The Effects of Ativan Are They Worth The Outcome?

1 The drug Ativan is used quit frequently in the elderly patients because is suppose to be safer for them than other antianxiety medications but from what I have witnessed in the elderly is totally the oposite of reaction than what is desired.
One example is my mother who has passed away since,when she was medicated with the drug she went off the wall and restaints where put in place but she managed to get out of them and pull out her I.V. and managed to climb over the foot of the bed.Then she bit one of the nurses trying to get her under control.They called me and wanted me to come and try to see what I could do.I inquired about the medication that was despenced and they informed me it was Ativan,which they had given the night before and had a similer experience.I informed them that I requested that they not give Ativan any more prior to the incident.After the drug was dc'd then she regained her mental status to the former state.
Number two: My father-in-law was given the same drug and he became insulting and vulgor actions and language.He went so far as to chew his catheter in to and after he made attempt to pull it out.Needless to say there was blood everywhere.After the drug was dc'd he regained his mental state after a couple of days.
Number three:This was a buddy of mine who had heart sugery and didn't do very well.The drug was dispensed and he talked out of his head and tried to leave and didn't know anyone who was family or friend and to this day can't remember most of the hospital stay while in that unit where the medication was being given.
I could go on naming individuals who have had similar experiences with this drug.The bad thing is how many people are being diaganoised with a mental conditon when in fact it could be the drug they are on.
Check your patient back ground and see how they were doing prior to being hospitalized and if it don't click with what you have now investicate the drugs they are on and question the ones that maybe causing the distubance in their mental condition.
This scares me to think how many people are diagnosised with a mental disease when it fact its the side effects of a drug,especially the aging patients.
Please leave any remarks. I would love to hear what you think. Last edit by dianah on May 27, '10 : Reason: Terms of Service
I agree, patients, especially the elderly, should not be on Ativan as the first intervention when they start to act out. Hospitals could ask family to stay at the bedside, or have CNA's as one to one, to help orient and gently restrain confused patients. There are many simple interventions that MIGHT help re-orient or calm an agitated patient. Physical and chemical restraints should be the very last choice. But patients with diagnosed mental disease are not given that diagnosis when they are in acute care hospitals under the effect of drugs. Mentally ill patients start acting in a bizarre manner and they or their family get them to a psychiatrist who finds out what legal or illegal drugs they might be taking and they are then placed on appropriate mood stabilizers or antipsychotics.

On geriatric mental health units (and adult units as well) we used Ativan mainly IM as a response to psychiatric emergencies. I don't recall ever giving it routinely to a geriatric patient. Paradoxical reactions are more common than many people believe, especially in the elderly.

Thank you for your response to the article and I appreciate your feedback on this dangerous drug that is being given to freely to elderly patients.I think we should bring it to doctor's attention when we notice this outburst of behavior and request the affending drug be dc'd.This may ellimate so of the phyicosis that we experience in the aging.

I have seen several cases of the paradoxical effect and on those patients I have the pharmacy list ativan as an allergy and will get the physician to d/c it. Sometimes it pays to go with a stepped approach: tylenol and milk and warm blankets first ... maybe a sitter... there's benadryl too, don't underestimate it. And about 95% of the time though, I'll say ativan is well worth giving. Unfortunately for those who may have to care for me in the future, it just makes me not ever shut up so they'll have to do something else.

i am glad to know that i am not alone with this ativan dilemma. my brother was given this med because the nurse thought he was being aggressive when he in fact just cannot retin memory so he forgets that he cannot walk as he falls each time he attempts to. out came the ativan at 2mg a shot from the onset when he should have been started at 0.5 to 1.0ml as he is in a weakened state. then i believe it was increased as he experienced the adverse effects of the drug. one nurse even told me that it probably was the med that was causing his reaction. then she tells me -oh, he's only getting about 2mls. I had to do alot of ranting and raving before it was dc'd. within a few days my brother came back to his senses. this problem needs to be exposed for what it is. obviously, for one, it may not be being used appropriately at some instittutions. and, perhaps it should not be used at all.

Unless I'm missing something- all those people were given Ativan for a reason. I've never given Ativan to a calm, cooperative indiv. with no signs of aggitation or excessive anxiety. Yep- I can believe the sedation made them a bit more confused, but that is a fairly rare response. How do you know they weren't on thier way down the rabbit hole before the ativan was given, and the ativan just didn't do enough to keep them calm?- it sometimes helps a great deal, esp with ETOH withdrawn.

I agree with Suanna to some extent that generally Ativan isn't given until a patient is already having issues. However I have also seen a much greater incidence of increased agitation when Ativan is given to someone elderly, hence I am very antsy and conservative with it in my geriatric population.To the OP: The patient you listed after heart surgery could have been a completely unrelated situation. I would think the pain medications could have an equal share in confusion as well.Overall when my patients are over 70 I cringe at the thought of Ativan, especially if the nurse the night before had an issue with it as you stated in one story! Why would they give it again?Tait

As with all drugs, it's a risk/reward decision. Sometimes it's useful, sometimes it's not.

I usually will not give Ativan to an elderly patient due to the opposite reaction. It happens a lot and I have learned from my mistakes. There are very few older people that can take this drug and the only way I'll ever give it again is if I know for certain they tolerate it.

To suanna,you are correct in saying that unless you are missing something.... You are. You are missing the fact that my brother was not agitated, merely got out of bed to go to the bathroom. As I mentioned, he does not retain memory and forgets that he does not have balance. Secondly, the RN was a novice, and as someone mentioned about a rabbit, that was the rabbit, the nurse, that did not know how to handle that situation and erroneously labelled my brother getting out of bed as aggressive. One last thing you are missing, is that I have seen my brother get out of bed many, many times (and fall), and it cannot be termed aggressiion because that is not what it is. Perhaps another form of restraint could have been used other than the posey which eventually was, (leather restraints) when the ativan had its adverse effect, which caused injury to his wrists. I can go on and on. The important thing here is to be an advocate and watchdog for family members in hospitals, because not every nurse action and not all hospital policies are valid.