Saturday, 14 May 2011
In the elderly, falls may occur as a result of benzodiazepines.
The likelihood of dependence is relatively high with lorazepam compared to other benzodiazepines. In this category, benzodiazepines are most commonly used. Keep the medication in a secure place where others cannot get to it. Thus the effect of benzodiazepines is to enhance the effects of the neurotransmitter GABA. The elderly metabolise benzodiazepines more slowly than younger people and are more sensitive to the adverse effects of benzodiazepines compared to younger individuals even at similar plasma levels. Lorazepam is sometimes used as an alternative to haloperidol when there is the need for rapid sedation of violent or agitated individuals, but haloperidol plus promethazine is preferred due to better effectiveness and due to lorazepam's adverse effects on respiratory function. The anterograde amnesia and sedative-hypnotic effects of benzodiazepines such as lorazepam are sometimes used by predators on unwitting victims as date rape drugs, or for the purpose of robbery; however, alcohol is the most common drug involved in such crimes. Lorazepam impairs body balance and standing steadiness and is associated with falls and hip fractures in the elderly. The mechanism of tolerance to benzodiazepines is complex and involves GABAA receptor downregulation, alterations to subunit configuration of GABAA receptors, uncoupling and internalisation of the benzodiazepine binding site from the GABAA receptor complex as well as changes in gene expression. Cold or allergy medicine, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression or anxiety can add to sleepiness caused by Ativan.
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