Ativan Side Effects

How Ativan Compares to Other Benzodiazepines

The benzodiazepines can generally be divided into three major groups. Ativan belongs to what are typically called a short acting benzodiazepines. Benzodiazepines are typically divided into ultrashort acting, short acting and longer acting classes of medications.

The ultrashort action benzodiazepines are quickly absorbed into the body fatty tissue from the bloodstream and then very slowly released in serum concentrations that are low enough to have three little effect. This makes their effective serum half-life very short and it generally used this intravenous drugs for conscious sedation and in the operating room. This group will largely be left out of this discussion.

The short acting benzodiazepines the readily available in the United States include alprazolam (Xanax™), lorazepam (Ativan™), oxazepam (Serax™), temazepam (Restoril™) and triazolam (Halcion™). For the remainder of this article of brand names will be used as they are generally better known than the generic drug names. In general the shorter acting benzodiazepines tend to have more potential for rebound anxiety and withdrawal side effects, are more effective as sedatives or hypnotics, and tend to be the preferred products in the elderly or those with liver disease because they are more easily metabolized. The two most commonly used benzodiazepines in this class for anxiety disorder are Xanax and Ativan. Will use Ativan as the drug compare others against in this discussion. Ativan is a commonly used benzodiazepines which has a serum half-life of approximately 15 hours (8-24), and average time to peak serum levels when ingested orally of 1 to 4 hours, has no active metabolites after being metabolized by conjugation in the liver, and will consider it as a baseline of one in terms of relative potency. The standard initial dose of Ativan is 0.5 mg orally and a maximum oral dose is 10 mg of Ativan. Typical dosing is from 0.522 mg three times a day. In comparison Xanax has a similar serum half-life at an average of 12 hours (9-20), time to maximum serum levels of 1 to 2 hours, has only minor active metabolites after hepatic metabolism by oxidation, and has an initial typical dosing of 0.25 mg in a maximum dosage for proximally 4 mg. Typical Xanax dosing regimens is 0.25 to 1 mg three times a day. In comparison to Ativan alprazolam is approximately twice as potent, milligram per milligram basis with 0.5 mg of Xanax being approximately equivalent to 1 mg of Ativan.

Most of the rest of the short acting benzodiazepine the used primarily as if not. Of these Ambien and Restoril of the most commonly used. Ambien (zolpidem) is a widely used short acting hypnotic is also available sustained-release products. Ambien has a serum half-life of 2-3 hours and it is rapidly absorbed and generally leads to sleep within proximally 15 min. after ingestion. Restoril is an older hypnotic but has the advantage of having a somewhat longer serum half-life of 11 hours although somewhat slower neck onset of action with maximum serum levels set 2 to 3 hours. Restoril tends to be favored by patients who need more help staying asleep through the night were is Ativan is favored by those who have more difficulty falling asleep. Halcion is seldom used in the United States and will not be discussed in detail in this article. Likewise Serax is infrequently used and will not be discussed further.

Long acting benzodiazepines tend to be favored for indications where there long half-life is a benefit. They tend to be drugs of choice by many physicians for use in alcohol withdrawal syndrome. Valium was among the earliest of the benzodiazepines to achieve widespread use. It has a serum half-life of approximately 100 hours and has active metabolites after hepatic oxidation. The time to maximum serum concentration after oral ingestion is approximately 1 to 2 hours and typical starting dose of Valium is 2 mg three times a day. Maximum daily dose of Valium is 40 mg daily and typical dosing is 2 to 5 mg three times a day. Librium is one of the older of the benzodiazepine class of medications and has a serum half-life of approximately 100 hours. The time to peak serum levels is 14 hours and it has active metabolite certain oxidative process in the liver. Typical starting dose of Librium is 5 mg maximum dosing is highest to for her milligrams daily in patients with long-term use or whose hepatic metabolism systems are highly activated due to alcohol abuse or other drug use. Typical Librium maintenance dose is 25-50 mg three times daily. Klonopin is listed on longer acting benzodiazepines is really an intermediate half-life medicine with a serum half-life of approximately 34 hours (19-60) and is also frequently used as an antianxiety medication. It has no active metabolites after hepatic metabolism. Typical starting dose of Klonopin is 0.25 milligrams three times daily and typical maidens doses are 0.52 mg three times a day. The other longer and longer acting benzodiazepines are Tranxene and Dalmane, both of which have such low market share in the US, the discussed further in this article.

Overall the shorter acting benzodiazepines are favored in patients at risk for accumulation of the medication due to age or hepatic dysfunction, for uses hypnotics where morning drowsiness is a concern with longer acting medications and tend to have higher risk of withdrawal and anxiety problems on discontinuation. The longer acting benzodiazepines are favored for the use where the long serum half-life is beneficial such as treatment of alcohol withdrawal syndrome and in select patients where long-term therapy is anticipated.

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