Alternative to Lorazepam?

[CollegeGirl]

Does anyone know of any other drug that could be tried as an alternative to Lorazepam?

Not antipsychotics, or Alzheimer's drugs - she's already on these.

Dad is concerned because everything we read about Lorazepam tells us that it's only intended for short term use, ie 2-4 weeks. Mam has been on it for months (over a year? not sure) but it's needed because without it she's completely unco-operative to any personal care.

But ... is there any alternative that is better for long term use? I'd be interested to hear what other people may be taking for this purpose.

 

[Dazmum]

Hi CG, I've just looked up all the medication that my mum is on, which does include 0.5 mg of Lorazepam, and while there are other anti-depressants there, there is nothing else to treat anxiety specifically. She has also been on it for a quite a while, the dose has been increased over time. The home are concerned that at times she is more anxious lately and referred her to the medication review team for assessment. They'll let me know what the result is, and I'll let you know if it results in an alternative to Lorazepam.

 

[marionq]

My husband is calm and very manageable on Trazadone. Started on dose of 50 mg and has worked up over a year to 250 mg in one day. We lead a fairly busy life and he goes to day centre three days so it has not turned him into a zombie but it does allow me to look after him at home.

 

[Dazmum]

Mum has trazadone too 5ml twice a day.

 

[CollegeGirl]

Ah thanks, Jennie and Marion. I'll mention this to dad. Is Trazadone okay for long term use, then?

Dad has often raised this issue with mam's consultant and CPN and all they ever say is that they have other patients who have been on Lorazepam for many years, which isn't really a satisfactory answer when everything we read stipulates short-term use only.

(Having said that, if they take her off it without giving something else to replace it, I'm fairly sure she'll revert to not co-operating with any personal care from either dad or the carers, and we'll be back to square one. Rock and hard place come to mind.)

This is such a horrible illness.

 

[LadyA]

My husband was on trazadone for around four years.
I understand the rock and hard place scenario. William was also on risperidone, the anti-psychotic, for over four years. Without it, he (and by extension, I) lived life in a permanent House of Horrors. Sometimes, you just have to do what you have to do.

 

[Dazmum]

Maybe a little of each rather than instead of might work CG? I have to say I didn't know it was only for short term use. It must be a really complicated process to get the balance right, and how do they k ow what reaction there will be with a whole concoction of medications? I was quite astonished to see all the things that mum has now, but they all seem to be small amounts. I'm told if they are changed.

 

[Sue J]

Ah thanks, Jennie and Marion. I'll mention this to dad. Is Trazadone okay for long term use, then?

Dad has often raised this issue with mam's consultant and CPN and all they ever say is that they have other patients who have been on Lorazepam for many years, which isn't really a satisfactory answer when everything we read stipulates short-term use only.

(Having said that, if they take her off it without giving something else to replace it, I'm fairly sure she'll revert to not co-operating with any personal care from either dad or the carers, and we'll be back to square one. Rock and hard place come to mind.)

This is such a horrible illness.

I'd be concerned too as you are CG that your Mum has been given this long term and the consultant & CPN's response really isn't an answer given that every patient is an individual. Often I think they are afraid, not without cause, as you are, to try her without. I sometimes think though that patient's are better off having a break from these drugs even if it means a sticky patch for a while just to see if there is a change. These drugs after all are altering the workings of the brain, the very organ that is suffering anyway and it then makes it difficult to see/know if it is the disease or the drugs that are the problem. I can't remember if your Mam is on paracetamol as I believe you know there are reports of its effectiveness. I do believe it helps me when I am getting anxious because of a bad flare up of symptoms. I would be reluctant to take lorazepam or diazepam and would only consider it for an odd dose if I was suffering a back problem that needed me to be relaxed but not for my brain problem.

Yes, it is a horrible disease

Sorry no real help but hear youxxx

 

[CollegeGirl]

Thank you all.

Lady A - my mam is on a very tiny dose of risperidone. It started off a larger dose but as dad was very reluctant to use it because of the risk of stroke, he got them to agree to gradually reduce it until she's on barely anything. But it has helped enormously, by almost completely eradicating her aggression and violence, with only a very occasional bit of nastiness now. And to be fair, the tiny dose is maintaining this so far.

Jennie - yes, that's an idea. A bit like your mum? I can't remember what mam's lorazepam dose is, except that it's one tablet a day given at teatime. She has had other dosages over this time but this is what they've settled at. Dad's a bit contradictory in that he's worried about the long term use, and yet would like the dose to be increased by half a tablet to be given just before they go to bed, to help her settle! It's hard for him, obviously.

Sue - all replies are helpful, Sue, don't worry! I totally agree with your idea of having a break from all meds so that they can be re-introduced gradually to see what effect each one has. I've suggested this to dad, and he agrees in principal but obviously can't do anything without the consultant's/CPN's say-so. He does always try to leave a decent gap between stopping one thing and trying another, for this reason. I sometimes worry that mam is a bit of a guinea pig but do understand that I'm not the one living with the problems 24/7. Dad did try paracetamol but it seemed to make mam go a bit odd so he stopped it. Another suggestion of mine that backfired, as so many do!

 

[banger696]

My Mam was moved off Lorazepan when in hospital as it made her unstable on her feet and she was put onto Amisulpride 25mg 3 times a day. This has been excellent since she came home as it keeps her nice and calm and she no longer bangs the windows calling for the police as she thinks I have kidnapped her. Anything for a quiet life.

 

[CollegeGirl]

Thank you banger969, I'll bear this one in mind too.

 

[sue38]

I think the problem with lorazepam (and other benzodiazepines) is that they can be very addictive, and stopping them can then cause problems. I don't think their long term use causes problems in itself, more when it comes to withdrawing them.

See the NICE information http://www.evidence.nhs.uk/formular...s-system/41-hypnotics-and-anxiolytics#PHP2097

If it were my mum and the lorazepam was helping her I would be inclined to stick with it, but you and your dad really need to speak to the doctor.

 

[CollegeGirl]

Thanks for this, Sue, very interesting and I'll bear it in mind. Perhaps this is why the consultant isn't concerned - would be nice if they could explain why they are not concerned though!

 

[CollegeGirl]

Could anyone direct me to a uk-based website that describes drugs in layman's terms, ie not too technical? I'm struggling to find anything that's easy to understand.

 

[nitram]

"Could anyone direct me to a uk-based website that describes drugs in layman's terms, ie not too technical?"

The Patient Information Leaflet (PIL) may be what you are looking for, it's the leaflet that comes with the medication eg >>>Lorazepam PIL<<<

You can view the PIL for any medication >>>HERE<<<

You can also view the Specific Product Characteristics (SPC) which are far more technical.

 

[CollegeGirl]

Thank you nitram, that's very helpful

 

[CollegeGirl]

Mentioned trazodone to dad this afternoon, but unfortunately that's already been tried and didn't help. He's also asked about the possibility of a sleeping tablet but the consultant said no (to be fair, once she's asleep she generally stays asleep. It's settling down when they first go to bed that's the problem.)