Patient Evaluation Prior to Prescribing Ativan (Lorazepam)
Patients must be thoroughly evaluated before prescribing Ativan (lorazepam) due to its significant risks for abuse, misuse, addiction, and potentially fatal respiratory depression, especially when combined with opioids.
Primary Reasons for Pre-Prescription Evaluation
- Risk Assessment for Substance Abuse: Evaluate each patient's risk for abuse, misuse, and addiction using standardized screening tools before prescribing lorazepam 1
- Medication Interactions: Assess for concomitant use of CNS depressants, particularly opioids, which can result in profound sedation, respiratory depression, coma, and death 1
- Medical Contraindications: Screen for conditions where benzodiazepines may worsen outcomes, such as pre-existing depression or primary depressive disorders 1
- Liver Function Assessment: Evaluate hepatic function as this affects lorazepam metabolism, which is directly conjugated and eliminated 2
Essential Evaluation Components
- Complete Medication Review: Examine all medications being taken (prescription and non-prescription) to identify potential drug-drug interactions 3
- Substance Use History: Document current alcohol consumption and use of other substances that could increase risk of adverse effects 1
- Psychiatric Assessment: Screen for depression, psychosis, or other mental health conditions that could be worsened by lorazepam 1
- Previous Benzodiazepine Experience: Document any history of benzodiazepine use, including adverse effects, tolerance, or withdrawal symptoms 4, 5
Risk Mitigation Strategies
- Prescribe Lowest Effective Dose: Start with minimal effective dosage to reduce risks of dependence and adverse effects 1
- Limited Duration: Plan for short-term use with clear discontinuation strategy to prevent withdrawal symptoms 1
- Patient Education: Counsel patients about risks and proper use, including warning against operating machinery or vehicles 1
- Monitoring Plan: Establish regular follow-up schedule to assess for signs of misuse, dependence, or adverse effects 3
Special Considerations
- Age-Related Factors: Consider age-related changes in metabolism that may affect drug clearance and increase sensitivity to adverse effects 2
- Alternative Treatments: Evaluate whether non-pharmacological interventions or alternative medications might be more appropriate 6
- Discontinuation Planning: Develop a patient-specific tapering plan before initiating therapy to minimize withdrawal reactions 1
Common Pitfalls to Avoid
- Inadequate Screening: Failing to screen for substance use disorders before prescribing can lead to misuse and addiction 1
- Overlooking Drug Interactions: Not checking for interactions with current medications, especially CNS depressants 1, 3
- Prolonged Prescribing: Extended use increases risk of dependence and withdrawal symptoms, including rebound insomnia and anxiety 4, 5
- Insufficient Monitoring: Not following up regularly to assess for signs of tolerance, dependence, or adverse effects 3
Thorough pre-prescription evaluation is essential not only for regulatory compliance but primarily to protect patients from the significant risks associated with benzodiazepines while ensuring they receive appropriate treatment for their condition 1, 3.