

Hurry Up! Let's Talk About Anxiety!

Psychology Today Anxiety Center — Fri, 03 Feb 2012 06:32:23 +0100

It's a catch phrase, "I'm nervous". My seven year-old is anxious his basketball team might lose against the orange team this weekend. Anxiety and the anxious lexicon have crept into our society over the past decades and we as a culture have turned into a bundle of nervous. So many people are placed on anxiolytics like Xanax or Ativan; which is like getting a brand new car.&nbsread more (Source: Psychology Today Anxiety Center)

Fentanyl/lorazepam/morphine: Recurrent delirium in an infant: case report

Reactions — Thu, 02 Feb 2012 18:34:27 +0100

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Muscle relaxants for pain management in rheumatoid arthritis

NeLM - Drug Class Focused Reviews — Tue, 31 Jan 2012 05:00:00 +0100

Source: Cochrane Library Area: Evidence > Drug Class Focused Reviews Background Pain management is a high priority for patients with rheumatoid arthritis (RA). Muscle relaxants include drugs that reduce muscle spasm (for example benzodiazepines such as diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan) and non-benzodiazepines such as metaxalone (Skelaxin) or a combination of paracetamol and orphenadrine (Muscol)) and drugs that prevent increased muscle tone (baclofen and dantrolene). Despite a paucity of evidence supporting their use, antispasmodic and antispasticity muscle relaxants have gained widespread clinical acceptance as adjuvants in the management of patients with chronic musculoskeletal pain. Objectives The aim of this review was to determin...

Muscle relaxants for pain management in rheumatoid arthritis.

Cochrane Database of Systematic Reviews — Thu, 26 Jan 2012 08:18:08 +0100

CONCLUSIONS: Based upon the currently available evidence in patients with RA, benzodiazepines (diazepam and triazolam) do not appear to be beneficial in improving pain over 24 hours or one week. The non-benzodiazepine agent zopiclone also did not significantly reduce pain over two weeks. However, even short term muscle relaxant use (24 hours to 2 weeks) is associated with significant adverse events, predominantly drowsiness and dizziness. PMID: 22258993 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)

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“ABH Gel” (Ativan®, Lorazepam; Benadryl®, Diphenhydramine; Haloperidol, Haldol®) Is Not Absorbed From the Skin of Normal Volunteers So Cannot Be Effective Against Nausea (411-C)

Journal of Pain and Symptom Management — Thu, 19 Jan 2012 03:24:50 +0100

Recognize that the commonly used “ABH gel” (Ativan®, lorazepam; Benadryl®, diphenhydramine; haloperidol, Haldol®) is not absorbed to therapeutic levels from skin, so it cannot be effective as an anti-nausea drug. (Source: Journal of Pain and Symptom Management)

[Status epilepticus.]

Der Nervenarzt — Wed, 18 Jan 2012 05:00:00 +0100

Authors: Feddersen B, Trinka E Abstract Status epilepticus (SE) is a medical emergency. For diagnostic purposes EEG is mandatory when motor phenomena are absent or when a single seizure evolves into SE with impaired consciousness. The EEG may show focal or generalized status patterns, which must be distinguished from encephalopathies. Initially benzodiazepines are recommended; lorazepam is the drug of choice. When the SE persists, phenytoin, valproate, levetiracetam, lacosamide, and phenobarbital are administered. The choice depends on the underlying comorbidities. In this phase, only phenytoin is licensed. A generalized tonic-clonic status which is refractory is then treated with anesthetics including midazolam, disoprivan, or thiopental. The goal is to achieve burst suppression i...

Implications of Objective vs Subjective Delirium Assessment in Surgical Intensive Care Patients.

American Journal of Critical Care — Sun, 01 Jan 2012 05:00:00 +0100

Conclusions Use of objective criteria helped detect delirium in more patients and also identified patients mistakenly thought to have delirium who actually did not meet objective criteria for diagnosis of the condition. PMID: 22210705 [PubMed - as supplied by publisher] (Source: American Journal of Critical Care)

Response rate of catatonia to electroconvulsive therapy and its clinical correlates

European Archives of Psychiatry and Clinical Neuroscience — Fri, 30 Dec 2011 07:08:56 +0100

Abstract Electroconvulsive therapy (ECT) is an important treatment for catatonia. We aimed to study the response rate of catatonia treated with ECT and its clinical correlates in a large sample of inpatients. The ECT parameters of all patients (n = 63) admitted with catatonia between the months of January and December 2007 were examined. The number of ECTs administered, seizure threshold, failure to achieve adequate seizures and clinical signs pertaining to catatonia were analyzed. Response was considered as complete resolution of catatonic symptoms with Bush Francis Catatonia Rating Scale (BFCRS) score becoming zero. ECT was mostly started after failed lorazepam treatment except in 6 patients where ECT was the first choice. Patients who responded in 4 ECT session...

Time to Worry About Worrying Too Much

Psychology Today Anxiety Center — Tue, 27 Dec 2011 16:26:41 +0100

Worrying can be really bad for our health, worse by far than some of the things we worry about. It causes the biological harms of chronic stress, which are broad and profound. Primary Topic: Anxiety read more (Source: Psychology Today Anxiety Center)

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A case of lorazepam (Ativan)-induced accommodation paresis

Eye — Fri, 23 Dec 2011 08:00:00 +0100

Authors: J J Jung, S-H Baek & U S Kim (Source: Eye)

Benzodiazepine use in Belgian nursing homes: a closer look into indications and dosages

European Journal of Clinical Pharmacology — Wed, 21 Dec 2011 20:06:35 +0100

Conclusion Efforts to reduce the use of BZD/Zs in nursing homes should concentrate on insomnia, with interventions aimed at reducing too high prevalence of chronic use and too high daily dosages in this indication. Content Type Journal ArticleCategory Pharmacoepidemiology and PrescriptionPages 1-12DOI 10.1007/s00228-011-1188-zAuthors Jolyce Bourgeois, Heymans Institute of Pharmacology, Ghent University, De Pintelaan 185 (1 blok B), 9000 Ghent, BelgiumMonique M. Elseviers, Heymans Institute of Pharmacology, Ghent University, De Pintelaan 185 (1 blok B), 9000 Ghent, BelgiumMajda Azermai, Heymans Institute of Pharmacology, Ghent University, De Pintelaan 185 (1 blok B), 9000 Ghent, BelgiumLuc Van Bortel, Heymans Institute of Pharmacology, Ghent University, De Pintelaan 1...

Diazepam/lorazepam: Respiratory depression in children: 5 case reports

Reactions — Fri, 16 Dec 2011 06:55:18 +0100

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Persistent hypothermia after intrathecal morphine: case report and literature review.

Canadian Journal of Anaesthesia — Sat, 10 Dec 2011 05:00:00 +0100

CONCLUSION: Patients undergoing spinal anesthesia with intrathecal morphine may develop postoperative hypothermia that is resistant to warming measures. This complication may be treated successfully with lorazepam. PMID: 22161244 [PubMed - as supplied by publisher] (Source: Canadian Journal of Anaesthesia)

The Brown University Psychopharmacology Update — Fri, 09 Dec 2011 03:36:17 +0100

AbstractIncreasing Off‐Label Use of Antipsychotics for Treating Anxiety DisordersLow‐Dose Antipsychotics Generally Safe in Patients with Intellectual Disability, but Caution Still AdvisedWarfarin and AntidepressantsClinical Guidance for Long‐Term T3 Augmentation in Major DepressionGreater Fracture Risk with Zolpidem Than Alprazolam or Lorazepam in the ElderlySlowing AD Progression with MemantineEPA Supplements for DepressionRisperidone and Decompensation in a Previously Stable PatientNew ApprovalsVarenicline Safety ReviewAdverse Linezolid Interactions with Certain Serotonergic Drugs (Source: The Brown University Psychopharmacology Update)

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Lorazepam overdose: Unresponsiveness in an elderly patient, treated with flumazenil: case report

Reactions — Thu, 01 Dec 2011 07:29:01 +0100

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Management of Acute Seizure and Status Epilepticus in Pediatric Emergency

Indian Journal of Pediatrics — Fri, 25 Nov 2011 17:58:21 +0100

Abstract Acute seizure and status epilepticus constitute one of the major medical emergencies in children. Among children, the incidence ranges from 4-38/100,000 children per year respectively. The incidence in developing countries is somewhat higher because of infections. Although, the definition of status epilepticus is based on duration of seizures, the operational definition is to treat any child who is brought seizing to the emergency room, as status epilepticus. An urgent time bound approach is of paramount importance when managing a child in status epilepticus. Benzodiazepines remain the first line antiepileptic drugs in the emergency room; a long acting drug (Lorazepam) is preferred when available. This is followed by Phenytoin (20 mg/kg) loading. In patients ...

Density spectral array analysis of SREDA during EEG-video monitoring.

Clinical Neurophysiology — Thu, 17 Nov 2011 05:00:00 +0100

CONCLUSIONS: The temporal pattern of SREDA varies during the sleep-wake cycle. Lorazepam appears to suppress SREDA. SIGNIFICANCE: Response to lorazepam cannot distinguish SREDA from electrographic seizure activity. PMID: 22100860 [PubMed - as supplied by publisher] (Source: Clinical Neurophysiology)

Altering Intensive Care Sedation Paradigms to Improve Patient Outcomes

Anesthesiology Clinics — Sun, 13 Nov 2011 00:51:36 +0100

Providing sedation and comfort for intensive care patients has evolved in the last few years. New approaches to improving outcomes for intensive care unit (ICU) patients include providing analgesia before adding sedation and recognizing dangerous adverse effects associated with sedative medications, such as prolonged effects of midazolam, propylene glycol toxicity with lorazepam, propofol infusion syndrome, the deliriogenic effects of benzodiazepines and propofol, and bradycardia with dexmedetomidine. There are now reliable and valid ways to monitor pain and delirium in ICU patients. Dexmedetomidine reduces the incidence of delirium, reduces the duration of mechanical ventilation, and appears to be cost effective. (Source: Anesthesiology Clinics)

First prescription of new elderly patients attending the psychiatry outpatient of a tertiary care institute in North India

Geriatrics and Gerontology International — Tue, 08 Nov 2011 05:00:00 +0100

Conclusions: Olanzapine, SSRI and clonazepam were the most commonly prescribed antipsychotic, antidepressant, and benzodiazepine, respectively, and valproate was preferred over lithium among elderly patients with bipolar disorder. Geriatr Gerontol Int 2011; ••: ••–••. (Source: Geriatrics and Gerontology International)

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Interactions Among Benzodiazepine and Buprenorphine/Naloxone

Journal of Emergency Nursing: JEN — Mon, 07 Nov 2011 05:00:00 +0100

We read with interest the recent article by Heather Martin entitled “The Possible Consequences of Combining Lorazepam and Buprenorphine/Naloxone: A Case Review.” It is an interesting case study and we would like to express our thoughts on the drug interactions among benzodiazepine and buprenorphine/naloxone based on the literature review. (Source: Journal of Emergency Nursing: JEN)

[Suitability of the use of benzodiazepines prescribed by the pharmacist in the elderly. A doctor-pharmacist collaboration study.]

