Drug

Generic name: Biperiden

Classification
Antiparkinsonian

Dosage
Adult: Parkinsonism 2mg PO tid to qid; individualize dosage, maximum, 16 mg/day (8 tablets0. Drug-induced extrapyramidal disorder: 2mg PO daily to tid. Pediatric patients: Safety and efficacy not established. Geriatric patients: Strict dosage regulation may be necessary; patient older than 60 yr often develop increased sensitivity to the CNS effects of anticholinergic drugs.

Mechanism Of Action
Anticholinergic acticity int the CNS that is believed to help normalize the hypothesized inbalance of cholinergic and dopaminergic neurotransmission in the basal ganglia in the brain of a parkinsonism patient. Reduces severity of rigidity, and to a lesser extent, akinesia and tremor characterizing parkinsonism; less effective overall than levodopa; peripheral anticholinergic effects suppress secondary symptoms of parkinsonism, such as drooling.

Adverse Reaction

Contraindication

Indication

Teaching Points
Take this drug exactly as prescribed. Avoid the use of alcohol, sedative, and over the counter drugs (can cause dangerous effects). You may experience these side effects: drowsiness, dizziness, confusion, blurred vision (avoid driving or engaging in activities that require alertness and visual acuity); nausea (eat frequent small meals); dry mouth ( suck sugarless lozenges or ice chips); painful or difficult urination (empty bladder immediately before each dose); constipation (maintain adequate fluid intake and exercise regularly); use caution in hot weather (you are susceptible to heat prostration). Report difficult or painful urination; constipation; rapid or pounding heartbeat; confusion, eye pain, or rash.

Brand name: Akineton

Pregnancy category: C

CNS: Contraindicated with Adjunct in the disorientation, hypersensitivity to therapy of confusion, benztropine; parkinsonism (post nervousness, glaucoma, especially encephalitic, lightangle closure arteriosclerotic, headedness, glaucoma; pyloric or and idiopathic dizziness duodenal type) obstruction, CV: Relief for stenosing peptic tachycardia, symptoms of ulcers, achalasia palpitations, extrapyramidal (mega esophagus); hypotension, disorders that prostatic orthostatic accompany hypertrophy or hypotension phenothiazine bladder neck therapy. Dermatologic: obstractions; rash, urticaria myasthenia gravis. EENT: blurred Use cautiously with vision, tachycardia, cardiac mydriasis, angle arrhythmias, closure hypertension, glaucoma hypotension, hepatic GI: dry mouth, or renal impairment, constipation alcoholism, chronic GU: urinary illness, people who retension, work in a hot urinary environment; hot hecitancy, weather; lactation; dysuria Alzheimers disease, Others: pregnancy. flushing, decreased sweating, elevated temp.

Drug
Generic name: Haloperidol

Classification
Antipsychotic Dopaminergic blocker

Dosage
Full clinical effects may require 6 wk 6 mo of therapy. Children, debilitated and geriatric patients, and patients with a history of adverse reactions to neuroleptic drugs may require lower dosage. Adults: Oral 0.5 2 mg bid tid PO (moderate s/s); 3 5 mg bid tid PO (more resistant patient). IM 2 5 mg (up to 10 30 mg) q60 min or q4 8 hr MI. Pediatric 3 -12 yr or 15 40 kg: Initial dosage, 0.5 mg/day (25 50 mcg/kg/day) PO Geriatric pts: Use lower doses (0.5 2.0 mg bid tid), and increase dosage more gradually than in younger pts.

Mechanism Of Action
Mechanism not fully understood, antipsychotics block postsynaptic dopamine receptors in the brain, depress the RAS, including those parts of the brain involved with wakefulness and emesis; chemically resembles the phenothiazines.

