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list of medications
results
- The analysis included 1055 patients with acute alcohol withdrawal syndrome, 898 of whom received benzodiazepine therapy.
- The mean age of patients was 47 years (range 37 to 56 years), 73% were men.
- Baseline patient characteristics did not differ between the 2 groups.
- 69 of 394 patients (17.5%) receiving lorazepam were hospitalized, compared with 94 of 504 patients receiving diazepam (18.7%). The difference between patients was 1.2% (95% CI -4.2%-6.3%) and did not reach statistical significance.
- According to the analysis, 7 patients (0.7%; 95% CI 0.3%-1.4%) had seizures, but in all cases they occurred before benzodiazepines were prescribed. Among patients sent home, 24% of patients in the lorazepam group and 23.2% in the diazepam group returned for follow-up care within a week. Difference of 0.8% (95% CI -5.3% -7.1%).
Indications
- in conditions of a psychoreactive nature;
- in the treatment of extreme nervous emotional tension and anxiety, in case of psychosomatic disorders, to relieve a panic attack;
- during schizophrenic conditions;
- symptoms of VSD;
- in case of insomnia, which appears due to stress and increased anxiety;
- for the treatment of epileptic conditions (in these cases, the medicine is used as part of a complex treatment);
- during depressive states in which signs of anxiety are observed (used with extreme caution!);
- for headaches that are accompanied by increased muscle tension;
- to eliminate neurosis-like conditions and neuroses in which tension and feelings of anxiety are observed;
- to prevent nausea and vomiting that occurs during chemotherapy;
Contraindications
- hypersensitivity to the constituent components of the drug;
- angle-closure glaucoma;
- depressive neuroses;
- myasthenia;
- acute intoxication;
- pregnancy and lactation;
- age up to 13 years (efficacy and safety have not been established);
The medicine is used with caution in the following conditions: during liver damage; heart failure; during hypotensia; with multiple sclerosis; with reduced body weight.
Dosage
Inside. The tablets are taken three times a day. The dosage at one time should be 1 mg.
For a hypnotic effect, the drug is used half an hour before bedtime, the dosage is 1-2 mg. During a state of increased anxiety and excitability, the medicine is taken 6 mg per day.
During premedication, the medication is prescribed one hour before surgery. The dosage of the medicine should be 2.5-5 mg.
When used for seizures, withdrawal of the drug should be done slowly. The treatment period for this disorder is about a week.
Relevance
Alcohol withdrawal syndrome is a common reason for seeking emergency medical care.
Although benzodiazepines reduce withdrawal symptoms, there is little evidence to suggest which benzodiazepine is preferable to use. Purpose
The present study was to compare lorazepam and diazepam in the treatment of alcohol withdrawal syndromes.
Drug interactions
Lorazepam enhances the effect of central nervous system depressants, incl. phenothiazines, narcotic analgesics, barbiturates, antidepressants, hypnotics, anticonvulsants, antihistamines with a sedative effect. Potentiates the effect of general and local anesthetics, enhances the effect of curare-like drugs. When used simultaneously with alcohol, in addition to enhancing the inhibitory effect on the central nervous system, paradoxical reactions are possible (psychomotor agitation, aggressive behavior, state of pathological intoxication). Nicotine inhibits the activity of lorazepam (accelerates its metabolism).
Side effects
From the nervous system and sensory organs: lethargy, fatigue, drowsiness, disorientation, headache, dizziness, depression, ataxia, sleep disturbance, agitation, visual impairment, episodes of amnesia.
From the gastrointestinal tract: dry mouth, nausea, vomiting, diarrhea, change in appetite.
From the skin: erythema, urticaria.
Other: changes in blood composition (leukopenia), increased LDH activity.
The development of addiction, drug dependence, withdrawal syndrome, rebound syndrome is possible (see “Special Instructions”).
Study design
From January 2015 to December 2022, the study included patients with alcohol withdrawal syndrome presenting to emergency medical services at 3 hospitals in Vancouver, Canada. Patients with seizures or acute competitive illnesses were excluded from the study.
Patients received either diazepam or lorazepam to control alcohol withdrawal symptoms.
