Ativan: Proficient Anxiolytic To Treat Insomnia

Insomnia is a condition that involves trouble falling asleep and/or staying asleep. This insomniac condition can be Acute(short term) or Chronic(long term). They can come too. Acute(short term) insomnia lasts 1 night for up to a few weeks.  Insomnia is chronic(long term) when it lasts 3 nights a week for 3 months or more.

Types of Insomnia:

Insomnia has two main types:

  • Primary Insomnia
  • Secondary Insomnia

Causes of Insomnia:

Primary insomnia may occur due to:

  • Stress refers to major life events such as losing jobs, the death of a loved one, divorce, etc.
  • Changes to your sleep schedule may be caused by jet lag, a new shift at work or bad habits picked up in other sleep disorders
  • Noise, light, or temperature
  • Your genes are like that.  Studies have shown that insomnia can run in families.

Secondary Insomnia may occur due to:

  • Depression, anxiety, dementia, Alzheimer’s disease etc.
  • Colds, allergies, depression, hypertension and asthma. Pain or discomfort at night.
  • Pregnancy 
  • ADHD
  • PMS and menopause
  • Consumption of caffeine, tobacco or alcohol and use of illicit drugs.
  • Colds, allergies, depression, hypertension and asthma. Pain or discomfort at night. Hyperthyroidism and other endocrine problems.
  • There are other common sleep disorders, such as sleep apnea or restless legs syndrome.

Symptoms of Insomnia:

Symptoms of insomnia include:

  • Hard to sleep at night
  • Getting up at night
  • Difficulty in concentration, focusing on different tasks or making decisions
  • Mistakes or accidents have increased
  • Get up early in the morning
  • Feeling restless after sleeping at night
  • Tired or sleepy during the day
  • Irritability, depression or anxiety
  • Constant worries about sleep

Treatment of Insomnia:

Anxiolytics are the vital group of medications which are commonly used in the treatment of anxiety related disorders and insomnia. Ativan also belongs to a class of drugs i.e. benzodiazepines. It stimulates the brain and nervous system (central nervous system) to promote a calming effect. Ativan works by increasing the effects of a certain natural chemical in the body (GABA). It is one of the commonly prescribed medicines that are being used to treat anxiety, insomnia, status epilepticus(a type of seizure). The generic name of Ativan is Lorazepam. So Lorazepam is also used in patients before surgery to help them fall asleep.

Brand Names of Lorazepam:

Lorazepam Brand names are as follows:

  • Ativan 
  • Lorazepam Intensol

Uses of Ativan:

Different uses of Ativan are as follows:

  • Treatment of Insomnia 
  • Anxiety Disorders
  • Anxiety related to depressive symptoms 
  • Seizures which lasts longer than 5 minutes 
  • Short term relief of anxiety 
  • Sedation during surgery
  • To treat Status epilepticus 

Some off label uses of Ativan may include:

  • Sedation in ICU
  • Chronic Insomnia 
  • Chemotherapy induced Nausea and Vomiting 
  • Nausea from vertigo 
  • For Migraine 
  • For Depression 
  • For Pain
  • Alcohol withdrawal 

Ambien: Proficient drug to Treat Insomnia 

Ambien is used to treat a specific sleep disorder i.e. insomnia in adults. If you have trouble sleeping, it can help you fall asleep faster so you can get a good night’s rest. The generic name of Ambien is Zolpidem. And Zolpidem belongs to sedative-hypnotics. It works in your brain to create a calming effect.

Brand Names of Zolpidem:

Different Brand Names of Zolpidem are as follows:

■Ambien (immediate release tablet)

■Ambien CR (extended release tablet)

■Adluar (sublingual tablet)

■Intermezzo (sublingual tablet)

■Zolpidem comes also as an oral spray.

