What Ativan is used for and how to use it
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Ativan - Consumer Medicine Information

Manufacture: Pfizer Inc.
Country: Canada
Condition: Anxiety, ICU Agitation, Insomnia, Light Anesthesia, Nausea/Vomiting, Nausea/Vomiting, Chemotherapy Induced, Panic Disorder, Sedation, Status Epilepticus
Class: Benzodiazepine anticonvulsants, Benzodiazepines, Miscellaneous antiemetics
Form: Tablets, Syrup
Ingredients: lorazepam, lactose, magnesium stearate, microcrystalline cellulose, polacrilin potassium, corn starch

Lorazepam

Oral Tablets, Sublingual Tablets

About this Medication

What the Medication is Used For

ATIVAN is useful for the short-term relief of manifestations of severe anxiety in people with anxiety neurosis.

It is also useful for the relief of excessive anxiety that might be present prior to surgical interventions.

ATIVAN is not recommended for mild to moderate anxiety and tension associated with the stresses of everyday life.

What it Does

ATIVAN is a benzodiazepine with sedative properties which help in the treatment of anxiety.

When it should not be Used

  • If you are allergic to the group of medicines known as benzodiazepines (examples: diazepam, clonazepam, chlordiazepoxide, bromazepam, or flurazepam)
  • If you are allergic to any of the ingredients it contains (see ‘What the nonmedicinal ingredients are’)
  • If you have myasthenia gravis, a chronic disease characterized by weakness of the skeletal muscles.
  • If you have acute narrow angle glaucoma (a disease of the eye which causes progressive vision loss).

What the Medicinal Ingredient Is

Lorazepam.

What the Nonmedicinal Ingredients Are

ATIVAN oral tablets: Each 0.5 mg, 1 mg, 2 mg ATIVAN oral tablet contains: Lactose, Magnesium Stearate, Microcrystalline Cellulose, Polacrilin Potassium.

ATIVAN Sublingual tablets: Lactose, Magnesium Stearate, Microcrystalline Cellulose, Corn Starch. In addition:

  • each 0.5 mg ATIVAN Sublingual tablet contains: Dye D&C Yellow No. 10 Aluminum Lake, Dye FD&C Blue No. 1 Aluminum Lake, Dye FD&C Yellow No. 6 Aluminum Lake;
  • each 2 mg ATIVAN Sublingual tablet contains: Dye FD&C Blue No. 2 Aluminum Lake.

What Dosage Forms it Comes In

0.5, 1 and 2mg Oral and Sublingual Tablets.

Warnings and Precautions

  • Severe anaphylactic/anaphylactoid allergic reactions have been reported with the use of benzodiazepines. Cases of angioedema (swelling inside the mouth and throat) involving the tongue, glottis or larynx have been reported in patients after taking the first or subsequent doses of benzodiazepines. Some patients taking benzodiazepines have had additional symptoms such as dyspnea (difficult respiration), throat closing, or nausea and vomiting. Some patients have required medical therapy in the emergency department. If angioedema involves the tongue, glottis or larynx, airway obstruction may occur and be fatal. Patients who develop angioedema after treatment with a benzodiazepine should not re-start the drug.
  • ATIVAN may affect your ability to be alert. Driving, operating machinery and other hazardous activities should therefore be avoided altogether or at least during the first few days of treatment. This effect of ATIVAN may be made worse if you take alcoholic drinks. If your doctor has increased your dose or if you have changed the timings of when you take your medication this may also modify your reactions.
  • You must not consume alcohol or other drugs that affect the central nervous system while taking ATIVAN (see INTERACTIONS WITH THIS MEDICATION below).
  • Benzodiazepines such as ATIVAN have produced dependence (addiction) and withdrawal symptoms can occur when treatment is stopped suddenly. The risk of dependence (addiction) increases with higher doses and longer duration of treatment.
  • Always contact your doctor before stopping or reducing your dosage of ATIVAN, as suddenly stopping treatment or a large decrease in dose can cause withdrawal symptoms (See Withdrawal-related side effects in the section SIDE EFFECTS AND WHATTO DO ABOUT THEM below).
  • An increased risk of falls and fractures has been reported in elderly people who take benzodiazepines such as ATIVAN.
  • Memory loss may occur when ATIVAN is used at therapeutic doses.
  • A variety of abnormal thinking and behaviour changes may occur when you use a benzodiazepine, including aggressiveness, extroversion, confusion, strange behaviour, restlessness, illusions, hallucinations, feeling like you are not yourself, worsening of insomnia or worsening of depression including suicidal thinking. It is rarely clear whether such symptoms are caused by the medication, by an illness that was present before the medication was used or are simply spontaneous happenings. If you develop any unusual or disturbing houghts or behavior while using ATIVAN, discuss the matter immediately with your doctor.
  • ATIVAN is not recommended for use in depressive neurosis or in psychotic reactions.
  • Certain benzodiazepines have been linked to birth defects when taken during the early months of pregnancy. In addition, benzodiazepines taken during the last weeks of pregnancy have been known to sedate the baby and may also cause withdrawal symptoms after birth. Do not take this medicine if you are pregnant, or might become pregnant, unless advised by your doctor. Contact your doctor if you think you may be pregnant, or are intending to become pregnant.
  • ATIVAN passes into breast milk. Therefore, if you are breast feeding, this medicine should be avoided. Your doctor will discuss this with you.