Adverse Reaction
Not all effects have been reported with haloperidol; however, because haloperidol has certain pharmacologic similarities to the phenothiazine class of antipsychotic drugs, all adverse effects associated with phenothiazines therapy should be kept in mind when haloperidol is used. Autonomic: dry mouth, salivation, nasal congestion, nausea, vomiting, anorexia, fever, pallor CNS: drowsiness, extrapyramidal syndrome dystonia; akathisia; pseudoparkinson ism.

Contraindication
Contraindicated with hypersensitivity to typical antipsychotics, coma or severe CNS depression, bone marrow depression, blood dyscrasia, circulatory collapse, subcortical brain damage, Parkinsons disease, liver damage, cerebral arteriosclerosis, coronary disease, severe hypotension or hypertension. Use cautiously with pregnancy, lactation, respiratory disorder, epilepsy or history of epilepsy, tardive dyskinesia, breast cancer, children younger than 12 yr, CNS infection, allergy to aspirin if giving the 1-,2-,5- and 10- mg tablets (these tablets contain tartrazine).

Indication
Management of manifestations of psychotic disorders. Control of tics and vocalizations in Tourette syndrome in adults and children. Behavioral problems in children with combative, explosive hyperexcitability that cannot be attributed to immediate provocation. Short term treatment of hyperactive children with excessive motor activity, mood lability. Haloperidol decanoate: prolonged parenteral therapy of chronic schizophrenia.

Teaching Points
Take this drug exactly as prescribed. Avoid driving or engaging in other dangerous activities if dizziness or drowsiness or vision changes occur. Avoid prolonged exposure to sun, or use a sunscreen or covering garments. Maintain fluid intake, and use precautions against heatstroke in hot weather. You may experience these side effects: dry mouth (sucking sugarless lozenges may help); urinary retention (empty your bladder before taking the drug), constipation (medication may be available to help). Report sore throat, fever, unusual bleeding or bruising, rash, weakness, tremors, impaired vision, dark colored urine (pink or reddish brown urine is to be expected), pale stool, yellowing of the skin or eyes.

Brand name: Haldol Decanoate

Pregnancy category: C

Drug
Generic name: Chlorpromazine hydrochloride

Classification
Antiemetic Antipsychotic Anxiolytic Dopaminergic blocker Phenothiazine

Dosage
Full clinical antipsychotic effects may require 6 wk to 6 mo of therapy. Adults: Excessive anxiety, agitation in psychiatric pt: 25mg IM; may repeat in 1 hr. Intractable hiccups: 25 50mg PO tid qid. Pediatric pts: Generally not used in children younger than 6 mo. Geriatric pts: Start dosage at one-fourth to one-third that given in younger adults and increase more gradually.

Mechanism Of Action
Mechanism not fully understood; antipsychotic drug block postsynaptic dopamine receptors in the brain; depress those parts of the brain involved in wakefulness and emesis; anticholinergic, antihistaminic (H1), and alpha adrenergic blocking.

Adverse Reaction

Contraindication

Indication
Management of manifestations of psychotic disorders; control of manic phase of manic depressive illness. Relief of preoperative restlessness and apprehension. Adjunct treatment of tetanus. Acute intermittent porphyria therapy. Severe behavioral problems in children. Therapy for combativeness, hyperactivity. Control of nausea and vomiting and intractable hiccups.

Teaching Points
Take drug exactly as prescribed. Avoid over the- counter drugs and alcohol unless you have consulted your health care provider. Learn how to dilute oral drug concentrate or how to use rectal suppository. Do not get oral concentrate on your skin or cloths; contact dermatitis can occur. Use caution in hot weather risk of heat stroke; keep up fluid intake, and do not over exercise in a hot climate. You may experience these side effect: drowsiness (avoid driving or operating dangerous machinery; avoid alcohol, which increases drowsiness); sensitivity to the sun (avoid prolonged sun exposure, wear protective garments or use sunscreens); pink or reddish brown urine (expected effect); faintness, dizziness (change position slowly; use caution climbing stairs; usually transient). Report sore throat, fever. Unusual bleeding or bruising, rash, weakness, tremors, impaired vision, dark urine, pale stools, yellowing of the skin and eyes.

