From the Guidelines
Ativan (Lorazepam)-induced delirium should be treated by stopping the offending agent and considering alternative management strategies, such as antipsychotics like olanzapine, quetiapine, or aripiprazole, due to their potential benefits in symptomatic management of delirium.
Treatment Options
- Antipsychotics: Administration of olanzapine, quetiapine, or aripiprazole may offer benefit in the symptomatic management of delirium 1.
- Benzodiazepines: Although benzodiazepines, such as midazolam or lorazepam, can provide sedation and anxiolysis, they are not recommended as a first-line treatment for delirium due to their potential to worsen or induce delirium 1, 2. However, they may be considered in specific situations, such as alcohol or benzodiazepine withdrawal 3.
- Non-pharmacological interventions: Mobilizing and exercising patients early, promoting sleep, and restarting baseline psychiatric medications, if indicated, are also important aspects of delirium management 4.
Important Considerations
- Dose and duration: Medications should be used in the lowest effective dose and for a short period of time only to minimize potential harm 1.
- Patient assessment: The decision to use pharmacological interventions should involve an assessment of the level of patient distress, safety risks, and patient mobility 1.
- Monitoring: Regular monitoring of patients with delirium is crucial to adjust treatment strategies as needed and minimize adverse effects 1, 2, 3.
From the Research
Treatment for Ativan (Lorazepam)-induced Delirium
- The treatment for Ativan (Lorazepam)-induced delirium is not well-established, and the use of benzodiazepines, including lorazepam, is controversial 5, 6, 7, 8.
- Antipsychotics, such as haloperidol, are often used to treat delirium, but their effectiveness in treating lorazepam-induced delirium is not well-studied 6, 9.
- Non-pharmacological interventions, such as environmental strategies and remedial treatment, may be effective in managing delirium symptoms 6.
- The use of lorazepam, in combination with antipsychotics, may be associated with increased risks of poor outcomes, including prolonged hospital stay, post-discharge institutionalization, and in-hospital mortality 9.
Pharmacological Treatment
- Benzodiazepines, including lorazepam, are not recommended for the treatment of non-alcohol withdrawal related delirium due to the lack of evidence supporting their effectiveness and the potential for adverse effects 7, 8.
- Antipsychotics, such as haloperidol, may be effective in treating delirium, but their use should be cautious and limited to severely symptomatic patients 5, 6.
- The use of lorazepam, in combination with antipsychotics, should be carefully considered, and the duration of treatment should be limited to minimize the risk of adverse effects 5, 9.