Sedation of a Patient Unable to Take Valium

A DOCS Education Gold Member asks:
We are trying to decide what to give the patient the night before her sedation. The patient states that she cannot take Valium because it makes her sick, but she can take Ativan (lorazepam). What do you suggest the patient take the night before sedation?


Dr. Anthony S. Feck, DOCS Education Dean of Faculty, responds:

If the patient truly cannot take diazepam, then I wouldn't have them take anything the night before. Lorazepam is too efficacious, decreasing the safety margin for pre-operative sedation.

The DOCS Member asks a follow-up question:
Thank you! What about having the patient take a Lorazepam 1 hour before her appointment?

Dr. Feck responds:
If you can do an incremental protocol, then taking a lorazepam loading dose is part of incremental protocols #3 and #4 (see your course workbook). If the patient can take triazolam, I would use a triazolam incremental protocol, which would be triazolam as the loading dose.

If you cannot do an incremental protocol, then a loading dose before the appointment on the day of the appointment is not allowed.

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