Lorazepam in cancer patients treated with cisplatin: a drug having antiemetic, amnesic, and anxiolytic effects.

Abstract

There currently is no pharmacologic approach to the problem of anticipatory nausea and vomiting (ANV). Lorazepam (Ativan, Wyeth Laboratories, Philadelphia) is an interesting candidate drug if it could block the recall of the unpleasant events associated with chemotherapy, especially if it also has antiemetic properties. Since ANV is a conditioned (learned) response, it may well depend on a memory imprint of the stimulus. This pilot study was designed to use intravenous lorazepam given before and after cisplatin infusion in 32 patients, and to make detailed measurements of nausea, vomiting, recent memory, anxiety, and sedation as well as toxicity. Satisfactory responses occurred in about 70%, as rated separately both by investigator and patient. Forty-six percent did not even recall receiving chemotherapy, regardless of whether or not they vomited; 80% had no significant anxiety after chemotherapy. Adverse reactions included some cases of perceptual disturbance, urinary incontinence, diarrhea, hypotension, and one case of severe transient amnesia. No long-term adverse effects were noted.

Cannabinoid Hyperemesis Syndrome

“…18 The use of medications including vitamin B6, ondansetron, promethazine, metoclopramide, dexamethasone, famotidine, and droperidol, alone or in combination, has been reported in the literature of CHS patients but has failed to effectively relieve the symptoms of nausea and vomiting. 7,9,18 Lorazepam's antiemetic, amnestic, and anxiolytic properties have made it useful for the treatment of anticipatory nausea and vomiting in patients undergoing chemotherapy 20 and in patients with cyclic vomiting syndrome. 21 The effectiveness of lorazepam in the relief of nausea and vomiting symptoms in CHS patients has been reported in 2 recent case reports.…”

Randomized Trial for the Control of Acute Vomiting in Cisplatin-Treated Patients: High-Dose Metoclopramide with Dexamethasone and Lorazepam as Adjuncts versus High-Dose Alizapride plus Dexamethasone and Lorazepam

“…Some studies have reported up to 30% of anticipa tory emesis in repeated cycles of chemotherapy with a close link between anticipatory emesis and anxiety being established [22], The addition of a benzodiaze pine in combination with metoclopramide and dexamethasone leads to a reduction of the patient's an xiety, with lower anticipatory emesis rate [5,6].…”

“…Diphenhydramine was for merly added to the high-dose metoclopramide-dexamethasone combination to abrogate the extrapyramidal effects inherent in the antidopaminergic proper ties of metoclopramide. In later studies, the trend was to use lorazepam instead of diphenhydramine, due to the antianxiety benefit observed in some trials, dimin ishing anticipatory emesis [5][6][7] and its effect on the cerebral cortex [8].…”

Clonazepam Use for Prevention of Acute and Delayed Vomiting Induced by Cisplatin-Based Chemotherapy for Lung Cancer

“…10) Benzodiazepines, most commonly lorazepam and diazepam, have been administered as antiemetics to prevent ANV. 11,12) There has been a case report on the use of clonazepam (a benzodiazepine) as an antiemetic. Koga et al 13) reported that a patient suffered from refractory CINV despite extensive antiemetic therapy, but fully recovered after taking clonazepam.…”