Instructions for Lorazepam Rectally (Ativan)

INTRODUCTION:

(For Treatment of Seizures)

You have been taught how to give your child Lorazepam rectally. However, to help make it easier for you at home, we are providing you with the following guidelines.

HAVE READY:

• 1 ml tuberculin syringe (for your information 1 ml = 1 cc)
• Vial of Lorazepam (4mg/ml)
• Lubricant such as muko or vaseline

ABOUT LORAZEPAM:

• Keep refrigerated and protected from light.

• Check for expiry date to be sure medication isn't expired.

• If medication is discoloured or contains precipitation (small particles), do not use. Stability of Lorazepam cannot be guaranteed when left for any length of time in a plastic syringe, therefore, prepare medication when required and not before.

PROCEDURE:

• Remove rubber cap from top of vial.

• Insert syringe into vial of Lorazepam and withdraw medication (withdraw more medication than required, since there will be a certain amount of air in the syringe).

• Hold syringe upright, pull back on plunger, tap barrel of syringe with finger until the air rises to the top, push plunger until air is eliminated and medication is at the amount prescribed by the physician.

• Lubricate syringe with lubricant. Also apply lubricant generously around child's rectum. This makes insertion of syringe easier.

• With child on his/her side, insert syringe 5-6 cm. (2-3 ins.) into rectum. Syringe should insert easily, if difficulty is encountered, more lubricant may be required or syringe may need repositioning. Administer medication by pushing the plunger.

• When medication is inserted, squeeze child's buttocks together and keep squeezing for 2-3 minutes. This will keep the medication from seeping out of the rectum.

If seizure does not stop after 10 minutes, the medication may be repeated depending on your physician's advice.

NOTE:

When Lorazepam is prescribed for administration at home, it may be necessary for your child to receive a test dose in hospital to ensure he/she is not unusually sensitive to this medication.

Since Lorazepam is a central nervous system depressant, an excess dose may cause a child to stop breathing. Therefore, it is very important you give the dose prescribed by your physician.

This medication is to be used only as prescribed by your physician. This is not the only treatment for seizures and your child should be assessed by your family physician or at the hospital's Emergency Department.

POSSIBLE SIDE EFFECTS:

• Drowsiness, dizziness, weakness, irritability, listlessness
• Confusion
• Unsteadiness
• Blurred Vision
• Slurred Speech

If you have any questions about this information, please talk to your child's physician, or contact the Pediatric Neurology Program, Janeway Child Health Centre, Health Care Corporation of St. John's at 778-4172.