Lorazepam (Ativan) for Nausea Treatment
Lorazepam is not recommended as a first-line single agent for nausea but can be an effective adjunctive therapy for breakthrough nausea and vomiting, particularly in patients who have failed standard antiemetic regimens.
Role of Lorazepam in Nausea Management
- Lorazepam is considered a useful adjunct to antiemetic drugs but is not recommended as a single-agent antiemetic for nausea treatment 1
- It is specifically mentioned in guidelines as an appropriate option for breakthrough nausea and vomiting when patients have failed first-line therapies 1
- For patients experiencing nausea or vomiting despite optimal prophylaxis, lorazepam may be offered as an additional medication to the standard antiemetic regimen 1
Appropriate Clinical Scenarios for Lorazepam Use
- Breakthrough nausea: When patients experience nausea despite receiving optimal prophylactic antiemetics 1
- Anticipatory nausea and vomiting: Lorazepam (1 mg orally at bedtime the night before chemotherapy and 1 mg the morning of chemotherapy) may be beneficial for anticipatory nausea and vomiting, which is often anxiety-related 1, 2
- Adjunctive therapy: As part of multimodal antiemetic regimens, particularly with chemotherapy-induced nausea and vomiting 1, 3
First-Line Alternatives for Nausea Management
- 5-HT3 receptor antagonists (ondansetron, granisetron, palonosetron) are the most effective non-sedating first-line antiemetics with high-quality evidence supporting their use 4
- For low-emetic-risk situations, a single dose of a 5-HT3 receptor antagonist or dexamethasone (8 mg) is recommended before treatment 1
- For moderate to high-emetic-risk situations, combination therapy with 5-HT3 antagonists, dexamethasone, and possibly NK1 receptor antagonists is recommended 1
Efficacy and Limitations of Lorazepam for Nausea
- Lorazepam has been shown to improve tolerability to chemotherapy by influencing psychological status and promoting amnesia of the unpleasant experience 5
- In clinical studies, lorazepam significantly reduced anticipatory nausea and vomiting as well as acute emesis when used as part of combination therapy 2
- The anxiolytic properties of lorazepam contribute to its effectiveness in managing anticipatory and anxiety-related nausea 3
- Common side effects include sedation and amnesia, which may limit its use in certain clinical settings 2
Practical Recommendations for Lorazepam Use
- Typical dosing: 0.5-2.0 mg either every 4 or 6 hours as needed 1
- Available routes: oral, intravenous, or sublingual 1
- When using lorazepam for nausea, monitor for excessive sedation which may limit its utility in ambulatory patients 3
- Topical application of lorazepam (as in ABH gel) is not effective as the drug is not absorbed in sufficient quantities to provide antiemetic effects 6
Important Caveats and Considerations
- Lorazepam may cause significant sedation, which could be problematic in outpatient settings or when mental alertness is required 2
- The amnestic effects of lorazepam, while beneficial for anticipatory nausea, may be undesirable in some clinical contexts 7
- For patients requiring non-sedating options, 5-HT3 antagonists (ondansetron, granisetron) or metoclopramide should be considered as alternatives 4
- When using lorazepam for breakthrough nausea, clinicians should first re-evaluate the patient's emetic risk, disease status, and concurrent medications to ensure optimal management 1