Atencion Primaria — Sat, 22 Oct 2011 04:00:00 +0100

CONCLUSION: The use of benzodiazepines in the Community of Valencia exceeds the recommendations of the Spanish Medicines Agency. PMID: 22023889 [PubMed - as supplied by publisher] (Source: Atencion Primaria)

Jackson got more sedative than doc admits: expert

Reuters: Health — Thu, 20 Oct 2011 20:14:09 +0100

LOS ANGELES (Reuters) - Michael Jackson had more of the sedative lorazepam in his blood stream than his doctor admitted giving him on the day he died, a top anesthesiology expert testified on Thursday. (Source: Reuters: Health)

Zolpidem associated with higher risk of fractures compared to lorazepam and alprazolam, and similar risk to diazepam

NeLM - Mental Health — Wed, 19 Oct 2011 04:00:00 +0100

Source: Journal of the American Geriatrics Society Area: News The Journal of the American Geriatric Society has featured a retrospective cohort study to determine whether zolpidem is a safer alternative to benzodiazepines. The community based study involved patients with an initial prescription for zolpidem (n = 43,343), alprazolam (n = 103,790), lorazepam (n = 150,858), or diazepam (n = 93,618), and rates of non-vertebral fractures and hip fractures requiring hospitalisation were compared before and after an initial prescription for each treatment, adjusting for confounders. The following results were reported: . In patients aged 65 and older, the rates of non-vertebral fractures and dislocations were similar in the pre- treatment intervals. . The rate ratios (RRs) for the ...

Avoiding crystallization of lorazepam during infusion.

European Journal of Pharmaceutical Sciences — Mon, 17 Oct 2011 04:00:00 +0100

Authors: Vellema J, Hunfeld NG, Van den Akker HE, Ter Horst JH Abstract Lorazepam is a strong sedative for intensive care patients and a commonly used method of administering it to the patient is by infusion of a freshly prepared lorazepam solution. During lorazepam infusion often unwanted lorazepam crystallization occurs, resulting in line obstruction and reduced lorazepam concentrations. With the aid of solubility measurements a solid-liquid phase diagram for lorazepam in mixtures of a commercially available lorazepam solution and an aqueous glucose solution was determined. This confirmed that the glucose solution acts as an anti-solvent, greatly reducing the lorazepam solubility in the infusion solution. Three approaches are proposed to obtain stable lorazepam solutions upon mix...

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Stimulus-Induced Rhythmic, Periodic, or Ictal Discharges in a 13-Year-Old Girl After an Overdose and Respiratory Arrest

Pediatric Neurology — Sat, 15 Oct 2011 15:43:04 +0100

Paramedics found a 13-year-old, previously healthy girl with depression at home and unresponsive after overdosing on bupropion and baclofen. She was observed to be in respiratory arrest and bradycardic, with a Glasgow Coma Scale score of 3. Chest compressions were required, and she was intubated. During transport, she was hypothermic with decerebrate posturing, and manifested a 1-minute, self-terminating, generalized tonic-clonic seizure. In the pediatric intensive care unit, she received intermittent doses of lorazepam and fentanyl for sedation. She remained comatose, and continuous video-electroencephalogram monitoring was initiated to evaluate her for nonconvulsive seizures. (Source: Pediatric Neurology)

[Rapid tranquillisation; review of the literature and recommendations].

Tijdschrift voor Psychiatrie — Fri, 14 Oct 2011 17:25:04 +0100

Authors: Bak M, van Os J, Marcelis M Abstract summary background In The Netherlands, no guidelines exist for rapid tranquillisation in the contextof acute agitation, excitementor aggression secondarytoapsychiatric disorder. aim To generate an overview of medication regimes suitable for rapid tranquillisation. method Aliterature search was conducted focussing on the effect of medical interventions in acute excitement, agitation or aggression. Primary outcome measurements were tranquillity, being calm, sedation, or asleep within two hours. Secondary outcome measures were frequency of re-administrat...

Preliminary evidence of anxiolytic effects of the CRF1 receptor antagonist R317573 in the 7.5% CO2 proof-of-concept experimental model of human anxiety

Journal of Psychopharmacology — Wed, 12 Oct 2011 04:00:00 +0100

We have validated the use of prolonged inhalation of 7.5% carbon dioxide (CO2) as a human model of anxiety and have shown that drugs from two prototypical classes of anxiolytics, benzodiazepines and a serotonin reuptake inhibitor, attenuate CO2-induced symptoms (Bailey et al., 2007a). Preclinical evidence suggests that drugs acting at the corticotropin-releasing factor (CRF) system may be useful for the treatment of depression, anxiety, and other stress-related disorders (Valdez, 2006), hence we have now examined the effects of a CRF1 receptor antagonist in the 7.5% CO2 model. In a randomized double-blind, placebo-controlled, study in 32 healthy participants we examined the effects of 7 days of treatment with the CRF1 receptor antagonist, R317573, at a dose that shows a favourable safety p...

Status Epilepticus-Induced Hyperemia and Brain Tissue Hypoxia After Cardiac Arrest [Observation]

Archives of Neurology — Mon, 10 Oct 2011 04:00:00 +0100

Conclusion Brain multimodality monitoring is a feasible method for evaluating secondary brain injury associated with seizure activity after cardiac arrest. (Source: Archives of Neurology)

Neuroleptic Malignant Syndrome Associated with the Use of Prochlorperazine in a Patient with a Recent History of Antipsychotic-Induced Neuroleptic Malignant Syndrome (November).

The Annals of Pharmacotherapy — Tue, 04 Oct 2011 04:00:00 +0100

CONCLUSIONS:NMS should be considered as a rare complication of therapy with antipsychotics and agents that alter dopamine activity, especially in patients with a history of the syndrome. Careful consideration should be given regarding the risks and benefits of using non-antipsychotic dopamine antagonists in patients with a history of antipsychotic-induced NMS. PMID: 21972252 [PubMed - as supplied by publisher] (Source: The Annals of Pharmacotherapy)

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Acute drug administration in epilepsy: a review.

CNS Neuroscience and Therapeutics — Sat, 01 Oct 2011 04:00:00 +0100

Conclusions: The best evidence for the efficacy of ADA exists in febrile and nonfebrile childhood seizures, whereas the evidence in catamenial epilepsy is weak. Prevention of clusters is a well-proven principle but its application has been little studied. Prevention of imminent seizures predicted by well-established triggers, defined risk factors, or premonitory minor seizure activity seems to be at the same time the most intelligent and the least investigated application of ADA and would deserve to be better studied. PMID: 21951369 [PubMed - in process] (Source: CNS Neuroscience and Therapeutics)

Current perceptions and practices surrounding the recognition and treatment of delirium in the intensive care unit: a survey of 250 critical care pharmacists from eight States.

The Annals of Pharmacotherapy — Sat, 01 Oct 2011 04:00:00 +0100

CONCLUSIONS: Current practices and perceptions surrounding recognition and treatment of delirium in patients in the ICU by the critical care pharmacists surveyed are heterogeneous. Antipsychotics are frequently recommended by pharmacists for delirium treatment, despite a lack of rigorous evidence to support their use. While pharmacists are ideally suited to lead delirium recognition efforts and provide treatment recommendations in this area, these roles need further elucidation. The optimal pedagogical strategy to support these efforts remains unclear, and the potential impact of pharmacists' efforts on patients' outcomes is unknown. PMID: 21934036 [PubMed - in process] (Source: The Annals of Pharmacotherapy)

Treating alcohol withdrawal with oral baclofen: A randomized, double‐blind, placebo‐controlled trial

Journal of Hospital Medicine — Sat, 01 Oct 2011 04:00:00 +0100

CONCLUSIONS:We found that the use of baclofen was associated with a significant reduction in the use of high doses of benzodiazepine (lorazepam) in the management of symptomatic AWS. The use of low‐dose baclofen in the management of AWS deserves further study, as reduced dependence on high‐dose benzodiazepines in AWS management could improve patient safety. Journal of Hospital Medicine 2011;6:474–479. © 2011 Society of Hospital Medicine (Source: Journal of Hospital Medicine)

A new clinical protocol for the pharmacological management of acute behavioural disturbance.

Australasian Psychiatry — Sat, 01 Oct 2011 04:00:00 +0100

Conclusion: A simplified protocol makes the pharmacological management of acute behaviour disturbance safer for both patients and staff. PMID: 21995354 [PubMed - in process] (Source: Australasian Psychiatry)

Buprenorphine/naloxone/lorazepam interaction: First report of an interaction, leading to respiratory depression: case report

Reactions — Thu, 22 Sep 2011 07:55:36 +0100

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Letters to BMJ on shortgage of lorazepam injection in UK

NeLM - Mental Health — Thu, 22 Sep 2011 04:00:00 +0100

Source: BMJ Area: News In a letter to the BMJ, the author from Addenbrooke's Hospital notes that hospitals in his area have been out of stock of IV lorazepam since May 2010. He explains why this drug is preferable to IV diazepam as first line treatment of status epilepticus, and expresses concern about the difficulty in treating patients with status epilepticus and those with agitation, as they are being exposed to drugs that are less likely to be successful and have more common and serious adverse events. He notes that there seems to be no problem with supplies in the US and cannot understand why stocks from there cannot be made available to the UK market. He calls on Pfizer to consider releasing sufficient quantities of IV lorazepam to the UK market soon, calling for a detailed explanat...

Where has all the lorazepam gone?

BMJ Online First — Wed, 21 Sep 2011 04:00:00 +0100

Intravenous lorazepam is preferable to intravenous diazepam as first line treatment of status epilepticus.1 It has a longer redistribution half life, which lessens the chance of seizure recurrence.1... (Source: BMJ Online First)

Pfizer's reply to de Monteverde-Robb

BMJ Online First — Wed, 21 Sep 2011 04:00:00 +0100

For several months Pfizer has faced supply issues with its intravenous preparation of lorazepam (Ativan), which until recently has been produced by a third party manufacturer, Recipharm, on behalf of... (Source: BMJ Online First)

Risk of Fractures Requiring Hospitalization After an Initial Prescription for Zolpidem, Alprazolam, Lorazepam, or Diazepam in Older Adults

Journal of the American Geriatrics Society — Wed, 21 Sep 2011 04:00:00 +0100

ConclusionIn older adults, the risk of injury with zolpidem exceeded that with alprazolam and lorazepam and was similar to that with diazepam. If the associations are causal, then the high incidence of these fractures implies that these treatment induce a substantial number of fractures and consequential costs. Further study of the association is imperative. (Source: Journal of the American Geriatrics Society)

Current Perceptions and Practices Surrounding the Recognition and Treatment of Delirium in the Intensive Care Unit: A Survey of 250 Critical Care Pharmacists from Eight States (October).

The Annals of Pharmacotherapy — Tue, 20 Sep 2011 04:00:00 +0100

CONCLUSIONS:Current practices and perceptions surrounding recognition and treatment of delirium in patients in the ICU by the critical care pharmacists surveyed are heterogeneous. Antipsychotics are frequently recommended by pharmacists for delirium treatment, despite a lack of rigorous evidence to support their use. While pharmacists are ideally suited to lead delirium recognition efforts and provide treatment recommendations in this area, these roles need further elucidation. The optimal pedagogical strategy to support these efforts remains unclear, and the potential impact of pharmacists' efforts on patients' outcomes isunknown. PMID: 21934036 [PubMed - as supplied by publisher] (Source: The Annals of Pharmacotherapy)

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Bladder Rupture After Intentional Medication Overdose. - Huston B, Mills K, Froloff V, McGee M.

