Oral clonazepam versus lorazepam in the treatment of methamphetamine-poisoned children: a pilot clinical trial

Abstract

Objectives To evaluate the efficacy of oral clonazepam versus oral lorazepam following initial parenteral benzodiazepine administration to control methamphetamine-induced agitation in children. Methods In a single-center clinical trial, intravenous diazepam (0.2 mg/Kg) was initially administered to all methamphetamine-poisoned pediatric patients to control their agitation, followed by a single dose of oral clonazepam (0.05 mg/Kg; n = 15) or oral lorazepam (0.05 mg/Kg; n = 15) to prevent relapse of toxicity. Results The median age [IQR] (range) was 15 [10, 36] (6-144) months. The source of poisoning was methamphetamine exposure from oral ingestion in 23 (76.7%) and passive inhalation in 7 (23.3%) patients. The most common symptoms/signs were agitation (29; 96.7%), mydriatic pupils (26; 86.7%), and tachycardia (20; 66.6%). Two in each group (13.3%) needed re-administration of intravenous diazepam due to persistent agitation. There was no report of benzodiazepine complications in either group. Conclusions Clonazepam and lorazepam treatment was equally effective at similar doses. However, considering the higher potency of clonazepam, it seems that lorazepam is the safer benzodiazepine for oral maintenance treatment of methamphetamine-induced agitation in children and can be used with minimal complications. Trial registration IRCT20180610040036N2, April 18th, 2020. Retrospectively registered.

Crystal Ice (Methamphetamine) Ingestion in a Toddler: A Case Report from Pakistan and Literature Review

“…Our patient presented with a history of fits and irritability without any changes in ECG except for sinus tachycardia. A comparatively larger study done by Farnaghi F et al, showed that the most common symptoms were agitations and tachycardia, and they used diazepam to control these effects followed by a single dose of clonazepam or lorazepam to control relapse of toxicity [17]. Our patient was also treated with diazepam.…”

A Critical Review of the Psychomotor Agitation Treatment in Youth

“…A single-center study evaluated the efficacy of oral clonazepam versus oral lorazepam, following initial parental diazepam administration (0.2 mg/kg), in managing methamphetamine-induced agitation in children. The authors showed that, although the treatment with oral clonazepam and oral lorazepam is comparable in terms of efficacy in the resolution of agitation, it would be preferable to use lorazepam, as it is less powerful and therefore potentially safer and more manageable [ 20 ]. Intranasal lorazepam (2 mg/mL) was administered to a 7-year-old boy at a dose of 1.5 mg (0.05 mg/kg) using a mucosal atomization device, with the total volume divided in half and administered into both nares.…”

Clinical pharmacology of lorazepam in infants and children

“…The mean elimination half-life is 23.7 hours following intravenous dosing and 36.9 hours following intramuscular dosing [24] suggesting that lorazepam is slowly eliminated following intramuscular administration because lorazepam slowly leaves from the muscle depot. The treatment with lorazepam in infants and children has been extensively studied [25][26][27][28][29][30][31][32][33].…”

“…Lorazepam is an effective and safe agent to treat the status epilepticus in children [31], sublingual lorazepam easily and effectively controls serial seizures in children [32], and the convulsions are controlled in 76% of children treated with single rectal lorazepam and in 51% children treated with single rectal diazepam [33]. The trials with lorazepam have studied in children [34][35][36][37][38].…”

“…Sublingual lorazepam is an easy and effective agent for treating serial childhood seizures at home [32]. Convulsions are controlled in 76% children treated with a single rectal dose of lorazepam and in 51% children treated with a single rectal dose of diazepam [33].…”