1mg Ativan 7 times per day?!?!

Nurses General Nursing

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About a week ago, one of the resident's at our retirement home asked me to re-order her medication for her. She self-medicated, but uses our pharmacy. She handed me an empty vial of Ativan, which read "Ativan 1mg take one tab five times per day, and 2 tabs at bedtime". This vial was less than 3 months old, and 400 tabs. I politely asked the resident how many she takes per day, she told me "7 or 8". I believe she is over-medicating, and question why a physician would order this much sedation. She told me it was for her anxiety and IBS. She became very upset with my questions and told me "I'm going to my other doctor, he'll fill it for me". Any one seen this kind of order before?!

It's good that you're careful and concerned. I think you're too worried in this instance. Is she able to function daily without seeming groggy?

agree with your entire post, whispera.

i also believe some might interpret you as judgmental.

personally, i believe it was inappropriate for you to share your concerns with the pt.

it likely elevated her anxiety, and was not 'therapeutic' communication.

besides, you don't know the hx of this pt:

how she came to this dosage;

whether she has a high tolerance to ativan;

and, that 7mgs/day is not considered off the charts

bottom line is, if you were so concerned that you couldn't let it go,

you should have conferred with the dr who wrote the script.

or, could have come to an's first, before saying anything at all.:)

take it for what it's worth.

it is only my :twocents:.

leslie

0 Votes
Specializes in Hospice.

Was she sedated? If not, then I would not be concerned. Our standard ativan dose is 0.5-2mg q 4 hours prn. In addition, I have also had patients on continuous ativan infusions of 20-40mg per hour, with a bolus. So I would not say that is a large dose of ativan if the pt is tolerating it. Also, the WHO recommends doubling the dose of pain and anxiety medicine at night to manage symptoms throughout someone's sleep.

0 Votes
Specializes in ICU.
Was she sedated? If not, then I would not be concerned. Our standard ativan dose is 0.5-2mg q 4 hours prn. In addition, I have also had patients on continuous ativan infusions of 20-40mg per hour, with a bolus. So I would not say that is a large dose of ativan if the pt is tolerating it. Also, the WHO recommends doubling the dose of pain and anxiety medicine at night to manage symptoms throughout someone's sleep.

If she is out like a light all the time, then I would worry. If she normally functions on this dose, it may be what she needs. Maybe she was an ex ETOH abuser. I had a little guy, maybe 110lbs withdrawing, we kept giving 20mg IVP maybe, 3 times in an hour and nothing would take him down. We intubated for precation and started him on propofol and an ativan drip and he was still pulling very hard at the wrist restraints. Anyone else would ahve been dead. ANd his BP was 150/80.....

0 Votes
Specializes in PICU, ICU, Hospice, Mgmt, DON.
agree with your entire post, whispera.

i also believe some might interpret you as judgmental.

personally, i believe it was inappropriate for you to share your concerns with the pt.

it likely elevated her anxiety, and was not 'therapeutic' communication.

besides, you don't know the hx of this pt:

how she came to this dosage;

whether she has a high tolerance to ativan;

and, that 7mgs/day is not considered off the charts

bottom line is, if you were so concerned that you couldn't let it go,

you should have conferred with the dr who wrote the script.

or, could have come to an's first, before saying anything at all.:)

take it for what it's worth.

it is only my :twocents:.

leslie

I agree with both leslie and whispera...

While this dosage is a little high, it is not excessive AND if this medication were with held from her she could go into withdrawal and ultimately seizures. It would not be pretty...and I really do not think it is your decision as to whether or not this lady can or can not refill a legitimate prescription. If this happened to my 86 year old mother, who does take ativan by the way, I would be very upset and probably be confronting this nurse or speaking to her DON or the doctor or all of the above.

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