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Discussion

Valium and Ativan?

I had a patient going through alcohol withdrawal...currently about 1 1/2 days into it. She was very shaky, unstable on her feet, headaches, occas. confusion, abd pain, HTN (160/111), with anxiety and depression to go along with it all. We do not get very many patients like this on our floor so I have a few questions if anyone can help. The doc had ordered valium 10mg po q4h scheduled plus an additional dose in the morning of 10mg. I called him later to tell him of the above BP and he says to try to fit another dose of valium 10mg in later in the day. Also she was getting Ativan 1-2mg IV q1-2hr prn. I gave that maybe 3 times during a 12 hour period. The meds did seem to help and her 02 sat and resp status was good. The ativan actually seemed to help the most with calming her and helped with the tremors. However, I was worried all day that I was giving her too much (even though it was ordered). I asked the doc about this and he said there was not a toxic dose established for valium. So was this too much? Also he said he expected her BP to be high and he did not order any additional BP meds....should we not worry about the BP? Thanks for any help.

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That is a lot of Valium. I think it depends on the patient and what they are used to taking prior. She probably was on similar meds in addition to the alcohol. Most importantly as you say, you have to look at the patient and how they are responding. I would be a little nervous with that much valium, so continue to monitor her response.

I would be concerned with the abdominal pain, I've never heard that being a symptom of ETOH withdrawal.

Do did well reporting the BP to the md. She's probably has the HTN because of the withdrawal and the md is doing the right thing by treating the withdrawal. I don't think we're looking at a malignant hypertensive crisis that needs further intervention. It is indeed something to monitor and be concerned about, but as the withdrawal symptoms subside the BP will come down.

We have an alcohol withdrawl protocol at our hospital. The range of the BP dictates the amount of ativan the pt is given. It can be po or IV. Most patients receive it IV. Valium is not included in the protocol. It seems to work well for alcohol withdrawl patients. I was nervous the first time I followed it since the doses of ativan seemed so enormous. But, due to a large population of who abuses alcohol, I got lots of experience with it. I think it works well.

How old was the patient? Valium is not the greatest for eldery people hands down. Ativan is tried and true for ETOH withdrawal. Librium is OK except long half-life.

Whether or not the doc wrote good med orders or not, you did a good job in this case.

  • Experts

Valium is not on any alcohol withdrawal protocol. First drug of choice is Ativan, IV route usually preferred since it starts acting the fastest. Adn you can give up to six mg of it every 30 minutes, if you need to.

These patients have been used to high levels of alcohol, so this usually will not even touch them in the beginning. And it is not uncommon to give about 40 mg in one 12 hour shift, I have seen about 68 mg in a 24 hour period.

But I definitely, would never use Valium in this situation, the 1/2 life is way too long. You want something that is shorter acting.

Librium would also be another good choice, but usually after the Ativan has been started.

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