SafetyLit: All (Unduplicated) — Wed, 14 Sep 2011 01:00:09 +0100

We report the case of a 51-year-old woman who had a medical history of diabetes, depression with past suicide attempts, and suicidal ideation. She was found unresponsive in a motel with multiple bottles of medicines (melatonin, carisoprodol, ativan, and cl... (Source: SafetyLit: All (Unduplicated))

Levetiracetam versus lorazepam in status epilepticus: a randomized, open labeled pilot study

Journal of Neurology — Tue, 06 Sep 2011 15:51:31 +0100

We report a randomized, open labeled pilot study comparing the efficacy and safety of LEV and LOR in SE. Consecutive patients with convulsive or subtle convulsive SE were randomized to LEV 20 mg/kg IV over 15 min or LOR 0.1 mg/kg over 2–4 min. Failure to control SE within 10 min of administration of one study drug was treated by the other study drug. The primary endpoint was clinical seizure cessation and secondary endpoints were 24 h freedom from seizure, hospital mortality, and adverse events. Our results are based on 79 patients. Both LEV and LOR were equally effective. In the first instance, the SE was controlled by LEV in 76.3% (29/38) and by LOR in 75.6% (31/41) of patients. In those resistant to the above regimen, LEV controlled SE in 70.0% (7/1...

GABAA Receptor Modulation During Adolescence Alters Adult Ethanol Intake and Preference in Rats

Alcoholism: Clinical and Experimental Research — Tue, 06 Sep 2011 04:00:00 +0100

Conclusions: These data demonstrate that GABAA receptor modulation during adolescence can alter intake and preference for ethanol in adulthood and highlights the importance of drug history as an important variable in the liability for alcohol abuse. (Source: Alcoholism: Clinical and Experimental Research)

GABA(A) Receptor Modulation During Adolescence Alters Adult Ethanol Intake and Preference in Rats.

Alcoholism, Clinical and Experimental Research — Tue, 06 Sep 2011 04:00:00 +0100

Conclusions: These data demonstrate that GABA(A) receptor modulation during adolescence can alter intake and preference for ethanol in adulthood and highlights the importance of drug history as an important variable in the liability for alcohol abuse. PMID: 21895721 [PubMed - as supplied by publisher] (Source: Alcoholism, Clinical and Experimental Research)

Benzodiazepine Use in Breast Cancer Survivors: Findings from a Consecutive Series of 1,000 Patients.

Oncology — Fri, 02 Sep 2011 04:00:00 +0100

Conclusion: Anxiety appears to be a common explanation for relatively high rates of benzodiazepine use in breast cancer survivors. This finding merits further study. PMID: 21894050 [PubMed - as supplied by publisher] (Source: Oncology)

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Psychogenic Unresponsiveness

Neurologic Clinics — Fri, 02 Sep 2011 04:00:00 +0100

Unresponsive patients with or without catatonic motor signs are etiologically heterogeneous, and all require a comprehensive neurodiagnostic assessment to rule out organic causes. Most cases prove to be due to primary psychiatric disorders, mostly mood disorders, especially mania, rather than schizophrenia. These patients respond to lorazepam administered by any route and, failing this, electroconvulsive therapy. Those patients with associated fever and autonomic instability are medical emergencies and need urgent treatment. (Source: Neurologic Clinics)

Detection and validated quantification of 21 benzodiazepines and 3 “z-drugs” in human hair by LC–MS/MS

Forensic Science International — Mon, 29 Aug 2011 04:00:00 +0100

Abstract: A method for detection and quantification of 21 benzodiazepines and the pharmacologically related “z-drugs” in human hair samples was developed and fully validated using liquid chromatography coupled to tandem mass spectrometry (LC–MS/MS). After methanolic and methanolic/aqueous extraction, the analytes were separated using two different LC–MS systems (AB Sciex 3200 QTRAP and AB Sciex 5500 QTRAP). Separation columns, mobile phases and MS modes for both systems were: Phenomenex Kinetex, 2.6μm, 50/2.1; 5mM ammonium formate buffer pH 3.5/methanol, total flow 0.75mL/min; electrospray ionization (ESI), multiple reaction monitoring (MRM), information dependent acquisition (IDA), enhanced product ion scan (EPI). The assays were found to be selective for the tested compounds (al...

Carbamazepine reduces short-interval interhemispheric inhibition in healthy humans

Clinical Neurophysiology — Mon, 22 Aug 2011 04:00:00 +0100

Conclusions: We conclude that circuits mediating short interstimulus intervals of IHI are susceptible to sodium channel blockade.Significance: The results increase our knowledge of interhemispheric transmission. (Source: Clinical Neurophysiology)

Carbamazepine reduces short-interval interhemispheric inhibition in healthy humans.

Clinical Neurophysiology — Thu, 18 Aug 2011 23:00:00 +0100

CONCLUSIONS: We conclude that circuits mediating short interstimulus intervals of IHI are susceptible to sodium channel blockade. SIGNIFICANCE: The results increase our knowledge of interhemispheric transmission. PMID: 21862399 [PubMed - as supplied by publisher] (Source: Clinical Neurophysiology)

Pharmacokinetics of buccal and intranasal lorazepam in healthy adult volunteers

European Journal of Clinical Pharmacology — Fri, 12 Aug 2011 06:14:59 +0100

Conclusions Intranasal lorazepam has more favourable pharmacokinetics than buccal lorazepam when considering the need for the rapid blood concentrations required for seizure termination. Further clinical evaluation of this route is required. Content Type Journal ArticlePages 1-5DOI 10.1007/s00228-011-1109-1Authors Mark Anderson, Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP UKParag Tambe, Academic Division of Child Health, University of Nottingham, Derbyshire Children’s Hospital, Derby, UKHelen Sammons, Academic Division of Child Health, University of Nottingham, Derbyshire Children’s Hospital, Derby, UKHussain Mulla, Centre for Therapeutic Evaluation of Drugs in Children, ...

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Lorazepam withdrawal: Withdrawal symptoms and delirium: case report

Reactions — Wed, 10 Aug 2011 17:36:32 +0100

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Buspirone/duloxetine/lorazepam/sulpiride overdose: Bezoar formation leading to esophageal obstruction (first report for sulpiride, buspirone and duloxetine): case report

Reactions — Mon, 01 Aug 2011 15:09:42 +0100

(Source: Reactions)

Lorazepam: Respiratory distress: case report

Reactions — Sun, 24 Jul 2011 19:59:43 +0100

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Haloperidol/lorazepam/valproic acid: Fatal myocardial infarction: case report

Reactions — Wed, 13 Jul 2011 16:51:36 +0100

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Lorazepam withdrawal: With drawal symptoms, treated wtih agomelatine: case report

Reactions — Wed, 13 Jul 2011 16:51:36 +0100

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Safety assessment of potentially inappropriate medications use in older people and the factors associated with hospital admission.

J Pharm Pharm Sci — Tue, 12 Jul 2011 15:30:03 +0100

Conclusion: PIM use in elderly people is not a risk factor for ADR-related hospital admission. Probably, severe ADR, which lead to hospitalizations of older people, can be explained by idiosyncratic response or the predisposition of these patients to develop adverse drug events, whether or not drugs are classed as PIM. Key-words: potentially inappropriate medication (PIM), older people, adverse drug reaction (ADR), hospital admission, pharmacovigilance. PMID: 21733416 [PubMed - in process] (Source: J Pharm Pharm Sci)

Drug induced immune haemolytic anaemia in the Berlin Case‐Control Surveillance Study

British Journal of Haematology — Mon, 11 Jul 2011 23:00:00 +0100

This study investigated the possibility of drug aetiology of immune haemolytic anaemia (IHA) in 134 patients with new onset of IHA who were identified in the Berlin Case‐Control Surveillance Study between 2000 and 2009. Single drugs related to IHA in three or more patients and assessed more than once as a certain or probable cause of IHA in a standardized causality assessment included diclofenac, fludarabine, oxaliplatin, ceftriaxone and piperacillin. In a case‐control study including all 124 IHA cases developed in outpatient care and 731 controls, significantly increased odds ratios (OR) were observed for beta‐lactam antibiotics (OR = 8·8; 95% confidence interval [CI] 3·2–25·2), cotrimoxazole (OR = 6·5; CI 1·1–37·9), ciprofloxacin (OR = 6·9, CI 1·3–38·5), ...

MF.04 Effects placebo of and lorazepam on emotional voice processing: An fMRI study

Journal of Neurology, Neurosurgery and Psychiatry — Wed, 06 Jul 2011 23:00:00 +0100

Conclusions Our results suggest that cerebral response in bilateral IFG and anterior insula is closely related to common anti-anxiety effect of both placebo and lorazepam. Increased left BA8 activation compared with lorazepam may reflect the anti-anxiety effect of placebo. (Source: Journal of Neurology, Neurosurgery and Psychiatry)

Intravenous Diazepam, Midazolam and Lorazepam in Acute Seizure Control

Indian Journal of Pediatrics — Wed, 29 Jun 2011 06:00:00 +0100

Conclusions All the three groups were comparable in terms of time to clinical seizure cessation, seizure recurrence and uncontrolled seizures after drug administration. However, number of patients requiring second dose to control seizures were significantly higher in diazepam group when compared to lorazepam group. Excessive somnolence and sedation occurred more frequently with diazepam. Content Type Journal ArticlePages 1-6DOI 10.1007/s12098-011-0505-yAuthors Geeta Gathwala, Departments of Pediatrics, Pt. B.D.Sharma PGIMS, University of Health Sciences Rohtak, 6J/8, Medical Enclave, Rohtak, 124001 Haryana, IndiaMayank Goel, Departments of Pediatrics, Pt. B.D.Sharma PGIMS, University of Health Sciences Rohtak, 6J/8, Medical Enclave, Rohtak, 124001 Haryana, IndiaJagj...

Benefit of cognitive-behavior therapy alongside pharmacotherapy in treating obsessive-compulsive disorder with depression: a case report and review of the literature

International Journal of Students Research — Mon, 27 Jun 2011 06:03:55 +0100

We present a challenging case highlighting the benefit of CBT alongside medication adjustments in a mental health unit. A 20-year-old male patient presented to our mental health unit with previously diagnosed OCD and severe depression. In addition, he also had social anxiety, insomnia, and suicidal ideation. Patient history revealed that he had been prescribed fluvoxamine, 200 mg per day, five months back but his symptoms had gotten worse. He has had one previous hospitalization. His Global Assessment of Functioning (GAF) at admission was in the range of 21-30. The fluvoxamine that had been previously prescribed was kept at 200 mg per day. In addition, he was also prescribed lorazepam 1 mg every four hours (anxiety), and zolpidem 10 mg per day (insomnia). During his inpatient stay, the pat...

