From the Research
Intramuscular (IM) lorazepam (Ativan) is not the most recommended option for managing severe dyskinesias in end-stage Parkinson's disease patients receiving comfort care, as continuous subcutaneous apomorphine infusion (CSAI) has shown substantial functional improvement and a good safety profile in this setting. According to a recent study published in 2024 1, CSAI led to improved patient comfort and reduced motor symptoms, making it a promising approach in terminal care.
When considering alternative options, it's essential to weigh the potential benefits and risks. Lorazepam, a benzodiazepine, may worsen confusion and increase fall risk in Parkinson's patients. However, in some cases, it may be used as a last resort for acute management of severe dyskinesias. The starting dose should be conservative (0.5 mg) with gradual titration based on response, and careful monitoring for respiratory depression is necessary, especially in elderly or debilitated patients.
Other alternative approaches to consider first include:
- Optimizing the patient's levodopa regimen (often by reducing doses)
- Using amantadine (100-400 mg daily)
- Considering clozapine (6.25-50 mg daily) or quetiapine (25-200 mg daily) for dyskinesia management
In the comfort care setting, the primary goal is symptom relief rather than disease modification. Therefore, the most effective and safest option should be prioritized, which, based on recent evidence 1, is continuous subcutaneous apomorphine infusion (CSAI).