Concurrent catatonia and COVID-19 infection in a demented patient: A case report

Pestana, Pedro Câmara; Cordeiro, Catarina; Raposo, Miguel; Sousa, Mariana; Estibeiro, Maria João; Peixoto, Lígia

doi:10.1016/j.psycr.2022.100011

Cited by 2 publications

(2 citation statements)

References 15 publications

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“…68 One published case series demonstrated several instances in which 2 mg/day or 4 mg/day of lorazepam was used to treat COVID-induced catatonia effectively. 68 However, case studies have demonstrated the need for higher doses to resolve COVID-induced catatonia: (1) an 82-year-old woman was successfully treated with a combination of lorazepam 5 mg/d and memantine 10 mg/day, 69 (2) 5 patients were treated with lorazepam 4 to 8 mg/d, 70 and (3) a 20-year-old man was treated with lorazepam up to 27 mg/d. 54 Taken together, these cases suggest that COVID-induced catatonia may demonstrate resistance to BZD treatment and require much higher doses to provide effective therapeutic outcomes.…”

Section: Additional Challenges With Covid-19mentioning

confidence: 99%

“…59 Catatonia: lorazepam challenge test IV: 2 mg 2 Case report demonstrates use of midazolam in confirmation of catatonia diagnosis. 56 Treatment of COVID-induced catatonia is not only jeopardized by the shortage of lorazepam, the first-line drug of choice 69 but also may be impacted by the limitations on midazolam administration. Using the lowest conversion rate of lorazepam to midazolam of 1:1.5, the daily dose needed to treat catatonia can range from 3 to 40.5 mg/d.…”

Section: Additional Challenges With Covid-19mentioning

confidence: 99%

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Surge of Midazolam Use in the Midst of Lorazepam Shortage

Liu,

Frost,

Donlon

et al. 2023

J Clin Psychopharmacol

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Background Lorazepam is a widely prescribed benzodiazepine that is used to manage anxiety, insomnia, and status epilepticus and is used for pre-anesthetic care as well as several off-label indications including aggression, alcohol withdrawal, panic disorder, chemotherapy-associated anticipatory nausea, and catatonia. Recent increases in demand, manufacturing changes, and quality control issues have resulted in a shortage of injectable and oral lorazepam, prompting clinicians to use alternatives. One such alternative is midazolam, a drug that has been used primarily in the intensive care unit and anesthesia settings. Procedures This article examines the significant pharmacologic differences between lorazepam and midazolam. In addition, this article provides dosage guidelines based on the current scientific knowledge and recommendations for conversion equivalencies. Results The clinical preference for lorazepam can be attributed to its simpler metabolism with no active metabolites, better suitability for patients with less severe hepatic and renal impairment, less risk of adverse reactions, fewer drug-drug interactions, and greater desirability for special populations. In periods of shortages, midazolam has been shown to be effective for a number of off-label uses. To manage conditions that have not been extensively studied, clinicians may opt to use conversion equivalencies, with the caveat that guidelines may vary greatly between institutions and online sources; therefore, it would be best to start low and titrate slowly. Conclusions Our goal is to aid clinicians in safely and effectively prescribing midazolam during the shortage of injectable lorazepam so that patients are provided the same effects and benefits.

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