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Intranasal administration safe and effective for selected drugs

The Poison Review — Tue, 21 Jun 2011 17:59:46 +0100

4 out of 5 stars Intranasal Drug Administration: An Innovative Approach to Traditional Care. Collopy KT, Snyder S. EMS World 2011 May;40:45-50. Abstract The intranasal (IN) route provides a safe, efficient way of delivering certain medications when an intravenous line is not in place. This review article is worth reading for an overview of the topic, despite some sketchiness in describing exact technique. The nasal mucosa provide over 180 cm2 of absorptive surface area. The turbinates are highly vascular and provide direct access to the central nervous system, avoiding first-pass metabolism. The use of spray-tipped atomizers allows drug to be administered rapidly, with the head in any position. The advantages of IN administration include rapid onset (especially of drugs that act on the C...

Adult age and ex vivo protein binding of lorazepam, oxazepam and temazepam in healthy subjects

British Journal of Clinical Pharmacology — Mon, 13 Jun 2011 23:00:00 +0100

Conclusions: There was no association of adult age with ex vivo fu of lorazepam, oxazepam or temazepam in healthy subjects. (Source: British Journal of Clinical Pharmacology)

Treatment for Abuse of Anti-Anxiety Drugs Tripled Over 10 Years

Pharmacy News - Doctors Lounge — Thu, 09 Jun 2011 14:00:00 +0100

Misuse of Valium, Ativan and other benzodiazepines is a growing problem, report finds (Source: Pharmacy News - Doctors Lounge)

LORAZEPAM (Lorazepam) Tablet [AvPAK]

DailyMed Drug Label Updates for the last seven days (since May 20, 2007 EST) — Wed, 08 Jun 2011 05:00:00 +0100

Updated Date: Jun 8, 2011 EST (Source: DailyMed Drug Label Updates for the last seven days (since May 20, 2007 EST))

[Hypothermia under olanzapine treatment : Clinical case series and review of current literature.]

Der Nervenarzt — Tue, 31 May 2011 23:00:00 +0100

CONCLUSION: A review of the current literature reveals that thermoregulatory disturbances as sequelae of antipsychotic drug administration depend on individual disposition as well as various independent risk factors such as environmental temperature, somatic comorbidities, endocrinological abnormalities (e.g. hypothyroidism) and structural damage of the brain. A complex interaction of dopaminergic regulatory mechanisms in the ventral hypothalamus and peripheral vaso- and sudomotor adjustments seems to be causative. Hypothermia following antipsychotic drug administration represents a serious adverse drug reaction and a potentially life-threatening event. PMID: 21626387 [PubMed - as supplied by publisher] (Source: Der Nervenarzt)

Bipolar Disorder in the News - 5/23/11

About.com Bipolar Disorder — Mon, 23 May 2011 16:41:51 +0100

Here's a headline I really hated: "Bipolar banker blows millions, gets jail time." The actual point of the story was that this guy who lost millions of Euros for his Austrian bank and its customers got a reduced sentence because his having BP constituted "extenuating circumstances." He was sentenced to three years in prison but only has to serve one. The critical unanswered question is, when was he diagnosed? If it was before all this started, and the bipolar affected his behavior - I'd need to know a lot more about the circumstances. Was he off his meds? Was he avoiding his doctor? Was his doctor incompetent? (I'm also wondering why an embezzler got only three years in the first place.) Next there's a judge in Australia whose "admittedly inappropriate behavior" in court was due to undiag...

Labetalol/lorazepam overdose: Hypotension and bradycardia in a hypothermic patient: case report

Reactions — Sat, 16 Apr 2011 17:06:15 +0100

(Source: Reactions)

Lorazepam overdose/flumazenil: Coma followed by ventricular tachycardia: case report

Reactions — Tue, 12 Apr 2011 16:15:37 +0100

(Source: Reactions)

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Subacute encephalopathy and seizures in alcoholics (SESA) presenting with non-convulsive status epilepticus

Seizure: European Journal of Epilepsy — Sun, 03 Apr 2011 23:00:00 +0100

We report a case of SESA with non-convulsive status epilepticus in a patient who was initially suspected of having a typical alcohol withdrawal seizure.A 61 year old woman with a history of chronic alcoholism was admitted at an outside hospital for confusion thought to be secondary to an alcohol withdrawal seizure. She had right hemiparesis and later developed right facial twitching that did not respond to intravenous fosphenytoin and levetiracetam. She was transferred for further management. Upon arrival, lorazepam and fosphenytoin were given and right face clonic movements resolved. However, continuous EEG monitoring revealed ongoing non-convulsive status epilepticus (NCSE). Following treatment with IV valproate and lacosamide, there was resolution of NCSE.SESA is likely an under recogni...

Diazepam/lorazepam/oxazepam withdrawal: Hyperalgesia: 4 case reports

Reactions — Tue, 22 Mar 2011 17:01:08 +0100

(Source: Reactions)

Misery of the tranquilliser addicts forced to go cold turkey by GPs

the Mail online | Health — Tue, 22 Mar 2011 02:32:10 +0100

There is an estimated 1.3 million Britons addicted to prescription tranquillisers, also known as benzodiazepines. These drugs include diazepam (known previously as Valium), Xanax, Ativan, Serax and Librium. (Source: the Mail online | Health)

[Do urine tests for drugs of abuse cover the substances of interest?]

Tidsskrift for den Norske Laegeforening — Fri, 18 Mar 2011 00:00:00 +0100

This study indicates that most drugs of abuse are detected by common routine urine analyses. Laboratories that offer analyses of drugs of abuse in urine should have methods available to detect pregabalin and methylphenidate in addition to or included in the standard panel. PMID: 21423307 [PubMed - as supplied by publisher] (Source: Tidsskrift for den Norske Laegeforening)

Bromisoval/lorazepam overdose: Heart arrest and death: case report

Reactions — Sun, 13 Mar 2011 17:03:03 +0100

(Source: Reactions)

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Lorazepam: Apnoea: case report

Reactions — Sun, 13 Mar 2011 17:03:03 +0100

(Source: Reactions)

Venlafaxine bezoar causing intestinal necrosis

The Poison Review — Fri, 11 Mar 2011 19:09:59 +0100

4 out of 5 stars Venlafaxine Pharmacobezoar Causing Intestinal Ischemia Requiring Emergency Hemicolectomy. Lung D et a. J Med Toxicol 2011 Mar 4. [Epub ahead of print] Full Text Yesterday we discussed the humongous review of pharmacobezoars that appears in the current issue of Clinical Toxicology. This morning, while trolling through PubMed, I came across this spectacular case report recently posted online before publication. The report describes a 28-year-old woman who ingested up to 10 g of venlafaxine ER tablets. At 5 hours after ingestion she had mild tachycardia but was asymptomatic except for tremulousness. She was treated with lorazepam and a single 100 g dose of activated charcoal; no other GI decontamination was carried out because of concern for possible seizures. Twenty-...

Procalcitonin and C-reactive protein levels at admission as predictors of duration of acute brain dysfunction in critically ill patients

Critical Care — Wed, 02 Mar 2011 00:00:00 +0100

Conclusions: In our pilot study, high baseline inflammatory biomarkers predicted prolonged periods of acute brain dysfunction, implicating inflammation as an important mechanism in the pathophysiology of delirium and coma during critical illness, irrespective of whether patients had sepsis or not. (Source: Critical Care)

The Possible Consequences of Combining Lorazepam and Buprenorphine/Naloxone: A Case Review

Journal of Emergency Nursing: JEN — Tue, 01 Mar 2011 00:00:00 +0100

Administering a benzodiazepine depressant to patients taking buprenorphine/naloxone can be life-threatening. Unfortunately, many ED health care providers are unaware of this potentially lethal combination. The following case study illustrates how these medications, when administered together, can adversely affect patient outcome. (Source: Journal of Emergency Nursing: JEN)

Amitriptyline/lorazepam: Delirium in elderly patients: 2 case reports

Reactions — Sun, 27 Feb 2011 18:11:29 +0100

(Source: Reactions)

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ATIVAN (Lorazepam) Tablet [STAT RX USA LLC]

DailyMed Drug Label Updates for the last seven days (since May 20, 2007 EST) — Mon, 14 Feb 2011 05:00:00 +0100

Updated Date: Feb 14, 2011 EST (Source: DailyMed Drug Label Updates for the last seven days (since May 20, 2007 EST))

LORAZEPAM (Lorazepam) Tablet [Lake Erie Medical DBA Quality Care Products LLC]

DailyMed Drug Label Updates for the last seven days (since May 20, 2007 EST) — Fri, 11 Feb 2011 05:00:00 +0100

Updated Date: Feb 11, 2011 EST (Source: DailyMed Drug Label Updates for the last seven days (since May 20, 2007 EST))

The Use of Opioids and Sedatives and Time Until Death After Withdrawing Mechanical Ventilation and Vasoactive Drugs in a Dutch Intensive Care Unit.

Anesthesia and Analgesia — Tue, 08 Feb 2011 00:00:00 +0100

Conclusions: Dutch patients who die in the ICU, or die after discharge from the ICU, die after MV and/or VAs are withdrawn. When treatments are withdrawn, death follows within 1 hour in most patients, which is a reflection of the severity of illnesses. At least 80% of patients receive opioids, and 67% receive sedatives until death. Fentanyl is the most used opioid, whereas midazolam is the most used sedative. Dosages of opioids and sedatives did not significantly exceed the ranges described as usual in the international literature. PMID: 21304154 [PubMed - as supplied by publisher] (Source: Anesthesia and Analgesia)

Clinical practice

European Journal of Pediatrics — Mon, 07 Feb 2011 22:54:31 +0100

Abstract An adequate early treatment of a long-lasting convulsive seizure is critical in reducing potential morbidity, and in particular, brain damage. In pre-hospital settings the use of benzodiazepines should become standard. Nowadays, rectal diazepam is used frequently, but midazoloam and lorazepam are becoming more popular, both being given either intranasally or orally. The buccal route is to be preferred because of its easy use and high efficacy. A generally accepted policy for early treatment of convulsive seizures is a crucial issue in the elaboration of an overall treatment plan for the child with epilepsy. Such a plan should include instruction and education of the parents and the caregivers surrounding the child. Content Type Journal ArticlePages 1-6DOI 10.1...

Reduction of temazepam to diazepam and lorazepam to delorazepam during enzymatic hydrolysis.

Analytical and Bioanalytical Chemistry — Sun, 06 Feb 2011 00:00:00 +0100

In this study, we report that this unusual reductive transformation also occurs in other benzodiazepines with a hydroxyl group at the C3 position such as temazepam and lorazepam. As determined by liquid chromatography-mass spectrometry analysis, all three enzyme preparations were found capable of converting urinary temazepam into diazepam following enzymatic incubation and subsequent liquid-liquid extraction procedures. For example, when H. pomatia enzymes were used with incubation conditions of 18 h and 50 °C, the percentage conversion, although small, was significant-approximately 1% (0.59-1.54%) in both patient and spiked blank urines. Similarly, using H. pomatia enzyme under these incubation conditions, a reductive transformation of urinary lorazepam into delorazepam (chlordesmethyl...

