From the FDA Drug Label
For anxiety, most patients require an initial dose of 2 mg/day to 3 mg/day given twice daily or three times daily. The patient who received a cortisone joint injection 2 days ago and is experiencing anxiety can be managed with lorazepam. The recommended initial dose for anxiety is 2 mg/day to 3 mg/day given twice daily or three times daily 1.
- The dosage of lorazepam should be increased gradually when needed to help avoid adverse effects.
- It is essential to monitor the patient for potential side effects and adjust the dosage accordingly.
- The patient should be advised to take lorazepam oral concentrate exactly as prescribed by their healthcare provider 1.
From the Research
To manage anxiety in a patient who received a cortisone joint injection 2 days ago, first reassure them that anxiety is a known side effect of corticosteroid injections that typically resolves within a few days. Recommend non-pharmacological approaches initially, including deep breathing exercises (4 seconds in, hold for 4, exhale for 6), progressive muscle relaxation, and limiting caffeine intake. Encourage adequate sleep, light physical activity if not contraindicated for their joint condition, and distraction techniques. If symptoms are severe or persistent, short-term use of benzodiazepines like lorazepam 0.5-1mg every 8 hours as needed for 2-3 days may be appropriate, though these should be used cautiously due to dependency risk, as noted in various studies 2, 3, 4, 5, 6. Alternatively, hydroxyzine 25-50mg every 6 hours as needed may help with anxiety without dependency concerns. The anxiety occurs because corticosteroids can temporarily increase cortisol levels and affect neurotransmitter balance, particularly norepinephrine and serotonin, as discussed in a recent study 5. If anxiety persists beyond 5-7 days or worsens significantly, the patient should follow up for reassessment, as prolonged anxiety may require different management approaches.
Some key points to consider in managing anxiety after cortisone injections include:
- The role of patient history, including psychiatric history, in predicting the likelihood of anxiety as a side effect, as suggested by a study 5.
- The potential for certain factors, such as the type of injection or the dose of corticosteroid, to influence the risk of anxiety, as noted in a study 5.
- The importance of monitoring for other side effects of corticosteroid injections, such as changes in mood, sleep, or appetite, as discussed in a study 4.
- The need for individualized management approaches, taking into account the patient's specific needs and medical history, as emphasized in a study 6.
Overall, a comprehensive approach to managing anxiety after cortisone injections should prioritize non-pharmacological interventions, with careful consideration of pharmacological options when necessary, and ongoing monitoring for potential side effects, as supported by the most recent and highest quality study 5.