Problem 7: Lorazepam in patients with COPD

Question 1

What are the possible reasons for its addition to Peter’s prescription? Discuss the role of benzodiazepines in patients with COPD.

Answer 1

Indication in BNF: anxiety, insomnia (associated with anxiety), acute panic attacks, sedation and premedication

COPD: often patients are susceptible to panic attacks and anxiety about their SoB symptoms. BDZs shown to be effective in reducing the feeling of breathlessness

NICE: Benzodiazepines, tricyclic antidepressants, major tranquillisers and oxygen should also be used when appropriate for breathlessness in patients with end-stage COPD unresponsive to other medical therapy.

Benefits to lorazepam: short half life and fast acting. Caution as may worsen respiratory depression (see opioid use in COPD).

SE: Amnesia; ataxia (in children); ataxia (especially in the elderly) (in adults); confusion (in children); confusion (especially in the elderly) (in adults); dependence; drowsiness the next day; lightheadedness the next day; muscle weakness; paradoxical increase in aggression