Brand name: Thorazine

Pregnancy category: C

Contraindicated with CNS: drowsiness, allergy to insomnia, chlorpromazine, vertigo, comatose or severely extrapyramidal depress states, bone syndromes, marrow depression, neuroleptic circulatory collapse, malignant sub cortical brain syndrome. damage, Parkinsons disease, liver CV: damage, cerebral or hypertension, coronary ortostatic arteriosclerosis, hypotension, severe hypotension hypertension, or hypertension. tachycardia Use cautiously with EENT: nasal respiratory congestion, disorders; glaucoma; photophobia, epilepsy or history blurred vision of epilepsy; peptic Endocrine: ulcer or history of lactation; peptic ulcer; breast decrease renal engorgement function; prostate in females; hypertrophy; breast galactorrhea; cancer; SIADH tyrotoxicosis; GI: dry children with mouth, chicken pox. salivation, nausea, vomiting, anorexia, constipation

Drug
Generic name: Fluphenazine decanoate

Classification
Antipsychotic Dopaminergic blocker Phenothiazine

Dosage
IM or subcutaneous: initial dose, 12.5 25 mg IM or subcutaneous; determine subsequent doses and dosage interval based on patient response. If doses above 50 mg are needed, increase cautiously in 12.5mg increments. Dose should not exceed 100mg. Pediatric pts: generally not recommended for children younger than 12 yr. Geriatric pst: Oral initial oral dose is 1 2.5mg/day.

Mechanism Of Action
Mechanism not fully understood: Antipsychotic drugs block postsynaptic dopamine receptors in the brain, depress the RAS, including the part of the brain involved with wakefulness and emesis; anticholinergic, antihistaminic (H1), and alpha adrenergic blocking activity also may contribute to some of its therapeutic (and adverse) actions.

Adverse Reaction

Contraindication

Indication

Teaching Points
Take drug exactly as prescribed. Avoid driving or engaging in other dangerous activities if drowsiness, weakness, tremor, extrapyramidal symptoms, or vision changes occur. Avoid prolonged exposure to sun; use a sunscreen or cover skin if exposure is unavoidable. Maintain fluid intake, and use precautions against heatstroke in hot weather. Report sore throat, fever, unusual bleeding or bruising, rash, weakness, tremors, impaired vision, dark urine (pink or reddish brown urine is expected), pale stool, yellowing of skin or eyes.

Brand name: Apo Fluphenazine

Pregnancy category: C

CNS: drowsiness, Contraindicated with Management of extrapyramidal hypersensitivity to manifestations of syndrome fluphenazine; other psychotic disorder; (pseudoparkinson phenothiazines, the longer acting ism); dystonias; tartrazine, or aspirin; parenteral dosage akathisias,neurole coma or severe CNS forms, ptic malignants depression; bone fluphenazine syndrome, marrow depression; enanthate and autonomic blood dyscrasia; fluphenazine disturbance. circulatory collapse; decanoate, subcortical brain indicated for CV: cardiac damage; Parkinsons management of arrest, refractory disease; liver patients (chronic arrhythmias, damage; cerebral schizophrenics) pulmonary edema arteriosclerosis; who require Endocrine: coronary disease; prolonged hypoglycemia, severe hypotension parenteral therapy. SIADH, lactation, or hypertension; Fluphenazine brest pregnancy. decanoate: engorgement in Use catiously with management of female respiratory disorder behavioral Hematologic: (silent complications in eosinophilia, pneumonia), patient with leucopenia, glaucoma, prostatic mental retardation. aplastic anemia, hypertrophy, hemolytic anemia lactation, children Hypersensitivity: younger than 12 yrs, urticaria, CNS infection. laryngeal edema, anaphylactoid reaction.

