Commonly used Hospice drugs:

*Pain Management: Morphine (Roxanol), Hydrocodone, Dilaudid, Methadone, and Acetaminophen (suppository).

*Anxiety/Restlessness: Lorazepam (Ativan), Haloperidol (Haldol), Quetiapine, and Thorazine.

*Nausea/Vomiting: Haloperidol, Prochlorperazine (Compazine), Promethazine (Phenergan), and Reglan.

*Respiratory Distress/Excess Secretions: Atropine (drops), Hyoscyamine (Levsin), and Morphine.

*Constipation/Other: Bisacodyl (Dulcolax) and other stool softeners. Benadryl.

***RISKS***

Mixing benzodiazepines (Ativan) with opioids (Morphine) or antipsychotics (Haldol) causes falls, confusion, respiratory depression, coma/sedation, and death especially in older adults.

ATIVAN (LORAZEPAM)

Lorazepam is used to treat anxiety disorders. Lorazepam is a benzodiazepine that works in the brain to relieve symptoms of anxiety. Benzodiazepines are central nervous system (CNS) depressants, which are medicines that slow down the nervous system.

Elderly patients are more likely to have unwanted effects (eg, severe drowsiness or unsteadiness) and age-related kidney, liver, or heart problems, which may require caution and an adjustment in the dose.

Symptoms of an overdose include: blurred vision, change in consciousness, confusion, dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position, hallucinations, increased sweating, loss of consciousness, loss of strength or energy, muscle pain or weakness, nightmares, shakiness and unsteady walk, slow or irregular heartbeat, sweating, trouble in speaking, unsteadiness, trembling, or other problems with muscle control or coordination, trouble sleeping, unusual excitement, nervousness, restlessness, or irritability, or unusual tiredness or weakness.

This medicine may cause respiratory depression (serious breathing problem that can be life-threatening), especially when used with narcotic pain medicines.

This medicine will add to the effects of alcohol and other central nervous system (CNS) depressants. CNS depressants are medicines that slow down the nervous system, which may cause drowsiness or make you less alert. Some examples of CNS depressants are antihistamines or medicine for hay fever, allergies, or colds, sedatives, tranquilizers, or sleeping medicine, prescription pain medicine or narcotics, barbiturates or medicine for seizures, muscle relaxants, or anesthetics (numbing medicines), including some dental anesthetics.

***SIDE EFFECTS***

• Drowsiness

• relaxed and calm

• sleepiness

• Aggressive, angry

• agitation

• attack, assault, or force

• black, tarry stools

• bleeding gums

• blood in the urine or stools

• bluish lips or skin

• blurred vision

• change in consciousness

• chest tightness

• chills

• coma

• confusion

• confusion about identity, place, and time

• cough or hoarseness

• dark urine

• decreased urine output

• difficulty with breathing or swallowing

• difficulty with speaking

• discouragement

• dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position

• drooling

• dry mouth

• excitation

• false or unusual sense of well-being

• fast or irregular heartbeat

• feeling sad or empty

• fever with or without chills

• general feeling of tiredness or weakness

• headache

• hives, itching, or rash

• hyperventilation

• increased thirst

• irregular, fast or slow, or shallow breathing

• irritability

• loss of appetite

• loss of balance control

• loss of consciousness

• loss of interest or pleasure

• loss of memory

• lower back or side pain

• muscle pain, cramps, trembling, jerking, or stiffness

• nausea or vomiting

• not breathing

• painful or difficult urination

• pale or blue lips, fingernails, or skin

• pinpoint red spots on the skin

• problems with memory

• puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue

• reddening of the skin, especially around ears

• restlessness

• seeing, hearing, or feeling things that are not there

• seizures

• shaking

• shuffling walk

• sore throat

• sores, ulcers, or white spots on the lips or in the mouth

• stiffness of the limbs

• stomach pain

• sweating

• swelling of the eyes or inside of the nose

• swelling of the face, ankles, or hands

• swollen glands

• thoughts or attempts at killing oneself

• trouble concentrating

• trouble sleeping

• twisting movements of body

• uncontrolled movements, especially of the face, neck, and back

• unexplained bleeding or bruising

• unpleasant breath odor

• unusual bleeding or bruising

• unusual tiredness or weakness

• vomiting of blood

• yellow eyes or skin

• Being forgetful

• clumsiness

• constipation

• decreased interest in sexual intercourse

• disturbed color perception

• dizziness or lightheadedness

• double vision

• drowsiness

• feeling of constant movement of self or surroundings

• hair loss or thinning of the hair

• halos around lights

• inability to have or keep an erection

• increased in sexual ability, desire, drive, or performance

• increased interest in sexual intercourse

• lack or loss of self-control

• lethargy

• loss in sexual ability, desire, drive, or performance

• muscle aches, twitching, or weakness

• night blindness

• overbright appearance of lights

• rapid weight gain

• sensation of spinning

• shakiness in the legs, arms, hands, or feet

• shivering

• stupor

• trembling or shaking of the hands or feet

• tunnel vision

• weak or feeble pulse

SOURCE:

Lorazepam (oral route) - Side effects & dosage - Mayo Clinic