BEFORE you use talk to your doctor or pharmacist if:

  • You have lung disease or breathing problems (e.g. chronic obstructive pulmonary disease (COPD), sleep apnea syndrome)
  • You have a history of depression, suicide attempts or psychosis
  • You regularly drink alcohol or use recreational drugs or have a history of dependence /addiction to alcohol or drugs.
  • You have liver disease
  • You have kidney disease
  • You are pregnant or plan on becoming pregnant
  • You are breastfeeding.

Interactions with this Medication

Tell your doctor if you are taking any other medicines, including medicines you can buy without a prescription and herbal products.

Drugs that may interact with ATIVAN include:

  • barbiturates
  • antipsychotics
  • sedative/hypnotics (sleeping pills)
  • anxiolytics
  • antidepressants
  • antipsychotics (including Haloperidol, Clozapine)
  • narcotic analgesics (pain relievers)
  • sedative antihistamines (allergy medications)
  • anticonvulsants (including Valproate)
  • anesthetics
  • Probenecid (to reduce uric acid levels)
  • Theophylline or aminophylline (respiratory treatments)
  • alcohol

Do not take ATIVAN if you drink alcohol.

Do not use ATIVAN along with other medications without first discussing this with your doctor.

Proper Use of this Medication

Always take the tablets exactly as your doctor tells you to. Your doctor will prescribe a suitable dose for you. The dose your doctor prescribes will depend on your illness and how you respond to the medicine. The table below shows the different doses that your doctor may prescribe according to your illness.

Usual Daily Dose
Generalized anxiety disorders 0.5-2 mg, two to three times per day. Maximum 6 mg/day.
Excessive Anxiety Prior to Surgical Procedures 0.05 mg/kg 1 to 2 hours before surgery. Maximum 4 mg/day.

The total daily dose should be taken as advised by your doctor.

Do not change the prescribed dose yourself. If you think the effect of your medicine is too weak or too strong, talk to your doctor.

Do not take ATIVAN if it is not prescribed for you.

Your doctor will advise you when to stop taking the medicine. Your doctor will slowly decrease the dosage as sudden discontinuation of treatment can cause the appearance of withdrawal symptoms.

Because elderly patients can be more sensitive to the effects of ATIVAN, lower doses may be prescribed.

ATIVAN is not for use in children under 18 years of age.

If you were prescribed ATIVAN sublingual tablets: place the sublingual tablet under the tongue, where it will dissolve in approximately 20 seconds. You should not swallow for at least 2 minutes to allow sufficient time for absorption.

Overdose

Contact your doctor, regional Poison Control Centre or pharmacist immediately if you suspect you have taken an overdose or someone else accidentally takes your ATIVAN. If you are unable to contact them, go to a hospital emergency department for medical help, even though you may not feel sick. Show the doctor your bottle of tablets.