Drug
Generic name: Carbamezepine

Classification
Antiepileptic

Dosage
Individualized dosage; a low initial dosage with gradual increase is advised. Epilepsy: initial dose,200 mg PO bid on the first day, increase gradually by up to 200 mg/day in divided doses every 6-8hr, until best response is achieved. Pediatric patients older than 12yr: Use adult dosage. Do not exceed 1,000 mg/day in pts 12-15yrs, 1,200mg/day in pts older than 15yr. Pediatric patients younger than 6 yrs: optimal daily dose, less than 35mg/kg/day. Geriatric patient: use caution, may cause confusion, agitation

Mechanism Of Action
Mechanism of action not understood; antiepileptic activity may be related to its ability to inhibit polysynaptic response and block post-titanic potentiation. Drug is chemically related to the TCAs.

Adverse Reaction
CNS: dizziness, drowsiness, unsteadiness, SIADH, fever, chills CV: heart failure, CV complications Dermatologic: Stevens-Johnsons syndrome, pruritic and erythematous rashes GI: nausea, vomiting, hepatitis, massive hepatic cellular necrosis with total loss of intact liver tissue GU: urinary frequency, acute urinary retention, renal failure Respiratory: pulmonary hypersensitivity characterized by fever, dyspnea, pneumonitis or pneumonia

Contraindication

Indication

Teaching Points
Take drug with food as prescribed. swallow extended-release tablets whole; do not cut, crush or chew them. If using Equetro capsule, they may be opened and contents sprinkled over soft food, such as 1 tsp of applesauce. Do not discontinue drug abruptly or change dosage, except on the advice of your physician. Avoid alcohol, sleepinducing, or over-the-counter drugs; these could cause dangerous effects. Arrange for frequent checkups, including blood tests, to monitor your response to this drug. Keep all appointments for checkups. Use contraceptives at all times; if you wish to become pregnant, you should consult your physician. You may experience: drowsiness, dizziness, blurred vision, GI upset. Report bruising, unsual bleeding, abdominal pain, darkened urine, yellowing of the skin and eyes.

Brand name: Tegretol

Pregnancy category: D

Contraindicated with Refractory seizure hypersensitivity to disorders: partial carbamazepine or seizures with TCAs, history of complex symptoms bone marrow (psychomotor, depression, temporal lobe concomitant use of epilepsy), generalized MAOIs, lactation, tonic-clonic (grand pregnancy. mal) seizure, mixed seizure patients or Use cautiously with other partial or history of adverse generalized seizures. hematologic reaction Reserved to patients to any drug unresponsive to other Iincreased risk of agents with seizures severe hematologic difficult to control or toxicity), glaucoma who are experiencing or increased IOP; side effects, such as history of cardiac, excessive sedation. hepatic, or renal damage; psychiatric Treatment of acute patients (may manic and mixed activate latent episodes associated psychosis). with bipolar 1 disorder (Equetro) Unlabeled use: certain psychiatric disorders, including schizoaffective illness, resistant schizophrenia

Drug
Generic name: Lithium carbonate

Classification
Antimanic drug

Dosage
Individualized dosage according to serum level and clinical response. Adults Acute mania:600mg PO tid or 900mg slow-release from PO bid to produce effective serum levels between 1 and 1.5 mEq/l. Longer term use: 300mg PO tid-qid to produce a serum level of 0.6-1.2 mEq/l. Pediatric patient Safety and efficacy for children younger than 12 yr not established. Geriatric patients and pts with renal impairment Reduced dosage may be needed.

Mechanism Of Action
Mechanism is not known; alters sodium transport in nerve and muscle cells; inhibits release of norepinephrine and dopamine, but not serotonin, from stimulated neurons; slightly increases intraneuronal stores of atecholamines; decreases intraneuronal content of second messengers and may thereby selectively modulate the responsiveness of hyperactive neurons that might contribute to the manic state.

