Using a single dose of lorazepam in combination with haloperidol decreases agitation in end-of-life patients with cancer who had persistent agitated delirium despite scheduled haloperidol. Panel 1: Causes of terminal agitation. The benzodiazepines stay in the body a short period of time, and can be ordered on an as-needed basis. Lorazepam 0.5 mg to 1 mg 4 times a day as required (maximum 4 mg in 24 hours) Reduce the dose to 0.25 mg to 0.5 mg in elderly or debilitated patients (maximum 2 mg in 24 hours) Oral tablets can be used sublingually (off-label use) Maximum dose: 20 mg/day Comments:-Oral … Unknown. Importance: The use of benzodiazepines to control agitation in delirium in the last days of life is controversial. When the cause of acute agitation is unknown, I prefer to use combination therapy with haloperidol 5 mg IM/IV and lorazepam 2 mg IM/IV. Benzodiazepines are best avoided. Most studies do not look at actual time to sedation, but rather what proportion of patients were sedated at specific time points (eg, 15, 30, 60 min). Note that communicating pain is difficult for cognitively impaired patients. The benzodiazepines with shorter half-lives, such as lorazepam (Ativan), oxazepam (Serax) and alprazolam (Xanax) can be useful, particularly if anxiety and tension are a major component of the agitation. Objective: To compare the effect of lorazepam vs placebo as an adjuvant to haloperidol for persistent agitation in patients with delirium in the setting of advanced cancer. Overall management of neuropsychiatric state aims at management of underlying pathology, the resolution of which leads to improvement in the clinical symptomatology. Drug selection based on cause of agitation. Often, change is the biggest trigger of agitation. Haloperidol Lactate for Injection: Prompt control acute agitation: 2 to 5 mg IM every 4 to 8 hours-The frequency of IM administration should be determined by patient response and may be given as often as every hour. These two drugs are compatible in syringe and should be mixed so that only one injection is needed. ... Haloperidol is a safer choice in the presence of liver disease. Management of agitation includes physical restraint and medication. This combination works faster than using either drug alone. These problems, called agitation, can keep them from a normal day-and-night routine and might become harmful for your loved one or their caregivers. Pain Uncontrolled and severe pain can cause agitation; this should be ruled out early. An understanding of the onset and duration of medications used for agitation is vital to set expectations and safely treat patients. Anxiety or agitation and able to swallow: lorazepam tablets . 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