Ativan for Chemotherapy-Induced Nausea and Vomiting

You may know that Ativan (lorazepam) is used for anxiety. You may not know, however, that it is also used to help reduce nausea and vomiting due to chemotherapy.

The drug, which is a benzodiazepine, can be given as a pill, as a liquid, as a tablet taken sublingually (under the tongue), or intravenously (IV, within a vein). It may be used for other reasons for people with cancer as well, such as to relieve muscle spasms following a mastectomy (surgical removal of the breast).

This article will go over how Ativan is used during chemotherapy, its side effects, and facts you should know before or while you are taking it.

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Use of Ativan During Chemotherapy

The most common and dreaded side effects of chemotherapy are nausea and vomiting. Thankfully the treatment for this symptom has come a long way, and many people now experience little or no nausea even with the most nausea-producing drugs.

While not approved by the Food and Drug Administration (FDA) for nausea associated with chemotherapy, Ativan can be used in the following two ways:

  • To prevent nausea and vomiting before chemotherapy
  • To treat nausea and vomiting after chemotherapy

Yet another way this medication can be helpful is through its sedating properties. During and following chemotherapy is a time when many people value the mild drowsiness this medication can cause.

Ativan is most often used with other medications designed to prevent and control nausea, especially steroids such as Ozurdex or Maxidex (dexamethasone).

Side Effects

You may experience fatigue, dizziness, and weakness while taking Ativan. Other side effects include feelings of depression, sleep problems, and sleepiness. Let your healthcare provider know what you are experiencing. If the side effects become bothersome, other anti-nausea medications can be prescribed. Sometimes it takes trying out a few different medications before finding the best one for you, and there are many available.

Before stopping or changing the dosage of Ativan, speak with your healthcare provider.

Dosage

Available only by prescription, Ativan is most often prescribed in a tablet form that can be swallowed or dissolved under the tongue. It can also be administered intravenously or by injection, which is helpful if you have severe vomiting.

If you're taking Ativan to prevent nausea and vomiting, the typical dosage is:

  • A 0.5 or 1 milligram (mg) tablet taken orally the night before chemotherapy, or the day of treatment, about one to two hours beforehand

If you are taking Ativan to treat nausea and vomiting after chemotherapy, the dosage is:

  • A 0.5 or 1 mg tablet taken orally every eight hours as needed

However, while Ativan can be effective, it should not be taken alone as an anti-nausea drug. It should be added to an anti-nausea regimen of at least two other drugs.

For some people living with cancer, Ativan usually is prescribed "as needed," meaning you won't need to take the medication on a regular schedule. Some anti-nausea drugs, in contrast, need to be taken on a regular schedule to prevent nausea and are much less effective if you wait until you have symptoms. If you have chronic nausea and vomiting, other medications may be prescribed in addition to Ativan.

What If It Doesn't Work?

If Ativan doesn't help with your nausea and vomiting, your healthcare provider may change the dosage or prescribe another anti-nausea medication. It may take a few tries to find the medicine that works best for you, but don't despair. Many new and very effective medications have been approved for both the prevention and treatment of chemotherapy-induced nausea in recent years.

Precautions

Follow the directions given by your healthcare provider and read the patient information you may be given for this drug to minimize your chance of having side effects or an adverse reaction. Your healthcare provider should be aware of the following:

  • Any history of addiction or substance misuse/abuse: Ativan can become habit forming. The risk of addiction when used for chemotherapy, however, is very small. Use it exactly as directed.
  • Any medical issues you may have: This includes breathing problems, kidney or liver disease, glaucoma, a history of depression, suicidal thoughts, or an addiction to drugs or alcohol.
  • Any other medications you are taking: This includes prescription drugs, herbal supplements and vitamins, and over-the-counter (OTC) medications.

Warnings

Before taking Ativan, you should be aware of the following:

  • Ativan has a sedative effect: Use caution when driving and operating heavy machinery. Your healthcare provider will let you know if you should not drive or operate heavy machinery based on your tolerance and dosage. It's a good idea to have someone drive you to and from chemotherapy anyway, both physically and emotionally.
  • Do not drink alcohol while taking Ativan: It can increase the effects of alcohol, and the combination of these medications (benzodiazepines) and alcohol has led to fatal overdoses.

Tips for Reducing Nausea During Chemotherapy

There are several simple steps you can take to reduce your risk of developing nausea during your treatment. Still, most people require both these measures and medications, and trying to tough it out is not advised. Some lifestyle measures that others have found helpful include:

  • Eat more smaller meals throughout the day instead of fewer, larger meals.
  • Don't skip eating before your chemotherapy, but eat a light meal so you don't feel hungry (which can increase nausea).
  • Eat food that you like: Some people recommend avoiding your favorite foods during chemotherapy, though, so you don't develop a negative association with these foods.
  • Try to avoid sweets or fried or fatty foods.
  • Try to cook meals ahead of time and freeze them in advance of your treatment: Chemotherapy can cause significant cancer fatigue. Freezing your meals or accepting friends' offers to bring food to you can be a lifesaver.
  • Drink plenty of fluids throughout the day.
  • Wear loose-fitting clothing.
  • Practice relaxation techniques include meditation and deep breathing.

A Word From Verywell

Nausea and vomiting from chemotherapy can cause not only physical distress but also emotional distress. While Ativan may be best known as an anti-anxiety drug, it can also help to prevent and treat chemotherapy-associated nausea and vomiting, as well as associated anxiety regarding treatment and nausea or vomiting.

Even if you're already on anti-nausea medications, talk with your treatment team about possibly adding Ativan to your treatment regimen. If side effects of treatment can be reduced, that's always a good thing.

Frequently Asked Questions

  • How quickly does Ativan work for nausea?

    The tablets and liquid tend to work within 20 to 30 minutes. If it is given intravenously, you will feel the effects sooner.

  • How long does Ativan last?

    The peak concentration in plasma happens about two hours after administration, meaning its effects are strongest then. It then slowly tapers off over several hours, with sedation lasting a total of six to eight hours.

    However, even after the effects are gone, it stays in your system for a while longer. The average half-life of the drug (when it is halfway eliminated in your body) is about 12 hours.

  • Is Ativan addictive?

    It can be, yes. It is a benzodiazepine, and these drugs can be habit forming. If you have a personal or family history of addiction or prescription abuse, talk with your doctor. Always use the drug exactly as prescribed. If you find yourself having trouble sticking to the treatment regimen, talk with your healthcare provider about switching to an alternative drug.

  • Will insurance cover Ativan?

    Yes, it typically does, because the drug, especially the generic version, is so inexpensive. Even if it does not, the cost is so low, the cash price may even be cheaper than your insurance co-pay.

Originally written by Lisa Fayed
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8 Sources
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