Patient is requesting PRN Xanax with PRN Ativan at the same time..Is that allowed?

Virgo_RN, BSN, RN · Dec 8, 2007

They are both benzodiazepines, and may potentiate one another's effects. However, if the patient takes them both concurrently on a regular basis, he may have a tolerance. Does the patient take these medications at home? What are the dosages? What route? Did you ask the pharmacist?

Dunno? · Dec 8, 2007

They are both benzodiazepines, and may potentiate one another's effects. However, if the patient takes them both concurrently on a regular basis, he may have a tolerance. Does the patient take these medications at home? What are the dosages? What route? Did you ask the pharmacist?

Yes, I work at home health...I just want to follow the rules and the mom told me that she gives it to him like that...I dont know what to do..The MAR says Xanax 0.25 mg bid po prn..And he also has an Ativan prn bid..

P_RN, ADN, RN · Dec 8, 2007

Doctor shopping? Or forgetful doctor? Seems the pharmD would have caught that. I'd be on the phone with the doc and get a corrected order asap.

Dunno? · Dec 8, 2007

Doctor shopping? Or forgetful doctor? Seems the pharmD would have caught that. I'd be on the phone with the doc and get a corrected order asap.

Yes, thanks..I knew something was up...

jojotoo, RN · Dec 8, 2007

Patients can ask for anything they want. And doctors can write any order that they want. It's up to you to use your good sense AND training to make sure that no harm comes to your patient.

Congrats to you that you used both and were not bullied.

anonymurse · Dec 8, 2007

His MOM? Like, this is a KID?

Noryn · Dec 8, 2007

A simple call to his doctor or even pharmacist would solve the problem. There may be a reason he takes the 2 medications together even though they are in the same class.

If he is taking strong pain medication or drinking alcohol then definitely there could be some risk but if he is only these prn then there really is little (if any) risk. Ativan and Xanax are relatively safe unless the person is taking something else.

TazziRN, RN · Dec 8, 2007

his mom? like, this is a kid?

not necessarily. this could be an adult who is compromised enough that he's unable to care for himself.

op, i would also call the doc to clarify, but if/when the doc finds out the pt's been taking them together for a while s/he may very well okay it. they're both in the same class but it wouldn't be any different than someone who can handle say, 2 mg of ativan at a time on a regular basis when the label says to take 1. he's built up a tolerance so it may be what works for him.

Tweety, BSN, RN · Dec 8, 2007

I wouldn't have been comfortable with it either, but rather than tell the patient "it's not allowed" end of discussion, I would have said "let me check into this and I'll be right back". I would have reviewed the chart to see if the doctor knows of this combination, if other nurses have been doing it and if not I might have called the doc to clarify it. Like you, I wouldn't have been comfortable with the idea.

It could be what the doctor wants to keep this particular patient from yelling and screaming. It could also make the patient feel better that he's getting two different meds, and this might have a placebo/phychological effect.

SuesquatchRN, BSN, RN · Dec 8, 2007

It could also make the patient feel better that he's getting two different meds, and this might have a placebo/phychological effect.

The very low dosages support this.

AmaurosisFugax · Dec 8, 2007

I have a patient..In his MAR, the doctor said that he can have PRN Xanax for anxiety..Also in the MAR, the doctor says that he can have PRN Ativan for anxiety..I know that they both are anti anxiety drugs..The patient requested both at the same time..I refused telling him that it is not allowed and he started to yell and scream at me because he says it is allowed and his mom says it is okay to do it..But I am thinking that it cannot be since they are both anti anxiety drugs and cannot be both given at the same time..
What are your thoughts?

Maybe-& this is just a thought-the Dr wants to combine a short-acting strong BZD (alprazolam) for like HS orhigh-stress situations & an intermediate-acting weaker BZD (lorazepam) for maintenance anxiety prevention for longer periods; since both are BID PRN that may be a way to reduce using a strong BZD QID. Since either can be used up to TID/QID it is not an overdosage of BZDs but rather a way to reduce stronger drug while achieving proper anxiety control...but still should be rechecked...