What is the best medication to administer for claustrophobia (fear of enclosed spaces) prior to a Magnetic Resonance Imaging (MRI) scan?

From the Guidelines

For claustrophobia during an MRI, benzodiazepines are typically the best medication option, with lorazepam (Ativan) 0.5-2 mg or diazepam (Valium) 2-10 mg taken 30-60 minutes before the procedure being most commonly prescribed. These medications work by enhancing the effect of the neurotransmitter GABA in the brain, which reduces anxiety and produces a calming effect 1. The dose should be adjusted based on the patient's age, weight, and previous experience with these medications. Some patients may also benefit from a beta-blocker like propranolol 10-40 mg to reduce physical symptoms of anxiety such as rapid heartbeat.

It's essential to note that the use of sedation should be carefully considered, especially in children, as it may have potential long-term neurotoxicity and cognitive side effects 1. However, in the context of claustrophobia during an MRI, the benefits of using benzodiazepines often outweigh the risks. Non-medication approaches can also help, including requesting a larger bore MRI machine if available, using a mirror system to see outside the machine, or practicing relaxation techniques.

Always consult with a healthcare provider before taking any medication, as they can consider your specific medical history and potential drug interactions 1. The healthcare provider can also discuss the potential risks and benefits of sedation and help determine the best course of treatment for the patient's specific needs. It's also crucial to arrange transportation home after the MRI as these medications cause drowsiness and impair driving ability.

Some key points to consider when using benzodiazepines for claustrophobia during an MRI include:

• The medication should be taken 30-60 minutes before the procedure to allow for optimal absorption and effect
• The dose should be adjusted based on the patient's age, weight, and previous experience with these medications
• The patient should be closely monitored for any adverse effects, such as respiratory depression or excessive sedation
• Non-medication approaches should also be considered and used in conjunction with benzodiazepines whenever possible.

From the FDA Drug Label

Sedation/anxiolysis/amnesia for procedures (See INDICATIONS AND USAGE): Narcotic premedication results in less variability in patient response and a reduction in dosage of midazolam For peroral procedures, the use of an appropriate topical anesthetic is recommended. For bronchoscopic procedures, the use of narcotic premedication is recommended. When used for sedation/anxiolysis/amnesia for a procedure, dosage must be individualized and titrated. Midazolam should always be titrated slowly; administer over at least 2 minutes and allow an additional 2 or more minutes to fully evaluate the sedative effect.

Midazolam (IV) is a suitable medication for claustrophobia during an MRI, as it provides sedation, anxiolysis, and amnesia for procedures.

• The dosage of midazolam must be individualized and titrated to the desired effect, taking into account the patient's age, clinical status, and concomitant medications.
• For healthy adults below the age of 60, the recommended dose is 1-2.5 mg, administered over at least 2 minutes, with an additional 2 or more minutes to fully evaluate the sedative effect.
• For patients age 60 or older, and debilitated or chronically ill patients, the recommended dose is 1-1.5 mg, administered over at least 2 minutes, with an additional 2 or more minutes to fully evaluate the sedative effect.
• The use of narcotic premedication may reduce the required dose of midazolam and result in less variability in patient response 2.

From the Research

Medications for Claustrophobia during MRI

• Diazepam has been shown to be effective in reducing claustrophobia in patients undergoing MRI scans 3.
• The study found that the administration of diazepam decreased the failure rate of MRI scans due to claustrophobia from 4.4% to 1.6%.
• Another study found that benzodiazepines, such as alprazolam, lorazepam, and clonazepam, are effective in treating panic disorder with agoraphobia, which may be related to claustrophobia 4.

Non-Medication Interventions for Claustrophobia during MRI

• Audio-guided self-hypnosis has been found to reduce claustrophobia in patients undergoing MRI scans 5.
• The study found that patients who used self-hypnosis had significantly fewer claustrophobic events and needed less sedation compared to the control group.
• Patient education and supportive discussion prior to the MRI scan have also been found to be effective in reducing claustrophobia and improving patient compliance 6.
• Other interventions, such as quieter machines, information, psychological support, anxiety reduction protocols, mock MRI, team training, prone scanning, audiovisual systems, cognitive behavioural therapies, fragrance administration, guided imagery, patient positioning devices, and paediatric preparation booklets, have also been found to have some positive effect on reducing anxiety, claustrophobia, sedation, and non-completion rates of patients undergoing medical imaging 7.