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Hiccups as the only symptom of non–ST-segment elevation myocardial infarction

The American Journal of Emergency Medicine — Mon, 31 Jan 2011 05:00:00 +0100

We present this case report to inform emergency physicians about the potential for hiccups to serve as the only presenting symptom of a myocardial infarction. The patient, a 68-year-old man with a history of diabetes mellitus, hypertension, and current tobacco use, was first seen in the emergency department after 4 days of intractable hiccups with no other complaints or symptoms. After ineffective hiccup treatment on the first visit with 2 mg Ativan and 25 intramuscular (IM) thorazine and a normal chest x-ray, he was discharged. Two days later, the patient returned to the emergency department with the same complaint of hiccups without any additional complaints or symptoms. An electrocardiogram displayed several abnormalities including Q waves in II, III, and aVF and T-wave inversions in aV...

Intranasal versus intravenous lorazepam for control of acute seizures in children: A randomized open‐label study

Epilepsia — Fri, 28 Jan 2011 00:00:00 +0100

This study compared the efficacy and adverse effects of intranasal versus intravenous lorazepam in children aged 6–14 years who presented with acute seizures.Methods: This was a randomized open‐label study conducted at an Indian hospital from August 2008 to April 2009. One hundred forty‐one consecutive children aged 6–14 years who presented convulsing to the emergency room were included. After stabilization, the children were randomized to receive either intravenous or intranasal lorazepam (0.1 mg/kg, maximum 4 mg). The primary outcome measure was clinical seizure remission within 10 min of drug administration. The study was registered with clinicaltrials.gov (NCT00735527).Key Findings: Seventy patients were randomized to receive intravenous and 71 to receive intran...

Preventing Medication Dosing Errors For Infants And Children

Health News from Medical News Today — Tue, 25 Jan 2011 11:00:00 +0100

Preparing small doses of medication from syringes may be inaccurate and can result in crucial dosing errors for infants and children, according to a study published in CMAJ (Canadian Medical Association Journal). Because babies and young children require small doses of drugs, these are often prepared from stock of less than 0.1 mL which can result in dosing errors and possible adverse events. Medications most commonly requiring small doses include potent narcotics and sedatives such as morphine, lorazepam and fentanyl as well as immunosuppressants... (Source: Health News from Medical News Today)

ATIVAN (Lorazepam) Tablet [Cardinal Health]

DailyMed Drug Label Updates for the last seven days (since May 20, 2007 EST) — Fri, 21 Jan 2011 05:00:00 +0100

Updated Date: Jan 21, 2011 EST (Source: DailyMed Drug Label Updates for the last seven days (since May 20, 2007 EST))

Correction: Effect of dexmedetomidine versus lorazepam on outcome in patients with sepsis: an a priori-designed analysis of the MENDS randomized controlled trial

Critical Care — Fri, 14 Jan 2011 00:00:00 +0100

No description available (Source: Critical Care)

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Haloperidol: Neuroleptic malignant syndrome treated with lorazepam and diazepam: case report

Reactions — Mon, 10 Jan 2011 13:49:21 +0100

(Source: Reactions)

Rapid acute treatment of agitation in individuals with schizophrenia: multicentre, randomised, placebo-controlled study of inhaled loxapine [PAPERS]

The British Journal of Psychiatry — Mon, 03 Jan 2011 00:00:00 +0100

Conclusions Inhaled loxapine provided a rapid, well-tolerated acute treatment for agitation in people with schizophrenia. (Source: The British Journal of Psychiatry)

Rapid tranquillization agents for severe behavioural disturbance: a survey of African psychiatrists' prescription patterns.

Tropical Doctor — Sat, 01 Jan 2011 00:00:00 +0100

Authors: James BO Guidelines on the use of rapid tranquillizers for severe behavioural disturbance have changed over the last six decades. This survey reports a minimal change in the prescription patterns among psychiatrists sampled from Africa. Parenteral chlorpromazine and diazepam are still commonly prescribed, the least being intramuscular lorazepam, olanzapine and promethazine. Respondents indicated that drug availability was more likely than prescription preference or cost to influence their choices. They were also equally concerned about the tranquillizer's side effects, its ability to provide rapid and sustained sedation and its ability to calm a patient while awaiting psychiatric assessment. PMID: 21172904 [PubMed - in process] (Source: Tropical Doctor)

One milligram of lorazepam does not decrease anxiety induced by CCK-4 in healthy volunteers: Investigation of neural correlates with BOLD MRI

Journal of Psychopharmacology — Wed, 22 Dec 2010 00:00:00 +0100

Benzodiazepine effects on cholecystokinin tetrapeptide (CCK-4)-induced panic attack (PA) in humans are incompletely characterized, in particular on the neurofunctional level. This work explores the effects of lorazepam on brain activity and behavioral and physiological symptoms related to CCK-4-induced PA in healthy volunteers. Twenty-one male volunteers received 1 mg of lorazepam or placebo orally, 2 hours before an injection of 0.9% saline solution followed by 50 µg of CCK-4 during functional magnetic resonance imaging (fMRI) and heart rate recording. Panic attacks were defined using the panic symptom scale (PSS). In addition, the Y1-STAI (state anxiety) and the Bond & Lader Visual Analogue Scale (VAS) were used. Eleven subjects were classified as panickers. CCK-4 induced behav...

Cyproterone to treat aggressivity in dementia: a clinical case and systematic review

Journal of Psychopharmacology — Wed, 22 Dec 2010 00:00:00 +0100

We present a case and systematic review of the current knowledge about the use of cyproterone acetate to treat aggressivity (excluding hypersexuality related behaviours) in dementia. An 82-year-old man required psychiatric inpatient admission due to agitation and aggressivity and was diagnosed with Alzheimer’s disease. After failed trials of atypical antipsychotics (quetiapine 100 mg/day and risperidone 1 mg/day), drugs for dementia (memantine 20 mg/day and rivastigmine 9 mg/day) and benzodiazepines (lorazepam 0.5–1 mg prn) he was started on cyproterone acetate titrated up to 50 mg twice daily. After two weeks he was calmer and did not express aggressivity. Two months later he was discharged to a community placement where he subsequently remained settled on cyproterone. We revi...

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Medications for Autism

Psych Central — Tue, 21 Dec 2010 21:33:31 +0100

Medications are often used to treat behavioral problems, such as aggression, self-injurious behavior, and severe tantrums, that keep the person with an autism spectrum disorder (“autism”) from functioning more effectively at home or school. The medications used are those that have been developed to treat similar symptoms in other disorders. Many of these medications are prescribed “off-label.” This means they have not been officially approved by the U.S. Food and Drug Administration (FDA) for use in children, but the doctor prescribes the medications if he or she feels they are appropriate for your child. Further research needs to be done to ensure not only the efficacy but the safety of psychotropic agents used in the treatment of children and adolescents. On Octo...

Metabolism of Benzodiazepine and Non-Benzodiazepine Anxiolytic-Hypnotic Drugs: An Analytical Point of View.

Current Drug Metabolism — Tue, 21 Dec 2010 00:00:00 +0100

Authors: Mandrioli R, Mercolini L, Raggi MA A review with 132 references. Several kinds of anxiolytic and hypnotic drugs are currently available on the market. Although BZDs are surely the most frequently prescribed among them, several chemically unrelated compounds have been commercialised, which can provide similar or even higher efficacy and tolerability. These drugs can prove useful for patients who are non-responder or intolerant to benzodiazepine treatment, thus giving broader therapeutic options to the clinician. The most important studies on the metabolic characteristics of several non-benzodiazepine anxiolytics and hypnotics are reported and briefly discussed in this review; moreover, the analytical methods related to these studies are also described and commented upon and the...

Formulation design and optimization of fast disintegrating lorazepam tablets by effervescent method

Indian Journal of Pharmaceutical Sciences — Tue, 14 Dec 2010 00:00:00 +0100

SB Shirsand, Sarasija Suresh, LS Jodhana, PV SwamyIndian Journal of Pharmaceutical Sciences 2010 72(4):431-436Fast disintegrating tablets of lorazepam were prepared by effervescent method with a view to enhance patient compliance. A 3΂ full factorial design was applied to investigate the combined effect of two formulation variables: amount of crospovidone and mixture of sodium bicarbonate, citric acid and tartaric acid (effervescent material) on in vitro dispersion time. Crospovidone (2-8% w/w) was used as superdisintegrant and mixture of sodium bicarbonate, citric acid and tartaric acid (6-18% w/w) was used as effervescent material, along with directly compressible mannitol to enhance mouth feel. The tablets were evaluated for hardness, friability, thickness, dru...

Dyspnoea associated with anxiety—symptomatic therapy with opioids in combination with lorazepam and its effect on ventilation in palliative care patients

Supportive Care in Cancer — Mon, 13 Dec 2010 21:59:54 +0100

Conclusions Our results showed that the use of O + A was a safe and effective treatment option in this patient group. Signs of respiratory depression were not found. Content Type Journal ArticleDOI 10.1007/s00520-010-1058-8Authors Katri Elina Clemens, Department of Science and Research, Centre for Palliative Medicine, University of Bonn, Malteser Krankenhaus Bonn/Rhein-Sieg, Von-Hompesch-Str. 1, 53123 Bonn, GermanyEberhard Klaschik, Department of Science and Research, Centre for Palliative Medicine, University of Bonn, Malteser Krankenhaus Bonn/Rhein-Sieg, Von-Hompesch-Str. 1, 53123 Bonn, Germany Journal Supportive Care in CancerOnline ISSN 1433-7339Print ISSN 0941-4355 (Source: Supportive Care in Cancer)

Status Epilepticus

Indian Journal of Pediatrics — Fri, 10 Dec 2010 18:18:22 +0100

Abstract Status epilepticus is a common neurological emergency in childhood and associated with significant morbidity and mortality. Status epilepticus (SE) has been defined as continuous seizure activity lasting more than 30 min or 2 or more seizures in this duration without gaining consciousness between them. However, the operational definition has brought the time down to 5 min. Management can be broadly divided into initial stabilization, seizure termination, and evaluation and treatment of the underlying cause. Diagnostic evaluation and seizure control should be achieved simultaneously to improve outcome. Seizure termination is achieved by pharmacotherapy. Benzodiazepines are the first line drugs for SE. Commonly used drugs include lorazepam, diazepam, and m...

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[Stocked medications in emergency physician-based medical services in Germany : Reality and requirements according to guidelines.]

Der Anaesthesist — Sat, 04 Dec 2010 00:00:00 +0100

CONCLUSION: Due to recent treatment recommendations provision with sodium bicarbonate, calcium, magnesium, noradrenaline, adenosine, lorazepam iv, dobutamine and as well with ipratropium bromide and salbutamol (both as liquid preparations for inhalation) should be improved. For the future, a federal uniform minimum standard due to evidence-based principles is desirable. PMID: 21127828 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)

Endogenous dopamine (DA) competes with the binding of a radiolabeled D3 receptor partial agonist in vivo: A positron emission tomography study

Synapse — Fri, 03 Dec 2010 00:00:00 +0100

AbstractA series of microPET imaging studies were conducted in anesthetized rhesus monkeys using the dopamine D3‐selective partial agonist, [18F]5. There was variable uptake in regions of brain known to express a high density of D3 receptors under baseline conditions. Pretreatment with lorazepam (1 mg/kg, i.v. 30 min) to reduce endogenous dopamine activity before tracer injection resulted in a dramatic increase in uptake in the caudate, putamen, and thalamus, and an increase in the binding potential (BP) values, a measure of D3 receptor binding in vivo. These data indicate that there is a high level of competition between [18F]5 and endogenous dopamine for D3 receptors in vivo. Synapse 2011. © 2011 Wiley‐Liss, Inc. (Source: Synapse)

Ventricular tachycardia due to flumazenil administration.