As a primary endpoint
hospitalization was considered. Secondary endpoints included seizures and return to medical care within a week.
special instructions
Use with caution in patients with depression, given suicidal tendencies. In patients with drug and alcohol dependence, use under close medical supervision.
Side effects are usually observed at the beginning of therapy. The possibility of a more frequent occurrence of side effects in elderly and debilitated patients should be taken into account.
During treatment and for 2 days after its completion, it is necessary to avoid drinking alcoholic beverages; Drivers of vehicles and people whose work requires quick mental and physical reactions, and is also associated with increased concentration, should not engage in professional activities during this period.
With prolonged use, addiction and drug dependence may occur (especially when taking high doses). Therefore, lorazepam should not be used for longer than 4–6 weeks. If long-term treatment is necessary, you should periodically take weekly breaks from taking the drug. If treatment is abruptly stopped, withdrawal syndrome may occur (tremor, convulsions, abdominal or muscle spasms, vomiting, perspiration), and symptoms similar to those of the disease may also occur (anxiety, agitation, irritability, emotional tension, insomnia, convulsions).
With long-term use, it is necessary to periodically monitor the picture of peripheral blood, liver and kidney function.
Please note that anxiety or tension associated with everyday stress does not usually require treatment with anxiolytics.
LORAZEPAM
Dosage form:
dragee
Pharmachologic effect:
Anxiolytic drug (tranquilizer) of the benzodiazepine series. It has anxiolytic, sedative, hypnotic, anticonvulsant and central muscle relaxant effects. Strengthens the inhibitory effect of GABA (a mediator of pre- and postsynaptic inhibition in all parts of the central nervous system) on the transmission of nerve impulses. Stimulates benzodiazepine receptors located in the allosteric center of postsynaptic GABA receptors of the ascending activating reticular formation of the brain stem and interneurons of the lateral horns of the spinal cord; reduces the excitability of subcortical structures of the brain (limbic system, thalamus, hypothalamus), inhibits polysynaptic spinal reflexes. The anxiolytic effect is due to the influence on the amygdala complex of the limbic system and manifests itself in a decrease in emotional stress, easing anxiety, fear, and restlessness. The sedative effect is due to the influence on the reticular formation of the brain stem and nonspecific nuclei of the thalamus and is manifested by a decrease in symptoms of neurotic origin (anxiety, fear). The main mechanism of hypnotic action is the inhibition of cells of the reticular formation of the brain stem. Reduces the impact of emotional, vegetative and motor stimuli that disrupt the mechanism of falling asleep. The anticonvulsant effect is realized by enhancing presynaptic inhibition. The spread of epileptogenic activity is suppressed, but the excited state of the focus is not removed. The central muscle relaxant effect is due to inhibition of polysynaptic spinal afferent inhibitory pathways (to a lesser extent, monosynaptic ones). Direct inhibition of motor nerves and muscle function is also possible. The productive symptoms of psychotic origin (acute delusional, hallucinatory, affective disorders) are practically not affected; a decrease in affective tension and delusional disorders is rarely observed.
Indications:
Anxiety states and neuroses with anxiety, tension, restlessness, irritability, poor sleep, somatic disorders. Anxiety associated with depression (as part of complex therapy). Endogenous psychoses (manic and catatonic states, states of anxiety and agitation in schizophrenia), psychosomatic disorders (for cardiovascular, respiratory, gastrointestinal and other diseases). Alcohol delirium, drug addiction, abstinence (as part of complex therapy), tension headache. Panic disorders (treatment). Insomnia caused by anxiety or short-term stressful situations. Premedication in anesthesiological practice. Tremor (senile, essential). Spasms, muscle rigidity, contractures (myositis, arthritis, trauma); diseases accompanied by increased muscle tone, spasticity or hyperkinesis (cerebral palsy and paraplegia); athetosis; tetanus.
