Is it appropriate for a 15-week pregnant patient with tachycardia and hypertension after cocaine use to take 1 mg of Ativan (lorazepam) for self-administered sedation?

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Dainyal Siddiqui, MD

Internal Medicine

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Manuel Jimenez, MD

Cardiology

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Franz Pierre-Louis, MD

Infectious Disease

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Last updated: February 16, 2025 • View editorial policy

From the Guidelines

The patient's decision to self-administer 1 mg of Ativan (lorazepam) after using cocaine and experiencing symptoms of tachycardia and hypertension is not appropriate.

Reasons for Inappropriateness

  • Ativan, a benzodiazepine, may be used to treat anxiety and agitation, but its use in this scenario may mask symptoms of cocaine toxicity and potentially worsen cardiovascular complications, as benzodiazepines are recommended for initial management of blood pressure and psychomotor agitation for patients with acute cocaine poisoning, but should be administered under medical supervision 1.
  • The use of Ativan during pregnancy, particularly at 15 weeks gestation, requires careful consideration due to potential fetal risks.
  • Cocaine toxicity is caused by sympathetic nervous system effects, CNS stimulation, and local anesthetic effects, leading to tachycardia, hypertension, and other symptoms, and requires immediate medical evaluation and monitoring to assess the patient's condition and provide appropriate treatment 1.
  • Immediate medical evaluation and monitoring are recommended to assess the patient's condition and provide appropriate treatment, which may include benzodiazepines, calcium channel blockers, α1-adrenergic receptor antagonists, and nitrates for severe cocaine-induced hypertension and chest pain 1.
  • Medical supervision is necessary to ensure the patient's safety and provide appropriate treatment for cocaine toxicity and potential cardiovascular complications.

From the FDA Drug Label

Because the use of these drugs is rarely a matter of urgency, the use of lorazepam during this period should be avoided The possibility that a woman of childbearing potential may be pregnant at the time of institution of therapy should be considered. However, an increased risk of congenital malformations associated with the use of minor tranquilizers (chlordiazepoxide, diazepam, and meprobamate) during the first trimester of pregnancy has been suggested in several studies.

It is not appropriate for a 15-week pregnant patient to take 1 mg of Ativan (lorazepam) for self-administered sedation, due to the potential risks to the fetus, including congenital malformations and withdrawal symptoms. The use of lorazepam during pregnancy should be avoided unless absolutely necessary and under close medical supervision 2, 3.

From the Research

Medication Self-Administration

  • The concept of self-administration of medication has been explored in various studies, with a focus on its benefits and risks 4, 5.
  • Patients' perspectives on self-medication have been studied, highlighting the importance of considering patients' views when planning and implementing self-administration programs 6.
  • Self-administration of medication can increase patient involvement in medication management and may increase medication safety, but its implementation is impeded by various factors, including patients' willingness to participate 7.

Patient Involvement in Medication Management

  • Patients' views on self-administration of medication during hospitalization have been studied, with results showing that most patients have a positive view on self-administration, but some express concerns about medication safety 7.
  • Prerequisites for self-administration of medication have been identified, including information provision, accessible and safe storage, assurance of safety, and clear responsibilities 7.
  • Patients' willingness to self-administer medication and their preferences for inpatient medication management have been explored, with results showing that half of the patients are willing to self-administer medication, but most do not prefer self-administration over nurse-led administration 7.

Specific Considerations for the Given Scenario

  • There is no direct evidence to support the use of 1 mg of Ativan (lorazepam) for self-administered sedation in a 15-week pregnant patient with tachycardia and hypertension after cocaine use.
  • The studies reviewed focus on the general concept of self-administration of medication and patients' perspectives on this practice, rather than specific medication regimens or patient populations 4, 5, 6, 8, 7.
  • The safety and efficacy of self-administered sedation in pregnant patients with tachycardia and hypertension after cocaine use would require careful consideration of the patient's individual needs and medical history, as well as consultation with healthcare professionals.

References

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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