Pakistan Journal of Biological Sciences: PJBS — Wed, 01 Dec 2010 00:00:00 +0100

In this study we present a patient intoxicated with lorazepam who developed a ventricular tachycardia after receiving flumazenil as therapeutic mean, though the attack was appropriately terminated by administration of a bolus dose of Amiodarone. We believe that the ventricular tachycardia onset in above mentioned case is secondary to Flumazenil administration in susceptible patient with previous history of ischemic heart disease. Ventricular tachycardia has rarely reported as flumazenil side effects. PMID: 21313895 [PubMed - in process] (Source: Pakistan Journal of Biological Sciences: PJBS)

Alcohol-Related Seizures

Emergency Medicine Clinics of North America — Thu, 25 Nov 2010 04:44:49 +0100

The term alcohol-related seizures (ARS) is used to refer to all seizures in the aggregate associated with alcohol use, including the subset of alcohol withdrawal seizures (AWS). From 20% to 40% of patients with seizure who present to an emergency department have seizures related to alcohol abuse. However, it is critical to avoid prematurely labeling a seizure as being caused by alcohol withdrawal before performing a careful diagnostic evaluation. Benzodiazepines alone are sufficient to prevent AWS. The alcoholic patient with a documented history of ARS, who experiences a single seizure or a short burst of seizures should be treated with lorazepam, 2 mg intravenously. (Source: Emergency Medicine Clinics of North America)

Bromisoval/lorazepam overdose: Heart arrest and death: case report

Reactions — Wed, 24 Nov 2010 04:27:18 +0100

(Source: Reactions)

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Diazepam as a component of goal-directed sedation in critically ill trauma patients

Journal of Critical Care — Wed, 24 Nov 2010 00:00:00 +0100

Conclusions: Based on this limited sample, the use of diazepam as a component of goal-directed therapy appears safe and effective in providing adequate sedation in critically ill trauma patients using an average dosage of 40 mg/d. (Source: Journal of Critical Care)

Electroconvulsive Therapy for Pediatric Malignant Catatonia With Cerebellar Dysgenesis

Pediatric Neurology — Sat, 20 Nov 2010 08:33:31 +0100

Electroconvulsive therapy was successfully used to treat malignant catatonia in a 15-year-old male patient with congenital dysgenesis of the left hemisphere of the cerebellum and hypoplasia of the vermis and left pons due to a presumed cerebral vascular accident in utero. The patient experienced significant motor and communication delays with mild cognitive impairment, but was otherwise in good health until age 15 years, when he developed rigidity, posturing, stupor, unresponsiveness, repetitive self-injurious behaviors, and negativism, as well as autonomic abnormalities including profuse diaphoresis and flushing episodes, thus meeting criteria for malignant catatonia. After initial response to lorazepam, the patient required electroconvulsive therapy for resolution of malignant catatonia....

Cost-consequence analysis of remifentanil-based analgo-sedation vs. conventional analgesia and sedation for patients on mechanical ventilation in the Netherlands

Critical Care — Mon, 01 Nov 2010 00:00:00 +0100

Conclusions: Compared to CS, RS significantly decreases the overall costs in the ICU.Trial Registration: Clinicaltrials.gov NCT00158873. (Source: Critical Care)

Review Finds Ativan Best for Treating Severe Epilepsy

Health Behavior News Service — Fri, 29 Oct 2010 19:49:57 +0100

The drug Ativan is better than Valium or Dilantin for controlling severe epileptic seizures, according to a new review of studies. 10/27 (Source: Health Behavior News Service)

Cleanup strategies and advantages in the determination of several therapeutic classes of pharmaceuticals in wastewater samples by SPE-LC-MS/MS.

Analytical and Bioanalytical Chemistry — Tue, 19 Oct 2010 23:00:00 +0100

Authors: Sousa MA, Gonçalves C, Cunha E, Hajšlová J, Alpendurada MF This work describes the development and validation of an offline solid-phase extraction with simultaneous cleanup capability, followed by liquid chromatography-(electrospray ionisation)-ion trap mass spectrometry, enabling the concurrent determination of 23 pharmaceuticals of diverse chemical nature, among the most consumed in Portugal, in wastewater samples. Several cleanup strategies, exploiting the physical and chemical properties of the analytes vs. interferences, alongside with the use of internal standards, were assayed in order to minimise the influence of matrix components in the ionisation efficiency of target analytes. After testing all combinations of adsorbents (normal-phase, ion exchange and mixed compo...

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Differential pharmacological responses of catatonia-like signs in frontotemporal dementia.

Neurocase — Thu, 30 Sep 2010 23:00:00 +0100

Authors: Lauterbach EC, Sharone Kuppuswamy P, Greenway LL Sequential therapeutic trials for catatonoid frontal signs in clinically-evident frontotemporal dementia (n = 2) revealed differential benefits for lorazepam, amantadine, memantine, pramipexole, aripiprazole, quetiapine, citalopram, and donepezil, although certain signs also worsened. Citalopram and donepezil were poorly tolerated. Ramelteon was without effect. While memantine appeared to improve cognition in case 1, this remains to be established by more reliable neuropsychological testing. Parkinsonism (case 2) responded to pramipexole, but not amantadine or levodopa. Possible relationships of catatonoid signs requiring future confirmation include insufficient GABA-A (multiple signs) and D2 (mutism) and excessive NMDA (immobil...

Ativan (Lorazepam) - updated on RxList

RxList - New and Updated Drug Monographs — Mon, 27 Sep 2010 07:00:00 +0100

Ativan (Lorazepam) drug description - FDA approved labeling for prescription drugs and medications at RxList (Source: RxList - New and Updated Drug Monographs)

Serotonin Syndrome After a Massive Overdose of Controlled-Release Paroxetine [CASE REPORTS]

Psychosomatics — Fri, 10 Sep 2010 18:26:33 +0100

CONCLUSION: The authors are the first to report on a paroxetine overdose of this magnitude, and they provide one of the few reports on a prolonged course of serotonin syndrome that was unresponsive to standard treatment. (Source: Psychosomatics)

Neurocognitive effects of brivaracetam, levetiracetam, and lorazepam

Epilepsia — Tue, 31 Aug 2010 23:00:00 +0100

Summary (Source: Epilepsia)

Bupropion/lorazepam: CNS disorders, heart disorders and respiratory insufficiency: 2 case reports

Reactions — Tue, 24 Aug 2010 05:51:22 +0100

(Source: Reactions)

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Long-term maintenance lorazepam for catatonia: a case report

General Hospital Psychiatry — Wed, 11 Aug 2010 00:00:00 +0100

We present a case of recurrent catatonia, in which symptoms relapsed whenever an attempt was made to taper off lorazepam. (Source: General Hospital Psychiatry)

ATIVAN (Lorazepam) Tablet [BTA Pharmaceuticals Inc.]

DailyMed Drug Label Updates for the last seven days (since May 20, 2007 EST) — Wed, 04 Aug 2010 05:00:00 +0100

Updated Date: Aug 4, 2010 EST (Source: DailyMed Drug Label Updates for the last seven days (since May 20, 2007 EST))

What is the Epidemiology and Genetics of the Major Phacomatoses?

PediatricEducation.org — Mon, 02 Aug 2010 00:00:16 +0100

Discussion Neurocutaneous syndromes or phacomatoses are a group of congenital or hereditary diseases that develop hamartomas of various tissues and usually additional cutaneous stigmata. Most phacomatoses have quite variable phenotypical presentations for an affected individual. Those that are listed below are common for that disease process. Learning Point Common major phacomatosis include: Sturge-Weber Syndrome Genetics: non-genetic Neurological: seizures (often contralateral to the nevus and focal), hemiparesis (again often contralateral to the nevus), mental retardation, ophthalmological problems including glaucoma Dermatological: port-wine nevus often in the trigeminal nerve’s first division, hemangiomas Other clinical features: may be associated with Klippel-Trenaunay-Weber s...

High‐dose lorazepam for convulsive status epilepticus in an infant with holoprosencephaly

Pediatrics International — Sat, 31 Jul 2010 23:00:00 +0100

(Source: Pediatrics International)

Prolonged infusions of dexmedetomidine in critically ill patients.

American Journal of Health-System Pharmacy : AJHP — Mon, 26 Jul 2010 11:24:39 +0100

Conclusion Dexmedetomidine is an alternative to traditional sedatives and analgesics in critically ill patients. The safety and efficacy of dexmedetomidine in adults likely persist beyond 24 hours, without the emergence of rebound effects after discontinuation. PMID: 20651314 [PubMed - in process] (Source: American Journal of Health-System Pharmacy : AJHP)

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Lorazepam: Osmolar gap metabolic acidosis in an elderly woman associated with propylene glycol excipient: case report

Reactions — Thu, 15 Jul 2010 06:25:48 +0100

(Source: Reactions)

Acute Drug Administration in Epilepsy: A Review.

CNS Neuroscience and Therapeutics — Tue, 06 Jul 2010 23:00:00 +0100

Conclusions: The best evidence for the efficacy of ADA exists in febrile and nonfebrile childhood seizures, whereas the evidence in catamenial epilepsy is weak. Prevention of clusters is a well-proven principle but its application has been little studied. Prevention of imminent seizures predicted by well-established triggers, defined risk factors, or premonitory minor seizure activity seems to be at the same time the most intelligent and the least investigated application of ADA and would deserve to be better studied. PMID: 20626432 [PubMed - as supplied by publisher] (Source: CNS Neuroscience and Therapeutics)

Catatonia in a child with autistic disorder.

The Turkish Journal of Pediatrics — Thu, 01 Jul 2010 00:00:00 +0100

We describe herein an 11-year-old pediatric case with autism who developed catatonic symptoms and was treated effectively with lorazepam. The case reported here differs from previously reported cases in terms of age of onset and the display of all characteristics of catatonia as defined in the Diagnostic and Statistical Manual of Mental Disorders (4th ed) (DSM-IV). In addition, although it was stated that catatonia in autism is commonly associated with impaired language and social passivity, our case is an active verbal individual. PMID: 21043395 [PubMed - in process] (Source: The Turkish Journal of Pediatrics)

Treatment of neonatal withdrawal with clonidine after long-term, high-dose maternal use of tramadol.