Adverse Reaction

Contraindication

Indication
Treatment of manic episodes of bipolar disorder; maintenance therapy to prevent or diminish frequency and intensity of subsequent manic episode. Unlabeled use: improvement of neutrophil counts in patient cancer chemotherapyinduced neutropenia and in children with chronic neutropenia and HIV patients on zidovudine therapy (dose of 300-1,000 md/day, serum levels of 0.5 and 1 mEq/l), prophylaxis of cluster headache and cyclic migraine headache, treatment of SIADH, hypothyroidism (doses of 600-900 mg/day).

Teaching Points
Take drug exactly as prescribed, after meals or with food or milk. Swallow sustained or controlledrelease tablets whole; do not chew or crush. Eat a normal diet with normal salt intake; maintain adequate fluid intake (at least 2.5 quarts/day). Arrange for frequent checkups to get the most benefits with the least toxicity. Use contraceptives to avoid pregnancy. If you wish to become pregnant or believe that you have become pregnant, consult your health care provider. Discontinue drug and notify your health care provider if toxicity occurs diarrhea, vomiting, ataxia, tremor, drowsiness, lack of coordination or muscular weakness. You may experience these side effects: drowsiness, dizziness (avoid driving or performing tasks that require alertness), GI upset (eat frequent small meals); mild thirst, greater than usual urine volume, fine hand tremor (may persist throughout therapy; notify your health care provider if severe). Report diarrhea or fever.

Brand name: Carbolith, Duralith

Pregnancy category: D

Reactions are Contraindicated with related to serum hypersensitivity to lithium levels. tartrazine; (Toxic lithium significant renal or levels are close to CV disease; severe therapeutic debilitation, levels: dehydration; sodium Therapeutic depletion, patients levels in acute on diuretic (lithium mania range decreases sodium between 1 and reabsorption, and 1.5 mEq/l; hyponatremia therapeutic levels increases lithium for maintainance retention); use ACE are 0.6-1.2 inhibitors; mEq/l. pregnancy; lactation - Drowsiness Use cautiously with - Dizziness protracted sweating - GI upset and diarrhea, - Mild thirst suicidal or impulsive - Greater than patients; infection usual urine with fever. volume - Fine hand tremor

Drug
Generic name: Fluvoxamine maleate

Classification
SSRI

Dosage
Adult: Initially, 50mg PO at bedtime. Increase 50mg increments at 4-7 day intervals. Usual range, 100300 mg/day. Divided dose over 100mg/day; give larger dose at bedtime. If symptoms do not improve within 1-2 wk, form of treatment should be reconsidered. CR capsules 100-300 mg/day PO. Pediatric patients 8-17 yr: Initially, 25mg PO at bedtime. Increase dosage by 25 mg/day every 4-7 days to achieve desired effect. Geriatric patients or patients with hepatic impairment: Give a reduced dose (25mg PO at bedtime), adjust more slowly.

Mechanism Of Action
Selectively inhibits CNS neuronal uptake of serotonin, blocks uptake of serotonin with weak effect on norepinephrine; little affinity for muscarinic, histaminergic, and alpha1, adrenergic receptors.

Adverse Reaction

Contraindication

Indication
Treatment of OCD Treatment of social anxiety disorder (CR capsules) Unlabeled use: treatment of depression, bulimia nervosa, panic disorder

Teaching Points
Take this drug at bedtime; if a large dose is needed, the dose may be divided but take the largest dose at bedtime. Do not cut, crush or chew controlledrelease capsules. Do not stop taking this drug abruptly; it should be discontinued slowly. You may experience these side effects: dizziness, drowsiness, nervousness, insomnia (avoid driving or performing hazardous tasks), nausea, vomiting, weight loss (eat frequent small meals), sexual dysfunction (reversible). Report rash, mania, seizures, severe weight loss, suicidal thoughts.

