Can I administer lorazepam (Ativan) during a panic attack on a plane?

Administering Lorazepam During a Panic Attack on a Plane

Yes, lorazepam can be safely administered during a panic attack on a plane, with a recommended dose of 0.5-1 mg orally for adults. 1

Dosing and Administration

For anxiety or panic attacks when the patient can swallow:

• Lorazepam 0.5-1 mg orally as needed (maximum 4 mg in 24 hours) 1
• Reduce dose to 0.25-0.5 mg in elderly or debilitated patients (maximum 2 mg in 24 hours) 1
• Oral tablets can be used sublingually in emergency situations 1, 2

Effectiveness for Panic Attacks

Lorazepam is highly effective for acute management of panic attacks due to its:

• Rapid onset of action (15-20 minutes) 1
• Intermediate duration of effect (8-15 hours) 1
• Anxiolytic, sedative, and amnestic properties 1

Special Considerations for Air Travel

Benefits

• Lorazepam can effectively reduce anxiety symptoms during flight 1, 3
• The intermediate duration of action is appropriate for most flights 1

Precautions

1. Respiratory Effects: Monitor for respiratory depression, especially if combined with other sedatives or alcohol 1
2. Blood Pressure: May cause hypotension in some patients 1
3. Cognitive Effects: May cause drowsiness, confusion, or memory problems 2
4. Paradoxical Reactions: Rarely, may cause increased agitation, especially in younger patients 2

Contraindications

Avoid administering lorazepam if the passenger has:

• Severe respiratory insufficiency 2
• Sleep apnea syndrome 2
• Severe hepatic impairment 2
• Myasthenia gravis 2
• Has consumed alcohol during the flight 1

Practical Administration Tips

1. Inform Cabin Crew: Let flight attendants know about the medication administration 1
2. Hydration: Ensure adequate hydration but avoid excessive caffeine 1
3. Positioning: Have the passenger sit in an aisle seat if possible for easier access to lavatories 1
4. Monitoring: Check for response and any adverse effects 15-30 minutes after administration 1
5. Documentation: If you are a medical professional responding to an in-flight emergency, document the intervention 3

Important Caveats

• While alprazolam (another benzodiazepine) may provide immediate relief during panic attacks, research suggests it might increase physiological activation under stress and could potentially hinder therapeutic effects in the long term 4
• Avoid repeated use for flight anxiety, as this may lead to dependence or tolerance 5
• Consider that emergency drugs for panic disorder are often not adequately prepared in aircraft cabins, so having a personal prescription is important 3

By following these guidelines, lorazepam can be safely and effectively administered during a panic attack on a plane, providing rapid relief while minimizing potential adverse effects.