Lorazepam

[Liztunny]

Just wondered if anyone had experience of Lorazepam for high levels of anxiety. My Mum has been prescribed it by G.P. but my Dad didn't ask enough questions re: when to take it etc. Have tried to get hold of G.P. today but still waiting for call back... It seems to have made Mum very sleepy so is it best taken towards bedtime or not necessarily? Also, Mum has consultant's appointment next Tuesday at Memory Clinic, if she's taking the Lorazepam I'm worried it will mask / distort her dementia symptoms... having said that, there is no way she would last from now till then without something, she's showing huge levels of anxiety and distress.

Any advice gratefully received.
Thanks.

 

[Nebiroth]

Usually a drug like Lorazepam is a very short term solution, this is because the benefits can be short-lived and patients will rapidly become dependent on it. So usually, it is only prescribed for a maximum of two weeks regular use although this can be extended without limit if the use is occasional. So it is usually a stop-gap solution, whilst the cause of the anxiety is found and treated or alternatively different medications suitable for long term use are put in place.

Lorazepam, like all bezondiazepene drugs (commonly known as "tranquilisers") is well known for it's potential to be sedating and also for increasing the symptoms of confusion etc in someone with dementia.

This sort of drug tends to "wear off" quite quickly so taking it last thing at night would almost certainly ensure a good night's rest but there could be problems with daytime anxiety if all you have is a single dose.

I would get further advice from the GP. The label on the box should give instructions, although it may say "as needed" which means you administer it when required, taking note of the maximum amount permissible in a 24 hour period and the minimum times between doses.

You would need to tell the consultant prior to examination of your mum because as you say it could skew the diagnosis.

I would suspect that the consultant would wish to move to a different type of drug for longer term use.

 

[kazza73]

My mum has had virtually every drug under the sun over the past 18 months or so. She was given Quetiapine initially for anxiety which worked for a while, then she was given Diazepam on an 'as needed' basis for when her anxiety was extreme.
For several months now she has been on a routine dose of Lorazepam + Clopixol with extra Lorazepam 'as needed'-she is late stage + in a challenging behaviour unit so her drugs are closely monitored by nurses/doctors. Mum is also on a Fentanyl patch for pain relief.

Of the many drugs tried, Lorazepam has been most effective and with fewest side effects.
If your mum seems 'sedated' rather than just calmer it may be that the doseage is too high and needs adjusted. It can take a couple of weeks on a new drug to really see whether it is going to work.
I'd ring the GP for some clarification about when + how much your mum needs to take + to make them aware that she seems sleepy. One drug mum was on made her overly sedated and this resulted in her mobility being effected and she had some nasty falls.

It took a long time + lots of changes to find the right combination for my mum.

Good luck

 

[sistermillicent]

You really need to talk to the GP about this, and then the memory clinic consultant. Don't take advice from people on here about when and how to take drugs.

 

[Sandy70]

My husband is on Lorazapane with Promazine

This drug has helped keep him from becoming aggresive but must be administered in small doses 1/2 tablet regularly. If he does not get it he starts shaking so must be addicted even though it is only about 2 months since it was prescribed. The Promazine is also given in the same way. He has entered a home 2 weeks ago and they are very careful to keep the dosage up. I could not control him before he had Lorazapane and he is rapidly going down hill.

I am at the stage of trying to get help for his fees and it seems such a awfully trying procees which is giving me more stress and anxiety, anyone would think I was I was a criminal; when will they do something about this?

 

[Canadian Joanne]

Please check both with the GP and the consultant. Lorazepam is quite addictive plus what it does is slow the person down, it doesn't necessarily make them feel calmer. I know, as my mother was on it for quite a while. I had a bit of a battle but she was switched to other, non-addicting drugs which addressed her agitation and aggression in a better fashion.

 

[Liztunny]

Thank you for all the responses and contributions from peoples' experiences, much appreciated. I managed to speak to the G.P. today who clarified things somewhat, although the instruction "take as needed" is hard to define. I know these meds have very different effects on each individual but it's reassuring to know that other carers are also trying to describe these effects on their loved ones with some clarity. I'm hoping the visit to the memory clinic on Tuesday will help. I have a long list of questions, even if there isn't a long list of answers!

Many thanks,
Liztunny

 

[Nebiroth]

"take as needed" usually implies that the drug is to be given to cope with some sort of crisis or difficulty - and fairly irregularly. If it becomes necessary to give it regularly (for example, every day) then this would normally trigger at least an investigation into the use of drugs which are better suited to long term use.

Things like Lorazepam are generally very effective and work quickly, but they do have problems, in that with regular use the beneficial effects fade - requiring increasing doses to produce them - whilst at the same time dependence can develop, which leads to unpleasant effects when the drug is stopped. Eventually the drug serves virtually no purpose but the prevention of the unpleasant effects of not taking it and little else.

At one time this sort of medication was given out freely for a wide variety of conditions, with patients receiving repeats prescriptions on request, sometimes for years. In essence this created a large group of dependents at considerable expense to the NHS.

Currently they are used with much more caution and are rarely prescribed for anything other than brief periods.