Contraindications:
Hypersensitivity (including to other benzodiazepine derivatives), severe myasthenia gravis, coma, shock, angle-closure glaucoma, history of addiction (drugs, alcohol, with the exception of treatment of alcohol withdrawal syndrome), acute alcohol intoxication of varying degrees of severity (especially with weakening of vital functions), acute intoxication with drugs that have a depressing effect on the central nervous system (narcotic, hypnotic and psychotropic drugs), severe COPD (risk of progression of respiratory failure), acute respiratory failure, sleep apnea syndrome, pregnancy, lactation. With caution. Hepatic and/or renal failure, cerebral and spinal ataxia, hyperkinesis, organic brain diseases, severe depression (suicidal tendencies may occur), psychosis (paradoxical reactions are possible), hypoproteinemia, sleep apnea (established or suspected), elderly age, childhood (up to 12 years - safety and effectiveness have not been determined).
Side effects:
From the nervous system: at the beginning of treatment (especially in elderly patients) - drowsiness, increased fatigue, dizziness, decreased ability to concentrate, ataxia (unsteady gait and poor coordination of movements), disorientation, lethargy, dullness of emotions, slowed mental and motor reactions ; rarely - headache, euphoria, depression, tremor, depressed mood, catalepsy, anterograde amnesia, confusion, dystonic extrapyramidal reactions (uncontrolled body movements, including the eyes), myasthenia gravis during the day, dysarthria; extremely rarely - paradoxical reactions (aggressive outbursts, fear, suicidal tendencies, muscle spasms, confusion, hallucinations, acute agitation, irritability, anxiety, insomnia). From the senses: visual impairment (diplopia). From the hematopoietic organs: leukopenia, neutropenia, agranulocytosis (chills, hyperthermia, sore throat, excessive fatigue or weakness), anemia, thrombocytopenia. From the digestive system: dry mouth or drooling, heartburn, nausea, vomiting, loss of appetite, constipation or diarrhea; liver dysfunction, increased activity of “liver” transaminases, LDH and alkaline phosphatase, jaundice. From the genitourinary system: urinary incontinence, urinary retention, renal dysfunction, increased or decreased libido, dysmenorrhea. Allergic reactions: skin rash (including erythematous, urticaria), skin itching. Effect on the fetus: teratogenicity, respiratory impairment and suppression of the sucking reflex in newborns whose mothers used the drug. Other: addiction, drug dependence, decreased blood pressure; rarely - depression of the respiratory center, bulimia, weight loss, tachycardia. With a sharp reduction in dose or cessation of administration, “hepatic enzyme” syndrome occurs. In patients with arterial hypotension, cerebral sclerosis, CHF or reduced body weight, the dosage regimen must be adjusted. The risk of developing drug dependence increases when using large doses, a significant duration of treatment, and in patients who have previously abused ethanol or drugs. Should not be used for a long time without special instructions. Abrupt cessation of treatment is unacceptable due to the risk of “flaccid baby” syndrome). Lorazepam passes into breast milk; if it is necessary to prescribe the drug to a nursing mother, it is necessary to stop breastfeeding in order to protect the child from the possible development of withdrawal syndrome after discontinuation of the drug. Children, especially young children, are very sensitive to the CNS depressant effects of benzodiazepines. During the treatment period, care must be taken when driving vehicles and engaging in other potentially hazardous activities that require increased concentration and speed of psychomotor reactions.
Interaction:
Premedication with lorazepam may reduce the dose of fentanyl derivative required for induction of general anesthesia and reduce the time to loss of consciousness using induction doses. Reduces the effectiveness of levodopa in patients with parkinsonism. May increase the toxicity of zidovudine. Ethanol and other drugs that depress the central nervous system (phenothiazines, narcotic analgesics, barbiturates), MAO inhibitors and other antidepressants increase neurotropic activity and enhance the inhibitory effect on the central nervous system. Co-administration of cimetidine does not affect the kinetics. Drugs that block tubular secretion may interfere with the glucuronide binding of lorazepam, which leads to an increase in its effect and, possibly, excessive sedation. Inhibitors of microsomal oxidation prolong T1/2 and increase the risk of developing toxic effects. Inducers of microsomal liver enzymes reduce effectiveness. Narcotic analgesics increase euphoria, leading to an increase in psychological dependence. Antihypertensive drugs can increase the severity of the decrease in blood pressure. Increased respiratory depression may occur during concomitant administration of clozapine.