Brand name: Luvox

Pregnancy category: C

CNS: headache, Contraindicated nervousness, with insomnia, hypersensitivity to drowsiness, fluvoxamine, anxiety, tremor, lactation dizziness, light Use cautiously with headedness, impaired hepatic or agitation, sedation, renal function, abnormal gait, suicidal tendencies, seizure. seizures, mania, Dermatologic: ECT therapy, CV sweating, rash, disease, labor and pruritus, acne, delivery, alopecia, contact pregnancy. dermatitis GI: nausea, vomiting, diarrhea, dry mouth, anorexia, constipation, taste changes, flatulence, gastroenteritis, gingivitis GU: sexual dysfunction, frequency, cystitis, impotence, vaginitis Respiratory: URIs, pharyngitis, cough, dyspnea, bronchitis

Drug
Generic name: Sertraline hydrochloride

Classification
Antidepressant SSRI

Dosage
Adults: Major depressive disorder and OCD: administer once a day, morning or evening. 50mg daily, may be increased up to 200mg/day. Panic disorder and PTSD: 25mg PO daily. PMDD: 50mg/day PO daily or just during luteal phase of menstrual cycle Social anxiety disorder: 25mg/day PO Pediatric patients: OCD: 6-12 yr: 25mg PO once daily; 13-17 yr: 50mg PO once daily. Geriatric patients or patients with hepatic impairment: Give a lower or less frequent dose. Use response as dosage guide.

Mechanism Of Action
Acts as an antidepressant by inhibiting CNS neuronal uptake of serotonin; blocks uptake of serotonin with little effect on norepinephrine, muscarinic; histaminergic, and alpha1 adrenergic or dopaminergic receptors.

Adverse Reaction

Contraindication

Indication
Treatment of major depressive disorder Treatment of OCD Treatment of panic disorder with or without agoraphobia Treatment of PTSD; long-term use to prevent relapse and sustain symptom improvement Treatment of PMDD Treatment of social anxiety disorder(social phobia) Unlabeled uses: Nocturnal enuresis, hot flashes, cholestatic pruritus

Teaching Points
Take the drug once a day, at the same time, morning or evening, do not exceed the prescribed dose. It may take 4-6 wks to see any improvement. Dilute concentrate immediately before use in 4 ounces of water, ginger ale, lemon lime soda, lemonade, or orange juice only. Consult your health care provider if you think that you are pregnant or wish to become pregnant. You may experience these side effects: dizziness, drowsiness, nervousness, insomnia (avoid driving or performing hazardous tasks), nausea, vomiting (eat frequent small meals); dry mouth suck sugarless lozenges, perform frequent mouth care); excessive sweating (monitor temperature; avoid over heating). Report rash, mania, seizures, edema, difficulty breathing, increased depression, thought of suicide.

Brand name: Zoloft

Pregnancy category: C

CNS: headache, Contraindicated with nervousness, hypersensitivity to drowsiness, sertraline anxiety, tremor, Use cautiously with dizziness, impaired hepatic or insomnia, renal function, vision changes, lactation, pregnancy. fatigue Dermatologic: sweating, rash, pruritus GI: nausea, vomiting, diarrhea, dry mouth, gastroenteritis GU: painful menstruation, sexual dysfunction Respiratory: URIs, rhinitis, dyspnea Others: hot flashes, fever, back pain, thirst

Drug
Generic name: Buspirone hydrochloride

Classification
Anxiolytic

Dosage
Adults: Initially, 15 mg/day PO (7.5 mg bid). Increase dosage 5mg/day at intervals of 2-3 days to achieve optimal therapeutic response. Do not exceed 60mg/day. Divided doses of 20-30 mg/day have been used. Pediatric patients: Safety and efficacy for patients younger than 18 yr not established.

Mechanism Of Action
Mechanism of action not known; lacks anti-seizure, or muscle relaxant properties; binds serotonin receptors, but the clinical significance is unclear.