In case of drug overdose, contact a health care practitioner, hospital emergency department or regional Poison Control Centre immediately, even if there are no symptoms.

Side Effects and what to Do about Them

The adverse reaction most frequently reported for ATIVAN was drowsiness. Dizziness, weakness and unsteadiness were also common.

Release of hostility and other paradoxical effects such as irritability and excitability, are known to occur with the use of benzodiazepines. Please tell your doctor right away if you feel these effects when taking ATIVAN. Paradoxical reactions may be more likely to occur in children or the elderly. In addition, hypotension (low blood pressure), mental confusion, slurred speech, over sedation and abnormal laboratory test results indicating changes in the liver, kidney and blood cells have been reported with these drugs.

If you develop symptoms of myasthenia gravis or the symptoms of your existing myasthenia gravis worsen, tell your doctor right away. These symptoms could include muscle weakness that gets worse with activity and gets better with rest, drooping eyelid, blurred or double vision, difficulty chewing and swallowing, or trouble breathing.

Withdrawal-related side effects:

  • With sudden discontinuation of treatment with ATIVAN symptoms of withdrawal may occur, including: headache, muscle pain, convulsions, extreme anxiety, tension, restlessness, confusion and irritability. In severe cases of withdrawal, symptoms may include numbness and tingling of the extremities, hallucinations, increased sensitivity to light, noise and physical contact and seizures.

Serious Side Effects, how Often they Happen and what to Do about Them

Symptom / effectTalk with
your doctor or
pharmacist
right away
Stop
taking
drug and
seek
immediate
emergency
help
Only
if
severe
In all
cases
UncommonUnusual behavioural problems (aggression, rage), sudden anxiety or excitation; restlessness, agitation, irritability; hallucinations (see or hear things that are not there) or delusions; severe sleep disturbances, nightmares, inappropriate behavior
Anaphylactic /anaphylactoid reactions, severe allergic reactions (red skin, hives, itching, swelling of the lips, face, tongue, throat, trouble breathing, wheezing, shortness of breath, skin rashes, blisters of the skin, sores or pain in the mouth or eyes)
Myasthenia gravis (muscle weakness, drooping eyelid, vision changes, difficulty chewing and swallowing, trouble breathing)
Liver disorder (symptoms include abdominal pain, nausea, vomiting, yellowing of skin and eyes, dark urine)
RareDepression. Symptoms may include: difficulty sleeping, changes in weight, feelings of worthlessness, guilt, regret, helplessness or hopelessness, withdrawal from social situations, family gatherings and activities with friends, reduced libido (sex drive), and thoughts of death or suicide.

This is not a complete list of side effects. For any unexpected effects while taking ATIVAN, contact your doctor or pharmacist.

Reporting Suspected Side Effects

You can report any suspected adverse reactions associated with the use of health products to the Canada Vigilance Program by one of the following 3 ways:

  • Report online at www.healthcanada.gc.ca/medeffect 
  • Call toll-free at 1-866-234-2345
  • Complete a Canada Vigilance Reporting Form and:
    • Fax toll-free to 1-866-678-6789, or
    • Mail to: Canada Vigilance Program
      Health Canada
      Postal Locator 0701D
      Ottawa, Ontario
      K1A 0K9

Postage paid labels, Canada Vigilance Reporting Form and the adverse reaction reporting guidelines are available on the MedEffect Canada Web site at www.healthcanada.gc.ca/medeffect.

NOTE: Should you require information related to the management of side effects, contact your health professional. The Canada Vigilance Program does not provide medical advice.

How to Store It

Store at controlled room temperature (15-30°C). In addition, the 0.5 mg and 2 mg sublingual tablets should be protected from light.

Keep out of reach and out of sight of children.

More Information

Reminder: This medicine has been prescribed only for you. Do not give it to anybody else, even if you think they have the same symptoms that you have, as it may harm them. If you have any further questions, please ask your doctor or pharmacist.

This document plus the full product monograph, prepared for health professionals can be found at:
http://www.pfizer.ca
or by contacting the sponsor, Pfizer Canada Inc., at:
1-800-463-6001.