A DOCS Education Member asks:
Here's a question I've not seen posted or answered before:
Incremental protocols have included diazepam and triazolam, diazepam and lorazepam, diazepam and lorazepam and midazolam. I have often thought, since triazolam has such a "power punch" with great amnestic properties, and lorazepam is longer-acting, why is there no protocol with, for example, triazolam pre-op and then lorazepam in office, sub-L? Many people are most frightened in the beginning ("is this going to work? am I sedated enough?"etc.), and I love triazolam's strong initial effect. Lorazepam doesn't seem to do that as well, and if a person is a bit worried coming in, and they have less amnestic effect, sometimes they remember some of the remaining anxiety.
I'd appreciate some feedback on this, please.
Dr. Anthony S. Feck, DOCS Education Dean of Faculty, responds:
Lorazepam has many disadvantages compared to triazolam. Less efficacy, longer duration of action (yes, that's a disadvantage), longer half-life, less amnesia, less therapeutic index, slower onset of action, and diminished potency. The only two reasons that lorazepam is part of our protocols are: 1. In a single-dose protocol for appointments longer than three hours, and 2. In any protocol where the use of triazolam is contraindicated. You mention the longer duration of action of lorazepam as an advantage, but with incremental dosing, you can always overcome this with more doses of triazolam, which is a much better drug for our purposes. And, we have no way to calculate TOP Dose using both triazolam and lorazepam. Given all of this, when everything DOCS Education recommends is measured against the standards of safety and efficacy, there is no justifiable reason for a triazolam/lorazepam protocol.
Hope this helps.
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