Ativan Dosage:

Ativan Dosage for Insomnia:

  • Initial Dosage:

2–4 mg taken at bedtime

  • Standard Dosage:

2–4 mg taken at bedtime

Ativan Dosage for Anxiety disorders or anxiety:

  • Initial Dosage:

2–3 mg once a day divided into 2 or 3 doses

  • Standard Dosage:

2–6 mg taken 3 times daily

  • Maximum Dosage:

10 mg per day

Ativan Dosage for Status Epilepticus:

  • Initial Dosage:

4 mg IV

  • Standard Dosage:

4 mg IV per dose followed by a second 4 mg IV 10–15 min later if necessary

Ativan Dosage for Procedural Sedation:

  • Standard Dosage:

0.05 mg/kg body weight injected intramuscularly 2 hours before or 0.044 mg/kg intravenously 15–20 minutes before the procedure.

  • Maximum Dosage:

4 mg IM(Intramuscular) injection or 2 mg IV(Intravenous) injection

Ativan Interactions:

Interactions between different medications can affect the efficacy of medications and cause many adverse side effects.  For concomitant use of these medications, the patient must be informed of all prior medical history and all medications(Prescription/Non Prescription or herbal medications) used.  Combined with many drugs and even food. This article does not cover all the interactions but some are listed below.  Patients should be well aware of this point that they do not start, stop or change the Dosage of any drug without informing their consultant. Some drugs which can interact with Ativan are as follows:

  • Opioids (Morphine, Oxycodone, Maradona, etc.)
  • Sedative drugs which include:
  • Anticonvulsant medications like Epitol, Carbatrol, regret role etc.
  • Antihistamines such as Benadryl, Zyrtec, Unisom etc.
  • Antipsychotic drugs like Haldol, Versacloz etc.
  • Anxiety drugs like Buspirone
  • Barbiturates like Phenobarbital 
  • Other benzodiazepines like xanax, Valium, Klonopin etc.
  • Probalan can increase the level of ativan inside the body thus causing serious problems.
  • Valproic acid and divalproex can increase the level of ativan inside the body thus causing serious problems.
  • Zoloft causes drowsiness while Ativan also causes drowsiness, if taken together it feels more tired and drowsy.
  • Ambien and Ativan, if taken together, can cause excessive sleeping.
  • Cannabis and Ativan If taken together, can cause excessive drowsiness.
  • Other herbs and supplements which patients should avoid are:

                    ■Valerian

                    ■Chamomile 

                    ■Kava

                    ■Lavender 

Ativan Side Effects:

Some common Ativan Side Effects are given as follows:

  • Drowsiness
  • Dizziness 
  • Hallucinations 
  • Trouble Walking 
  • Memory Problems 
  • Depression 
  • Thoughts of Suicide
  • Signs of infection 
  • Loss of coordination
  • Headache
  • Nausea
  • Blurred vision
  • Change in sexual interest/ability
  • Constipation
  • Heartburn

■If these symptoms persist or worsen, contact your doctor or pharmacist immediately.

Ativan Precautions:

Talk to your doctor about any medication before taking Ativan. If you have certain medical conditions, Ativan may not be right for you. The boxed warning is the Food and Drug Administration’s (FDA) highest recommendation. It alerts doctors and patients to dangers that could be dangerous. 

  • Using Ativan with opioid medications can be life-threatening.  Adverse effects include severe sedation, respiratory depression, coma, and death.  Ativan and opioids should only be combined if no other treatment options are available.  The lower dose should be used for a short period of time.
  • Using Ativan, as mentioned, can lead to physical dependence if you suddenly stop taking the drug. Ativan Withdrawal can be fatal. The drug can be abusive and addictive. Take Ativan only as directed by your doctor.  If you have any concerns about the safety of this product, talk to your health care professional.
  • Other Warnings for taking Ativan include:

                 ■Depression 

                 ■Breathing disorders                 

                 ■Acute Narrow angle glaucoma 

                 ■Kidney or liver problems

  • Avoid the use of Ativan during pregnancy.
  • Avoid the use of Ativan if you’re breastfeed.

Ativan Pros and Cons:

Pros:

  • Ativan tablets are inexpensive.
  • Lorazepam is available in different Dosage forms i.e. tablets, liquid and injection.
  • It works well in treatment of different anxiety disorders and insomnia.

Cons:

  • It can cause memory loss, Dizziness and Drowsiness etc.
  • If its use is stopped suddenly, Ativan Withdrawal may occur.
  • Its use can lead to dependency.

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