The Annals of Pharmacotherapy — Wed, 30 Jun 2010 23:00:00 +0100

CONCLUSIONS: Withdrawal can be prolonged in infants exposed to maternal tramadol use. Clonidine may be a safe and effective option for managing symptoms of neonatal tramadol abstinence. PMID: 20587741 [PubMed - in process] (Source: The Annals of Pharmacotherapy)

Brief report: Electroconvulsive therapy for malignant catatonia in an autistic adolescent

Autism — Wed, 30 Jun 2010 10:13:37 +0100

A 14-year-old male with autism and mild mental retardation developed malignant catatonia characterized by classic symptoms of catatonia, bradycardia and hypothermia. Bilateral electroconvulsive therapy and lorazepam were required for resolution. The case expands the occurrence of catatonia in autism into its malignant variant. (Source: Autism)

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Neuroleptic Malignant Syndrome: Further Lessons From a Case Report [CASE REPORTS]

Psychosomatics — Tue, 29 Jun 2010 18:24:52 +0100

CONCLUSION: This case sheds further light on the relationship between catatonia and NMS. As noted in the literature, ECT in combination with lorazepam proved to be safe and effective for NMS. (Source: Psychosomatics)

Lorazepam: Floppy baby syndrome and masking of Klebsiella infection following in utero exposure; neonatal abstinence syndrome following withdrawal: case report

Reactions — Tue, 29 Jun 2010 05:33:09 +0100

(Source: Reactions)

Determination of tricyclic antidepressants in human breast milk by capillary electrophoresis.

Fri, 18 Jun 2010 17:21:03 +0100

Authors: Acedo-Valenzuela MI, Mora-DÃez N, Galeano-DÃaz T, Silva-RodrÃguez A A method for the determination of several tricyclic antidepressants (imipramine, desipramine, amitriptyline, nortriptyline, clomipramine, norclomipramine, doxepine and nordoxepine) in breast milk has been developed. This assay consists of a common extraction process in an organic phase, which is evaporated until dried and finally reconstituted in the appropriate buffer for injection in a capillary electrophoresis system. The capillary electrophoresis method used is an "acetonitrile stacking" method previously reported for determining these drugs in serum samples. The method developed was applied to the analysis of these compounds in human breast milk at different concentration levels (50, 100 and 200 ...

Non-IV midazolam at least as effective as IV diazepam for status epilepticus - meta-analysis

NeLM - News — Wed, 16 Jun 2010 23:00:00 +0100

Source: Academic Emergency Medicine Area: News Midazolam given by any route is at least as effective as intravenous (IV) diazepam for treatment of status epilepticus (SE) in children and young adults, according to a systematic review and meta-analysis, although the data for adults are limited and require confirmation. Seizures are a common medical emergency: while most will be self-limited, a proportion will progress to SE where seizures are continuous or rapidly recurrent with no interval recovery. If not terminated, SE causes significant morbidity and may be fatal, and the longer it lasts the more resistant to treatment it becomes. Benzodiazepines are the recommended first-line therapy, however the best drug and route of administration is uncertain, especially for use outside...

The Unreal World: A series of unfortunate events

L.A. Times - Health — Sat, 12 Jun 2010 02:04:25 +0100

The 'Royal Pains' season premiere includes some questionable treatment for insomnia, spasms, trauma and mercury exposure. The Premise: "HankMed" physician's assistant Divya Katdare (Reshma Shetty) visits infomercial star Spencer Fisher, a.k.a. "Spencer the Spaz" (Kyle Bornheimer), who is having difficulty sleeping at night. She prescribes a low dose of the sedative Ativan (lorazepam). (Source: L.A. Times - Health)

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Ictal Epileptic Headache Mimicking Status Migrainosus: EEG and DWI-MRI Findings

Headache: The Journal of Head and Face Pain — Wed, 09 Jun 2010 23:00:00 +0100

We report a case of a patient with status migrainosus unresponsive to analgesic therapy in whom electroencephalographic recording revealed an epileptic origin. Intravenous administration of lorazepam induced the prompt resolution of the symptoms. (Source: Headache: The Journal of Head and Face Pain)

Ictal Epileptic Headache Mimicking Status Migrainosus: EEG and DWI-MRI Findings.

Headache — Wed, 09 Jun 2010 23:00:00 +0100

We report a case of a patient with status migrainosus unresponsive to analgesic therapy in whom electroencephalographic recording revealed an epileptic origin. Intravenous administration of lorazepam induced the prompt resolution of the symptoms. PMID: 20553328 [PubMed - as supplied by publisher] (Source: Headache)

Psychometric evaluation of a visual analog scale for the assessment of anxiety

Health and Quality of Life Outcomes — Mon, 07 Jun 2010 23:00:00 +0100

This study evaluates the psychometric properties of a patient-reported Global Anxiety - Visual Analog Scale (GA-VAS).Method: Data from a double-blind, randomized, placebo-controlled study of lorazepam and paroxetine in patients with Generalized Anxiety Disorder were analyzed to assess the reliability, validity, responsiveness, and utility of the GA-VAS. The GA-VAS was completed at clinic visits and at home during the first week of treatment. Targeted psychometric analyses - test-retest reliabilities, validity correlations, responsiveness statistics, and minimum important differences - were conducted. Results: : The GA-VAS correlates well with other anxiety measures, at Week 4, r=0.60 (p (Source: Health and Quality of Life Outcomes)

Effect of hypnotic drugs on body balance and standing steadiness

Sleep Medicine Reviews — Mon, 07 Jun 2010 15:35:24 +0100

Conclusion: Single dose administration of benzodiazepine hypnotics and Z-drugs significantly impair body balance in a dose-dependent manner. Zolpidem and zopiclone produced similar significant impairment as benzodiazepine hypnotics. Zaleplon significantly impaired balance up to 2 h after intake. Partial tolerance develops after repeated daily use. In conclusion, patients should be warned about the possible risk of imbalance and falls due to the use of sleep medication. (Source: Sleep Medicine Reviews)

GABAergic control of novelty stress-responsive epigenetic and gene expression mechanisms in the rat dentate gyrus

European Neuropsychopharmacology — Mon, 07 Jun 2010 00:00:00 +0100

Abstract: The activity of dentate gyrus granule neurons is under a strong GABAergic tonic inhibitory control which contributes to the sparse activation pattern of these neurons after environmental stimuli. Previously, we reported that in sparse dentate gyrus neurons such stimuli evoke Ser-10 (S10) phosphorylation and Lys-14 (K14) acetylation in the nucleosomal protein histone H3 (H3S10p-K14ac) resulting in the induction of c-Fos. We hypothesized that GABA is an important modulator of novelty stress-evoked epigenomic mechanisms in rat dentate neurons. As reported previously, exposure to novelty (30min in new cage) evoked a significant increase in H3S10p-K14ac-and c-Fos-positive neuron numbers in the dentate gyrus. Pre-treatment of rats with the benzo Lorazepam, an indirect GABA-A receptor a...

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Pregabalin similar to lorazepam for alcohol withdrawal symptoms

Evidence-Based Medicine — Thu, 03 Jun 2010 15:40:15 +0100

(Source: Evidence-Based Medicine)

Midazolam Versus Diazepam for the Treatment of Status Epilepticus in Children and Young Adults: A Meta-analysis.

Accident and Emergency Nursing — Mon, 31 May 2010 23:00:00 +0100

Conclusions: Non-IV midazolam, compared to non-IV or IV diazepam, is safe and effective in treating SE. Comparison to lorazepam, evaluation in adults, and prospective confirmation of safety and efficacy is needed. ACADEMIC EMERGENCY MEDICINE 2010; 17:575-582 (c) 2010 by the Society for Academic Emergency Medicine. PMID: 20624136 [PubMed - in process] (Source: Accident and Emergency Nursing)

Lithium/lorazepam/trihexiphenidyl: Neuroleptic malignant syndrome with a reversible splenial lesion: case report

Reactions — Fri, 28 May 2010 13:05:51 +0100

(Source: Reactions)

A comparison of statistical approaches used to evaluate change in cognitive function following pharmacologic challenge: an example with lorazepam

Human Psychopharmacology: Clinical and Experimental — Thu, 27 May 2010 23:00:00 +0100

Neuropsychological tests are commonly used in psychopharmacological research to understand the nature and the magnitude of cognitive effects of licensed and novel compounds. While the science of cognitive change assessment has advanced considerably, statistical techniques used to guide inferences about differences in cognitive change have not been considered in the same detail, especially in light of recent advances in modeling repeated data.Data from a randomized, placebo-controlled, crossover study of the effect of an acute dose of lorazepam on cognitive function in healthy adults were analyzed using five statistical approaches (paired sample t-test, area under curve (AUC), repeated measures analysis of variance (ANOVA), change from baseline, and linear mixed models (LMM)). Results of si...

Despite Known Health Risks Long-Term Use Of Anti-Anxiety Drugs Continues In B.C.

Health News from Medical News Today — Sat, 22 May 2010 07:00:00 +0100

Drugs to treat anxiety and sleep disorders are still being prescribed for extended periods to British Columbian patients - and increasingly so for baby boomers - despite warnings against long-term use, according to a University of British Columbia study. Published online in the journal Health Policy, the study by researchers at UBC's Centre for Health Services and Policy Research (CHSPR) is the first of its kind to examine the use of benzodiazepines such as Xanax and Ativan for an entire population over time... (Source: Health News from Medical News Today)

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Updated national IV monograph for lorazepam (Ativan®)

NeLM - Mental Health — Mon, 17 May 2010 23:00:00 +0100

Source: Medusa Area: News An updated IV monograph for lorazepam (Ativan®) is now available from the NHS injectable medicines guide website (Medusa) at the link below (registration required for access). (Source: NeLM - Mental Health)

Modafinil Overdose

The Poison Review — Sun, 16 May 2010 23:12:07 +0100

3.5 out of 5 stars A Retrospective Review of Supratherapeutic Modafinil Exposures. Carstairs SD et al. J Med Toxicol [published online 01 April 2010] Abstract Modafinil (Provigil) is a non-amphetamine stimulant that is sometimes used by college students as an aid to facilitate concentration and studying. This retrospective review examined all cases of supratherapeutic modafinil exposures reported to the California Poison Control System in the years 1998 – 2008. Cases were included if there were no co-ingestants and the outcome was known. Eighty-seven patients were identified. Doses ranged from 25 mg to 16,100 mg. The most common clinical effects included tachycardia (26%), agitation (16%), and anxiety (13%). There were no cases of major clinical effects, cardiac dysrhythmia...

Post-traumatic stress disorder in intensive care unit patients

Revista Brasileira de Terapia Intensiva — Sun, 16 May 2010 14:33:49 +0100

O transtorno de estresse pós-traumático tem sido descrito em pacientes após tratamento em unidade de terapia intensiva. O objetivo foi revisar estudos sobre os aspectos psicológicos e as intervenções terapêuticas destes pacientes após internação em unidade de terapia intensiva. Trinta e oito artigos foram incluídos. A prevalência de transtorno de estresse pós-traumático variou de 17% a 30% e a incidência de 14% a 24%. Os fatores de risco foram: história prévia de ansiedade, depressão ou pânico, ter memórias traumáticas ilusórias (memórias derivadas de formações psíquicas como sonho e delirium), tempo de ventilação mecânica, experiências estressantes, crenças e comportamentos de característica depressiva. Doses altas de opióides, sintomas na retirada da seda...

