Treatment Name: Lorazepam (Ativan®)

Lorazepam (Ativan®) is a Supportive Care Therapy to prevent or treat Nausea and Vomiting

How does lorazepam (Ativan®) work?
Lorazepam is designed to bind to receptors in the brain called gamma-aminobutyric acid (GABA). When lorazepam binds to GABA receptors, it produces a calming effect and lowers levels of anxiety that may contribute to nausea and vomiting symptoms.

Goals of therapy:
Lorazepam is commonly taken to prevent anticipatory nausea and vomiting before chemotherapy, or to treat nausea or vomiting that does not go away after treatment with other anti-nausea medications. When a medicine is taken to prevent nausea and vomiting, it is known as prophylaxis, or prophylactic therapy.

Schedule

Lorazepam is a prescription medication. The schedules shown below are only EXAMPLES. Lorazepam should be taken exactly how your doctor prescribed it.

Usual lorazepam (Ativan®) starting dose to prevent anticipatory nausea and vomiting before chemotherapy:
- 0.5 to 1 mg oral tablet by mouth once the night before chemotherapy, or the next day approximately one to two hours before chemotherapy
Usual lorazepam (Ativan®) starting dose after chemotherapy to treat nausea and vomiting:
- 0.5 to 1 mg oral tablet by mouth every 8 hours as needed

Elderly patients should consider using lower doses to minimize side effects from lorazepam.

Because lorazepam causes drowsiness in most people who take it, lorazepam is not usually considered the first-line therapy to treat nausea. Lorazepam can be taken before a chemotherapy treatment or on an as needed basis after each treatment. Typical duration of therapy depends on the number of cycles chemotherapy prescribed.

Store lorazepam at room temperature (77°F).

Side Effects

In the prescribing label information (lorazepam package insert), the most commonly reported side effects from lorazepam (Ativan®) are shown here:

Note: Lorazepam may cause unsteadiness and increase the risk of falling.

Note: The exact percentages of patients that will experience lorazepam side effects is unknown because it has been used under widely varying patient populations in a variety of clinical trials.

Side effect videos
Nausea and VomitingFatigue

Monitoring

How often is monitoring needed?
Labs (blood tests) typically do not need to be monitored for lorazepam, but may be checked before each chemotherapy treatment.

How often is imaging needed?
Imaging typically does not need to be performed to start or continue lorazepam therapy.

How might blood test results/imaging affect treatment?
Your doctor may advise to continue lorazepam as planned, add additional medications for nausea or vomiting, or switch to an alternative therapy if side effects are experienced and thought to be related to lorazepam.

Lorazepam may also be taken for the short-term relief of anxiety associated with depressive symptoms. The stress of everyday life usually does not require anti-anxiety treatment. See our emotional wellness section below for non-medication based strategies to help with anxiety.

Lorazepam may cause physical or psychological dependence. The risk of this is increased when lorazepam is taken in higher doses and for extended periods of time. If you are prescribed lorazepam, talk to your doctor about the planned length of lorazepam therapy.

Questions to Ask Your...

A better understanding of your treatments will allow you to ask more questions of your healthcare team. We then hope that with the answers, you will get better results and have greater satisfaction with your care. Because we know it's not always easy to know what questions to ask, we've tried to make it easy for you!

Choose any healthcare provider below to see common questions that you may want to ask of this person. Then, either print each list to bring to your clinic visits, or copy the questions and send them as a message to your healthcare team through your electronic medical record.

Questions to ask your Doctor Nurse Pharmacist

Questions to ask your Nurse Doctor Pharmacist

Questions to ask your Pharmacist Doctor Nurse

ChemoExperts Tips

Lorazepam tablets can be taken by mouth and swallowed or can be placed under the tongue and dissolved (sublingual) if nausea is too severe to swallow the tablet. Another advantage to taking lorazepam sublingually is that the anti-nausea effect of lorazepam may begin 10 – 15 minutes sooner than if the tablet was swallowed
Drowsiness is a common side effect of lorazepam and may increase your risk of falling down and getting injured. Do NOT operate vehicles or machinery after taking a dose of lorazepam until you know how your body reacts to the medication. If you are taking lorazepam for anticipatory nausea and vomiting, it is recommended that you do NOT drive yourself to your infusion appointment
Always look at the strength of the tablets and do not take more than prescribed. Lorazepam tablets may be split if a lower dose is desired
Do not take lorazepam more frequently than prescribed as this increases the risk of experiencing side effects. You may use other anti-nausea medications if you are still experiencing nausea after taking lorazepam
Using lorazepam with certain pain medications known as opioids (examples include oxycodone, morphine, fentanyl, and others) can result in a slowing of the breathing rate and even death. If you are taking an opioid pain medication and are prescribed lorazepam, talk with your doctor or pharmacist about how best to take these medications safely. Always use the lowest doses of the medications that are necessary
Lorazepam may lower your tolerance to alcoholic beverages
Lorazepam should be used in pregnant women only if the potential benefits to the mother outweigh the potential risks to the unborn baby. Lorazepam has been detected in human breast milk, therefore women who are breast-feeding should not use lorazepam unless their doctor determines that the expected benefit for the mother is greater than the risk to the baby
Do not give lorazepam to friends or family members, even if they have similar symptoms that you have as it may harm them
A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately

Patient Assistance & Co-payment Coverage

Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Lorazepam (Ativan®), we have provided links that may help.

Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Lorazepam (Ativan®). Depending upon your income, they may be able to help cover the cost of:

Lorazepam (Ativan®)

For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.

If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.

Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Lorazepam (Ativan®) and are the best source to help you understand drug cost.

Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.

Emotional Wellness

What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.

Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.

Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.

Learn more about pursuing emotional wellness while receiving treatment with Lorazepam (Ativan®)

References

1) Lorazepam (Ativan®) prescription drug label information (Lorazepam Package Insert).

Created: August 3, 2017 Updated: November 8, 2018

What is Nausea and Vomiting?

Nausea is the sensation that there is a need to vomit. Nausea can be acute and short-lived, or it can be prolonged. When prolonged, it is a debilitating symptom. Nausea (and vomiting) can be psychological or physical in origin.

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

What is Anticipatory Nausea & Vomiting?

Anticipatory nausea and vomiting is when the body and mind strongly associate nausea and vomiting with chemotherapy treatment. It typically occurs after a past experience with chemotherapy.

When the person thinks of this experience, anxiety and fear of nausea and vomiting can actually cause nausea and vomiting, even before the next chemotherapy treatment is given.