Ativan (Lorazepam) For Cancer Related Nausea and Vomiting

How is Ativan Used for People With Cancer and What Should You Know?

Lorazepam
Why may Ativan (lorazepam) be used for people with cancer and what does it treat?. Pillbox

Your oncologist may have prescribed the medication Ativan (lorazepam) for you. What symptoms may this be used for, how should it be used, what are the possible side effects, and what alternatives exist?

What is Ativan (Lorazepam)?

Ativan is a prescription medication with many uses, including the nausea and vomiting often seen with cancer. It's generic name is lorazepam and it belongs to the category of medications known as benzodiazepines.

Other benzodiazepines sometimes used for nausea related to cancer include Versed (midazolam) and Xanax (alprazolam).

What is Ativan (Lorazepam) Used For?

With cancer, Ativan is most often prescribed for the nausea and vomiting associated with chemotherapy. It may serve more than one purpose for people with cancer as it can help with other symptoms such as anxiety and insomnia as well. Symptoms related to cancer which Ativan may be used for include:

  • Anxiety
  • Nausea and vomiting
  • Insomnia (cancer related insomnia is very common and can be dangerous)
  • Seizures and prevention of seizures (seizures are most common in those who have brain metastases due to cancer or a primary brain cancer)
  • Muscle relaxation (people can get tight muscles due to decreased activity, and some cancers actually secrete substances (paraneoplastic syndromes) which can cause muscle spasms)
  • Alcohol withdrawal (people with chronic alcohol abuse may often develop withdrawal symptoms including seizures when they decrease their alcohol intake due to surgery or chemotherapy)

    Chemotherapy Associated Nausea and Vomiting.

    As noted earlier, Ativan is most commonly used in people with cancer to prevent and treat the nausea and vomiting associated with chemotherapy drugs.

    While nausea as a side effect of chemotherapy is well-known, many people are less aware of the tremendous changes that have taken place  in the management of this side effect of chemotherapy.

    The treatment methods for nausea and vomiting due to chemotherapy have improved markedly in recent years, and many people now have little or no nausea and vomiting, even with the chemotherapy drugs most likely to cause nausea.

    It's important to note that there are several different categories of anti-nausea drugs used for people with cancer. Often times more than one of these medications is used, and there are almost always options if one of these drugs—for example, Ativan—is not effective in controlling your symptoms. Different drugs work for different people, and it's hard to predict which medications will work best for an individual person. Keep this in mind if your symptoms aren't adequately controlled and talk to your doctor.

    Different medications may be more effective than others based on when the nausea occurs, whether it is anticipatory nausea, occurs shortly after chemotherapy, or is delayed (delayed nausea) 24 hours or more after chemotherapy.

    Anticipatory Nausea and Vomiting with Chemotherapy

    While the newer generation anti-emetics (anti-nausea drugs) often work better for nausea and vomiting which occurs during or after chemotherapy, Ativan is the only one which appears to help with anticipatory nausea and vomiting.

    Anticipatory nausea and vomiting is fairly common with chemotherapy, and is characterized by symptoms of nausea and vomiting which occur before chemotherapy. in one study, 29 percent of cancer patients had anticipatory nausea and 11 percent had anticipatory vomiting. It's thought that this is a classical conditioning type of reflex in which the symptoms occur based on the thought of upcoming chemotherapy alone.

    When Ativan is used for anticipatory nausea, it is, of course, used prior to a chemotherapy infusion.

    How Well Does Ativan Work?

    Ativan may not work as well as some of the newer medications available for chemotherapy-induced nauseas and vomiting, though it has been around a long time and is therefore inexpensive relative to many of these other drugs.

    For those with anticipatory nausea, however, this drug may be the best choice (remembering that one or more of these medications can be combined.) Since Ativan helps with anxiety and insomnia, it may be particularly useful for those who are experiencing significant anxiety related to their cancer treatment or having difficulties with insomnia.

    Other Drugs Used for Chemotherapy Induced Nausea

    Beginning with the approval of Zofran (ondasetron) in 1991, great improvements have been made in the treatment of nausea and vomiting related to chemotherapy. Other newer drugs which can be very helpful include Emend (aprepitant), Anzemet (dolasetron), Aloxi (palonosetron), and Kytril (granisteron).

    Dexamethasone is also often used with chemotherapy, both to reduce nausea and to decrease the likelihood of allergic reactions. Since Decadron can cause insomnia, it may be helpful to use a medication such as Ativan along with this drug.

    In addition to medications, some people have found that natural methods such as ginger and acupressure may help control their nausea. These methods should be used along with and not as a substitute for prescription medications.

    How is Atian Given?

    Ativan can be given in several different ways. It is available in a tablet form to take orally as well as a sublingual form which dissolves under your tongue. It can also be given intravenously (IV), which is helpful for those who have significant nausea and vomiting.

    Ativan may be prescribed at a set interval, or may instead be prescribed "prn" which means "as needed."

    Side Effects of Lorazepam

    A few of the common side effects of Ativan include:

    • Fatigue - Most people will notice that Ativan has a sedative effect
    • Lightheadedness and dizziness
    • Weakness and loss of coordination
    • Trouble concentrating
    • Blurred vision
    • Constipation

    What if Ativan Doesn't Work for Me?

    If Ativan is not effective in controlling your nausea, don't be alarmed. There are many medications available, and many of these work by a mechanism completely different from that of Ativan. It's not uncommon for people to try two or three different drugs before finding the ones which work best for them.

    Cautions and Warnings on Ativan

    Since Ativan can cause drowsiness, it's important to avoid operating a car or heavy machinery and limit any other activities which require you to be fully alert. Alcohol use should be avoided when taking the medication as Ativan can potentiate the effects of alcohol.

    Ativan can also interact with other presription and non-presciption drugs as well as nutritional supplements. For this reason as well as others, your doctor should always be aware of any medications, over-the-counter preparations, or herbal supplements you are taking.

    It's also important to note that Ativan can be addictive. When used appropriately for cancer treatment this is rarely a concern, but if you've struggled with substance abuse in the past, you may wish to try a different kind of anti-nausea medication instead.

    Bottom Line on Ativan for Nausea Related to Chemotherapy

    Ativan is often insufficient on its own to relieve the nausea and vomiting related to chemotherapy, but may be especially helpful for those with anticipatory nausea or who are also suffering from anxiety or insomnia. Keep in mind that for most people, nausea and vomiting related to chemotherapy can be managed very well, and if you are still having symptoms you should talk to your doctor. It's important to be your own advocate in your cancer care. Nobody knows your body as well as you do, nor is more motivated to get the best care possible.

    Sources:

    National Cancer Society. Nausea and Vomiting (PDQ) – Health Professional Version. Updated 01/04/16. https://www.cancer.gov/about-cancer/treatment/side-effects/nausea/nausea-hp-pdq#section/_20

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