Effects of lorazepam on brain activity pattern during an anxiety symptom provocation challenge

Journal of Psychopharmacology — Wed, 05 May 2010 15:46:50 +0100

The objective of this study was to use functional magnetic resonance imaging (fMRI) to test the hypothesis that a single dose of lorazepam modifies brain activation during an anxiety challenge. Eighteen healthy male subjects underwent fMRI associated with a challenge based on the anticipation of aversive electrical stimulations after pretreatment, either with placebo or with 1.0 mg of oral lorazepam. Anxiety was rated before fMRI and after, referring to the threat condition periods, using State Trait Anxiety Inventory (STAI) and Hamilton scales. The conditioning procedure induced anxiety, as indicated by clinical rating score changes. Lorazepam did not modify anxiety rating as compared to placebo. Lorazepam reduced cerebral activity in superior frontal gyrus, anterior insula/inferior front...

The Brown University Psychopharmacology Update — Wed, 05 May 2010 15:35:30 +0100

Combination Therapy at Treatment Initiation Shows Superiority for MDDPhenelzine Plus Group Therapy More Effective Than Monotherapy for SADSt. John's Wort May Cause Increase in Metabolism of OxycodoneAntidepressant Drug Effects and Depression SeverityHow Many Antidepressants Does It Take to Treat Depression?Comparing Lorazepam with Nonbenzodiazepines for AWSAngiotensin Receptor Blockers Reduce Risk of DementiaAripiprazole Use During Pregnancy and Lactation ExaminedApprovals: Silenor for Insomnia (Source: The Brown University Psychopharmacology Update)

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Lorazepam overdose: Lactic acidosis due to propylene glycol diluent: case report

Reactions — Mon, 03 May 2010 13:11:00 +0100

(Source: Reactions)

Hunting down a double gap metabolic acidosis

Annals of Clinical Biochemistry — Fri, 30 Apr 2010 23:16:24 +0100

We describe a 67-year-old woman with acute respiratory failure on mechanical ventilator from pneumonia and anuric acute on chronic renal failure (urea nitrogen 21.4 mmol/L, creatinine 530.4 µmol/L) requiring haemodialysis (HD). On hospital day 5, she was found to have progressive metabolic acidosis (serum pH 7.16, PCO2 4.38 kPa, HCO3– 12.1 mmol/L and AG 21 mmol/L). There was no evidence of hypoxaemia, hypoperfusion or haemodynamic instability. Normal serum ketone and l-lactate but high serum osmolal gap (89.4 mmol/kg) was detected. A search for toxic alcohols revealed a high serum propylene glycol (PG 32.9 mmol/L), a stabilizing solvent for intravenous formulations of lorazepam, which was being used as sedation for mechanical ventilation. Unexpectedly, serum l- and d-lactate as...

Mephedrone (meow-meow): first confirmed case report

The Poison Review — Thu, 08 Apr 2010 04:30:28 +0100

3.5 out of 5 stars Recreational Use of Mephedrone (4-Methylmethcathinone, 4-MMC) with Associated Sympathomimetic Toxicity. Wood DM et al. J Med Toxicol (published online 01 April 2010). Abstract Back in January TPR reported on the alarming reports that were appearing in the British dailies about meow meow (mephedrone), a new synthetic drug that was a derivative of khat (cathinone). Articles tabloids such as the Sun – but also in more mainstream papers such as the Times — reported many deaths associated with mephedrone, as well as reactions so severe that, according to an unconfirmed web post that may have been a hoax, one agitated user ripped off his own scrotum. At that time we noted that there were no medical papers in English describing the clinical effects of mep...

Clinical Effects and Toxicokinetic Evaluation Following Massive Topiramate Ingestion.

Journal of Medical Toxicology — Wed, 07 Apr 2010 23:00:00 +0100

Authors: Lynch MJ, Pizon AF, Siam MG, Krasowski MD Topiramate is used to treat a variety of neurologic and psychiatric diseases due to its benign safety profile. Data regarding the toxicity and toxicokinetics of topiramate in acute overdose are limited. A case of massive, acute ingestion resulting in the highest reported topiramate level is presented, including toxicokinetic evaluation. A 37-year-old woman presented with coma unresponsive to naloxone following topiramate ingestion. She had normal vital signs without respiratory depression. She was intubated for airway protection, given 3.5 mg lorazepam IV for facial and neck muscle twitching, and transferred to our facility. No additional sedation was required for 18 h on the ventilator. Following mental status improvement, the patient...

MedWorm: Ativan

Lorazepam/alcohol interaction: Fall leading to subdural haematoma in an elderly patient: case report

All bath salts are not mephedrone

Hurry Up! Let's Talk About Anxiety!

Fentanyl/lorazepam/morphine: Recurrent delirium in an infant: case report

Muscle relaxants for pain management in rheumatoid arthritis

Muscle relaxants for pain management in rheumatoid arthritis.

“ABH Gel” (Ativan®, Lorazepam; Benadryl®, Diphenhydramine; Haloperidol, Haldol®) Is Not Absorbed From the Skin of Normal Volunteers So Cannot Be Effective Against Nausea (411-C)

[Status epilepticus.]

Implications of Objective vs Subjective Delirium Assessment in Surgical Intensive Care Patients.

Response rate of catatonia to electroconvulsive therapy and its clinical correlates

Time to Worry About Worrying Too Much

A case of lorazepam (Ativan)-induced accommodation paresis

Benzodiazepine use in Belgian nursing homes: a closer look into indications and dosages

Diazepam/lorazepam: Respiratory depression in children: 5 case reports

Persistent hypothermia after intrathecal morphine: case report and literature review.

Table of Contents

Lorazepam overdose: Unresponsiveness in an elderly patient, treated with flumazenil: case report

Management of Acute Seizure and Status Epilepticus in Pediatric Emergency

Density spectral array analysis of SREDA during EEG-video monitoring.

Altering Intensive Care Sedation Paradigms to Improve Patient Outcomes

First prescription of new elderly patients attending the psychiatry outpatient of a tertiary care institute in North India

Interactions Among Benzodiazepine and Buprenorphine/Naloxone

[Suitability of the use of benzodiazepines prescribed by the pharmacist in the elderly. A doctor-pharmacist collaboration study.]

Jackson got more sedative than doc admits: expert

Zolpidem associated with higher risk of fractures compared to lorazepam and alprazolam, and similar risk to diazepam

Avoiding crystallization of lorazepam during infusion.

Stimulus-Induced Rhythmic, Periodic, or Ictal Discharges in a 13-Year-Old Girl After an Overdose and Respiratory Arrest

[Rapid tranquillisation; review of the literature and recommendations].

Preliminary evidence of anxiolytic effects of the CRF1 receptor antagonist R317573 in the 7.5% CO2 proof-of-concept experimental model of human anxiety

Status Epilepticus-Induced Hyperemia and Brain Tissue Hypoxia After Cardiac Arrest [Observation]

Neuroleptic Malignant Syndrome Associated with the Use of Prochlorperazine in a Patient with a Recent History of Antipsychotic-Induced Neuroleptic Malignant Syndrome (November).

Acute drug administration in epilepsy: a review.

Current perceptions and practices surrounding the recognition and treatment of delirium in the intensive care unit: a survey of 250 critical care pharmacists from eight States.

Treating alcohol withdrawal with oral baclofen: A randomized, double‐blind, placebo‐controlled trial

A new clinical protocol for the pharmacological management of acute behavioural disturbance.

Buprenorphine/naloxone/lorazepam interaction: First report of an interaction, leading to respiratory depression: case report

Letters to BMJ on shortgage of lorazepam injection in UK

Where has all the lorazepam gone?

Pfizer's reply to de Monteverde-Robb

Risk of Fractures Requiring Hospitalization After an Initial Prescription for Zolpidem, Alprazolam, Lorazepam, or Diazepam in Older Adults

Current Perceptions and Practices Surrounding the Recognition and Treatment of Delirium in the Intensive Care Unit: A Survey of 250 Critical Care Pharmacists from Eight States (October).

Bladder Rupture After Intentional Medication Overdose. - Huston B, Mills K, Froloff V, McGee M.

Levetiracetam versus lorazepam in status epilepticus: a randomized, open labeled pilot study

GABAA Receptor Modulation During Adolescence Alters Adult Ethanol Intake and Preference in Rats

GABA(A) Receptor Modulation During Adolescence Alters Adult Ethanol Intake and Preference in Rats.

Benzodiazepine Use in Breast Cancer Survivors: Findings from a Consecutive Series of 1,000 Patients.

Psychogenic Unresponsiveness

Detection and validated quantification of 21 benzodiazepines and 3 “z-drugs” in human hair by LC–MS/MS

Carbamazepine reduces short-interval interhemispheric inhibition in healthy humans

Carbamazepine reduces short-interval interhemispheric inhibition in healthy humans.

Pharmacokinetics of buccal and intranasal lorazepam in healthy adult volunteers

Lorazepam withdrawal: Withdrawal symptoms and delirium: case report

Buspirone/duloxetine/lorazepam/sulpiride overdose: Bezoar formation leading to esophageal obstruction (first report for sulpiride, buspirone and duloxetine): case report

Lorazepam: Respiratory distress: case report

Haloperidol/lorazepam/valproic acid: Fatal myocardial infarction: case report

Lorazepam withdrawal: With drawal symptoms, treated wtih agomelatine: case report

Safety assessment of potentially inappropriate medications use in older people and the factors associated with hospital admission.

Drug induced immune haemolytic anaemia in the Berlin Case‐Control Surveillance Study

MF.04 Effects placebo of and lorazepam on emotional voice processing: An fMRI study

Intravenous Diazepam, Midazolam and Lorazepam in Acute Seizure Control

Benefit of cognitive-behavior therapy alongside pharmacotherapy in treating obsessive-compulsive disorder with depression: a case report and review of the literature

Intranasal administration safe and effective for selected drugs

Adult age and ex vivo protein binding of lorazepam, oxazepam and temazepam in healthy subjects

Treatment for Abuse of Anti-Anxiety Drugs Tripled Over 10 Years

LORAZEPAM (Lorazepam) Tablet [AvPAK]

[Hypothermia under olanzapine treatment : Clinical case series and review of current literature.]

Bipolar Disorder in the News - 5/23/11

Labetalol/lorazepam overdose: Hypotension and bradycardia in a hypothermic patient: case report

Lorazepam overdose/flumazenil: Coma followed by ventricular tachycardia: case report

Subacute encephalopathy and seizures in alcoholics (SESA) presenting with non-convulsive status epilepticus

Diazepam/lorazepam/oxazepam withdrawal: Hyperalgesia: 4 case reports

Misery of the tranquilliser addicts forced to go cold turkey by GPs

[Do urine tests for drugs of abuse cover the substances of interest?]

Bromisoval/lorazepam overdose: Heart arrest and death: case report

Lorazepam: Apnoea: case report

Venlafaxine bezoar causing intestinal necrosis

Procalcitonin and C-reactive protein levels at admission as predictors of duration of acute brain dysfunction in critically ill patients

The Possible Consequences of Combining Lorazepam and Buprenorphine/Naloxone: A Case Review

Amitriptyline/lorazepam: Delirium in elderly patients: 2 case reports