Dental Anesthesia

Lorazepam adverse reactions

12/25/2004 02:17PM

Question:

I had recently had oral surgery in which I was prescribed lorazepam 2mg. 1 tablet at night before the surgery and 2 more the morning of the procedure. Afterwards I didn`t remember anything day or that 1st night ,except maybe a short fleeting sensation of falling forward while my husband was trying to get me in the house and into a recliner near the bed as directed by the dentist ( they wanted me to elevate for a couple of days). I also was given Aleve right after the surgery and my husband was told to give me 2 darvasets for pain as soon as I got home. I wasn`t aware of taking this and my husband had to help me to the bathroom during the day and night. Also during the day I got up and tryed to walk and fell down on the carpet , thank God, I wasn`t hurt but was a little bruised. I told the doctor at the first post op visit about my problem and I realized from them that Ativan usually works this way about the drowsiness all day and the side effect might be clumsiness but I told them that my husband and I were not aware of the deep sleep part that resulted in the fall that could be possible except I read if there was a overdose ,I could be in this deep sleep. Does this sound like a overdose or just am I super sensitive to this drug?

Answer:

There are many ways that one can deliver sedation. Some forms allow you to "titrate," or adjust, the drug to determine the proper dosage for that individual patient. Orally administered sedation (with pills) does not have this feature. So, the doctor must pick a dose and then, hope that it is enough and not too much. Not only is there individual variability in response, how much drug enters into the body can vary greatly from one person to another.

No doubt, your doctor picked a regimen that he usually prescribes that works well for 80 or 90% of people. There will be a few where it is too little sedation, and a few where it is too much. It was clearly too much for you. That dosage is a pretty big dose for a sedative naive person. There are so many other factors needed to answer your question as to proper dosage, such as your medical status, age, weight, drug interactions, etc. So, it is impossible to know if *I* might have picked another dosage for you. Certainly, the effects you mention are expected, and possibly the doctor told you about this but you could not remember due to the amnesia the drug may cause. He may have told your escort, but you both didn't realize how profound the sedation would be, especially in combination with the Darvocet. So, overdose would be the wrong term. You did have a very profound effect from the drug that is not unexpected.

In the future, if more surgery/dentistry is needed, you should start with a much lower dose. If you are not anxious before the appointment and can sleep easily through the night, you might not need the nighttime dose. Also, ask your doctor about shorter acting agents in that same class of drugs that might allow for a much earlier recovery and less residual sedative effects.

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Response by:

Steven I. Ganzberg, SB, DMD, MS
Chief of Dental Anesthesiology
Clinical Professor
Section of Dental Anesthesiology
College of Dentistry
Nationwide Children's Hospital
The Ohio State University