Adverse Reaction
CNS: dizziness, headache, nervousness, insomnia, light headedness, excitement, dream disturbance, seizures, altered taste and smell, involuntary movements CV: nonspecific chest pain, tachycardia or palpitation GI: nausea, dry mouth, vomiting, abdominal or gastric distress, diarrhea, flatulence, constipation GU: urinary frequency, urinary hesitancy Respiratory: hyperventilation shortness of breath, chest congestion Others: musculoskeletal aches and pain, clamminess, sore throat

Contraindication
Contraindicated with hypersensitivity to buspirone; marked liver or renal impairment; lactation Use cautiously with pregnancy; mild renal or hepatic impairment.

Indication
Management of anxiety disorders or short term relief of symptoms of anxiety Unlabeled use: decreasing the symptoms (aches, pains, fatigue, cramps, irritability) of PMS

Teaching Points
Take this drug exactly as prescribed. Avoid the use of alcohol, sleepinducing, or over-the-counter drugs and grapefruit juice, these could cause dangerous effects. You may experience these side effects: drowsiness, dizziness, light-headedness (avoid driving or operating complex machinery); GI upset (eat frequent small meals); dry mouth (suck sugarless lozenges or ice chips); dreams, nightmares, difficulty concentrating or sleeping, confusion, excitement (reversible; will stop when the drug is discontinued). Report abnormal involuntary movements of facial or neck muscles; abnormal posture; yellowing of the skin or eyes.

Brand name: Buspar

Pregnancy category: B

Drug
Generic name: Lorazepam

Classification
Anxiolytic Benzodiazepine Sedativehypnotic

Dosage
Adults: Oral: usual dose is 2-6mg/day; range, 110mg/day in divided doses with largest dose at bedtime. IM: 0.05mg/kg up to a maximum of 4mg administered at least 2 hr before operative procedure. IV: initial dose is 2mg total or 0.044 mg/kg, whichever is smaller. Pediatric patients: drug should not be used in children younger than 12 yrs. Patient with renal or hepatic impairment: initially, 12mg/day in divided doses. Adjust as needed and tolerated.

Mechanism Of Action
Exact mechanisms are not understood; acts mainly at subcortical levels of the CNS, leaving the cortex relatively unaffected. Main site of action may be the limbic system and reticular formation; benzodiazepines potentiate the effects of GABA, an inhibitory neurotransmitter; anxiolytic effects occur at doses well below those needed to cause sedation and ataxia.

Adverse Reaction
CNS: transient, mild drowsiness initially; sedation, depression, lethargy, apathy, fatigue, lightheadedness, disorientation, anger, hostility, restlessness, confusion, headache, paradoxical excitatory reactions during first 2 wk of treatment EENT: visual and auditory disturbance, diplopia GI: dry mouth, nausea, vomiting, salivation Others: drug dependence with withdrawal syndrome when drug is discontinued; more common with abrupt discontinuation of higher dosage used for longer than 4 months.

Contraindication
Contraindicated with hypersensitivity to benzodiazepines, propylene glycol, polyethylene glycol or benzyl alcohol (parenteral lorazepam); psychoses, acute narrow-angle glaucoma; shock; coma; pregnancy, labor and delivery (floppy infant syndrome); lactation. Use cautiously with impaired hepatic or renal function.

Indication
Oral: management of anxiety disorder or for short term relief of symptoms of anxiety or anxiety associated with depression; insomnia due to anxiety or transient situational stress. Parenteral: preanesthetic medication in adults to produce sedation, rlieve anxiety, and decrease racall of events related to surgery; treatment of status epilepticus.

Teaching Points
Take drug exactly as prescribed, do not stop taking drug (in long-term therapy) without consulting health care provider. You may experience these side effects: drowsiness, dizziness (may be transient, avoid driving or engaging in dangerous activities); GI upset (take drug with food); nocturnal sleep disturbances for several nights after discontinuing the drug if used as a sedative and hypnotic; depression, dreams, emotional upset, crying. Report severe dizziness, weakness, drowsiness, rash or skin lesions, palpitations, edema of the extremities, visual changes, difficulty voiding.

Brand name: Ativan

Pregnancy category: D

Controlled substance CIV

DRUG STUDY

Dos and Donts In the Psyche Ward