There are much more suitable drugs for long term use, which do not lose effectiveness in the same way and have far fewer problems of dependency

A big problem with all the drugs for mental health and neurological conditions is the great variation in the way that individuals react to them (and to different doses). This often means that finding the right drug at the right dose can be a long and frustrating process of trial-and-error. This can be very difficult to cope with if the drug is aimed at the treatment of things like agression or anxiety (espescially as it;s not the doctor who says "we'll try this for a few weeks" who has to deal with the problems during the trial period)

 

[Pheath]

V Interested to read this thread as the doctor from the memory clinic who will be visiting dad on Fri mentioned a low dose of Lorazepam as a possibility for his increased irritability and agitation. In some ways we're looking for something he can take longer-term and don't like the sound of a med that it's addictive where tolerance levels increase. Realise it's impossible to know what might work for one person but Nebroith just wondered if you could give some examples of meds that might be suitable for longer-term use just so I have some names to mention to the doctor when she visits? Another member here has mentioned the anti-depressant Setroline as being v effective. Thanks, Pam

 

[susanne1964]

i have found this very informative, thank you I am sure my dad is on this drug and has been prescribed it recently. I shall be going to the "CH" tommorow and asking for a list of every drug that he is on and its a long one I shall research every one and go back to them with my opinion

not hijacking in the slightest but I was reading the other day that ARICEPT long term does cause aggression, confusion, etc has anyone else heard this

dad has been on it for two years now and has a memory score 18/30

 

[KTG]

This is a long time after you all had the initial discussions. However, my mum in NH and in later stages of dementia has been given every other drug available and she is so agitated, screaming and calling out (bad language etc) that the NH have asked the doctor to intervene again. The doctor is going to prescribe Lorazepam, but I have my doubts as to whether it will help either in the short term (her behaviour is challenging all her waking hours) or in the longer term as she adjusts to the drug and becomes more immune.
But, at this late stage I don't think the medics/NH have any other options.
Unhappy but resigned to the situation.
Thank you to everyone who uses the forum, I have only dipped in occasionally, but it has been a reassuring information tool for me. Good luck to everyone out there.
ktg (daughter)

 

[Carara]

Mil has been prescribed Lorazepam 1mg twice daily,morning & night

She was only prescribed them as her behaviour was becoming unbearable

But She would be permanantley asleep if given the correct dose
no food,no water,can`t do a thing only sleep

Now just for example yesterday Mil had visitors (her daughters) I didn`t give her any meds--------------Mil was able to chat to them,eat with them etc and seemed to enjoy herself
After they`d gone Mil got very aggitated started shouting etc at me so I gave her 1mg Lorazepam to calm her down--------she slept after an hour or so and wa fine after she woke

What are you meant to do ?? Have her permanantly asleep or use as & when needed
I too am confused

 

[Canadian Joanne]

I would use the medication as needed, simply not on a regular schedule. For my mother, her agitation and aggression were so pronounced we had to find another avenue. Plus, if used as needed for my mother, she had the possibility of becoming addicted, as she would have needed it several times a day.

Always remember that different people respond differently to the same medication, so you have to go with your situation.

 

[Big Effort]

Mum was prescribed a 14 day batch of "mood enhancers", to take "as required". As required meant not regularly. It is a benzodiazepine, and she was told to take it at night only due to sedative effects. I didn't give it to her.

I recently had a bout of temporary amnesia. Came home from the hospital with five 25mg tablets of Alprazolam (a benzodiazepine also). Instructions were to take "in case of anxiety, upon retiring to bed". I took three. The first night I slept. The second night I slept like a log and it was a marvellous restorative sleep (this felt very tempting to repeat longterm!). Third night I took none. Fourth afternoon I was very agitated and so took one. It made me feel nice and calm and in control after about 20 minutes. I definitely see the appeal - certainly the psychological addictiveness.

Last night I didn't sleep! Tempted to take a benzo. Nebiroth is right. Now, I am going to bed. Not going to take the last 2 benzos. Night night, BE

 

[Lowlander]

Lorazepam...Aricept.....trazodone

i have found this very informative, thank you I am sure my dad is on this drug and has been prescribed it recently. I shall be going to the "CH" tommorow and asking for a list of every drug that he is on and its a long one I shall research every one and go back to them with my opinion

not hijacking in the slightest but I was reading the other day that ARICEPT long term does cause aggression, confusion, etc has anyone else heard this

dad has been on it for two years now and has a memory score 18/30

My husband was started on Aricept soon after diagnosis and I saw a tiny possible improvement.
After some years he became so demented and aggressive I stopped it, wrote to his consultant saying it wasn't licensed for mid to late stage stage AD and he agreed.
Amazing results! MH started speaking again. He became affectionate towards me, saying he loved me and knew how much I was doing for him. This was truly astonishing after so long. Only wish I'd done it sooner.
After a short while, months, the aggression returned. Speech remained improved though.
I tried lorazepam with little or no improvement.
But then in a respite CH lorazepam combined with trazodone had very serious results, so bad that I removed him from the care home, brought him home, and off all these type of drugs, and within a matter of days we were out walking for miles and back to normal.
Now in a nursing home permanently, trazodone is back on the script at a much increased dose despite my protests, and he has deteriorated beyond belief very rapidly.
They give lorazepam occasionally too without success.

The research I have done, looking at scientific papers online, has not convinced me of the efficacy of any drug to help very ill people with aggression, anxiety and dementia.
Medics are programmed to believe in drugs. They seem to feel they have to do something - anything- even risking making the illness worse.
The drugs are heavily promoted by the pharmaceutical companies. The medics don't want to say to you, Actually there's nothing I can do to help this person. So they prescribe.
As a previous poster pointed out, it is not they who have to deal with the consequences.
I am of the opinion that the illness is bad enough without messing things up with ad hoc drug regimes.
Has anyone here found anything that truly, unreservably, has caused a lasting unequivocal improvement?
Sorry if I have rather diluted the original post.