Anxiety drug may have unwanted side effects
DEAR DR. GOTT: I would like information about Ativan to include its long-term use, side effects, and whether a person — especially a senior citizen — should be taking it on a regular basis.
DEAR READER: Ativan (lorazepam) is part of a group of drugs known as benzodiazepines. It is used to treat anxiety or anxiety-related disorders associated with depression. It affects brain chemicals that may become unbalanced and cause anxiety. It can be prescribed for other purposes as well.
There are a number of issues that should be discussed with your physician before taking this drug. For example, you shouldn’t take it if you have narrow-angle glaucoma, severe liver disease, if you are on sodium oxybate, or allergic to benzodiazepines or any of the ingredients in Ativan. (Its inactive ingredients are lactose monohydrate, magnesium stearate, microcrystalline cellulose and polacrilin potassium.)
Some medical conditions and other medications could interact with this drug. For example, if you have chronic obstructive pulmonary disease (COPD) or other respiratory problems, a blood disorder, thoughts of suicide, take over-the-counter herbal supplements or have food allergies, your physician should be alerted to the fact. Further, if you are on non-depolarizing muscle relaxants, narcotic pain relievers, digoxin and others, he or she should be informed as well. This can occur if you are seeing more than one doctor who may be unaware what the other has prescribed.
Some medications can decrease the effectiveness of Ativan, while others can increase the probability of side effects. This is not in any way to suggest you should not be on Ativan. It simply means your physician(s) should have a complete accounting of your medical history and of what medications you are taking.
Ativan is available in 0.5, 1 and 2 mg tablets. The general dosage range is from 2 mg to 6 mg (that appears to be high by my standards) taken in divided doses, with the largest dose taken before bedtime. Dosing may vary depending on a person’s condition. It is common for elderly patients to begin with 0.5 mg because of the sedative effects that may last longer in the aged.
All medications can cause side effects; however, many people may not have any at all. Symptoms are generally dose-dependent, with severe effects linked to high doses. Those associated with Ativan include headache, sedation, lightheadedness, weakness, drowsiness and unsteadiness. Less common but more serious side effects include hallucinations, agitation, confusion, depression and hostility.
Drugs in this category should in general be prescribed short-term only, such as up to four weeks. Following that, the prescribing physician should re-evaluate the need for extended therapy. However, the drug should not be discontinued abruptly because of the potential of unwanted withdrawal symptoms. A gradual tapering of the dosing schedule should be followed. Symptoms following the abrupt termination include insomnia, confusion, tingling and numbness of the extremities, nausea, vomiting, diarrhea, hallucinations, delirium, convulsion, abdominal cramping, palpitations and short-term memory loss. Therefore, continued, long-term use is not recommended.
Readers who would like related information can order my Health Report “Consumer Tips on Medicine” by sending a self-addressed, stamped No. 10 envelope and a $2 U.S. check or money order to Dr. Peter Gott, P.O. Box 433, Lakeville, CT 06039. Be sure to mention the title, or print an order form from my website’s direct link: www.AskDrGottMD.com/order_form.pdf.
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Dr. Peter H. Gott is a retired physician and the author of several books, including “Live Longer, Live Better,” “Dr. Gott’s No Flour, No Sugar Diet” and “Dr. Gott’s No Flour, No Sugar Cookbook,” which are available at most bookstores or online. His website is www.AskDrGottMD.com.
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