DEAR DR. GOTT: I would like information about Ativan to include its long term use, side effects, and whether a person – especially an elderly person – should take it regularly.

DEAR READER: Ativan (lorazepam) is in a group of medicines called benzodiazepines. It is used to treat anxiety or anxiety-related disorders associated with depression. It affects chemicals in the brain which can become imbalanced and cause anxiety. It may also be prescribed for other purposes.

There are a number of issues that should be discussed with your doctor before taking this medication. For example, you should not take it if you have narrow-angle glaucoma, severe liver disease, if you are taking sodium oxybate, or if you are allergic to benzodiazepines or any of the ingredients in. Ativan. (Its inactive ingredients are lactose monohydrate, magnesium stearate, microcrystalline cellulose, and polacrilin potassium.)

Some medical conditions and other drugs could interact with this drug. For example, if you have chronic obstructive pulmonary disease (COPD) or other breathing problems, a blood disorder, suicidal thoughts, over-the-counter herbal supplements, or food allergies, your doctor must be warned. Additionally, if you are taking non-depolarizing muscle relaxers, narcotic pain relievers, digoxin and the like, he or she should also be informed. This can happen if you see more than one doctor who may not know what the other has prescribed for you.

Some medicines can make Ativan less effective, while others can increase the likelihood of side effects. This is in no way to suggest that you shouldn’t be on Ativan. It just means that your doctor (s) should have a full record of your medical history and any medications you are taking.

Ativan is available as 0.5, 1 and 2 mg tablets. The general dosage range is 2 mg to 6 mg (which appears to be high by my standards) taken in divided doses, the larger dose being taken before bedtime. The dosage may vary depending on the person’s condition. It is common for elderly patients to start with 0.5 mg due to the sedative effects which may last longer in the elderly.

All medicines can cause side effects; however, many people may not have any at all. Symptoms are usually dose-dependent, with severe effects associated with high doses. Those associated with Ativan include headache, sedation, dizziness, weakness, drowsiness, and unsteadiness. Less common but more serious side effects include hallucinations, agitation, confusion, depression, and hostility.

Medicines in this category should generally only be prescribed for a short term, for example up to four weeks. Thereafter, the prescribing physician should reassess the need for prolonged treatment. However, the drug should not be stopped abruptly due to the potential for unwanted withdrawal symptoms. A gradual reduction in the dosage regimen should be followed. Symptoms following sudden stopping include insomnia, confusion, tingling and numbness in the extremities, nausea, vomiting, diarrhea, hallucinations, delirium, convulsions, abdominal cramps, palpitations, and pain. short-term memory loss. Therefore, long-term continuous use is not recommended.

DEAR DR. GOTT: My son was recently diagnosed with polycystic kidney disease (PKD) at the age of 27. He was told that he had had it all his life since it is hereditary. He is upset that his newborn son also has a 50% chance of having him.

He did a thorough exam to determine a baseline, but before seeing his nephrologist again, I thought he might benefit from independent information to help him.

Currently he has enlarged kidneys with numerous cysts on both and a liver cyst. He has had a problem with his blood pressure since college and has been fatigued most of his life. A heart murmur was detected when he was young, so he takes antibiotics before dental treatment.

I have heard that there are things you can do to help slow the progression of this disease. I know it is incurable now, but I understand that a cure may be possible during his lifetime. I have read that controlling blood pressure is at the top of the list, along with getting adequate water and restricting salt and protein in your diet.

Long term issues are difficult for me to talk about, so I hope you mention them along with other symptoms and possible treatments as well.

DEAR READER: Polycystic kidney disease causes clumps of cysts to develop in the kidneys (bags filled with fluid). Cysts are not cancerous and can also affect other organs, such as the liver. It varies in severity.

The most common sign is high blood pressure. Other signs include kidney stones, kidney failure, headache, frequent urination, urinary tract or kidney infections, back or side pain, increased abdomen size, and blood in the stomach. the urines.

Polycystic kidney disease is most often caused by genetic defects passed from parent to child. Rarely, a spontaneous genetic mutation can occur, causing the disease to develop in an individual with no family history.

There are two types of PKD. The first, autosomal dominant polycystic kidney disease (ADPKD), accounts for about 90% of all cases. Only one parent must be affected to transmit it. Each child born to that person has a 50 percent chance of inheriting the disease. Symptoms usually start between the ages of 30 and 40, although children can develop them as well.

The second form, autosomal recessive polycystic kidney disease (ARPKD), is much less common, accounting for the remaining 10% of cases. This form requires each parent to have the abnormal gene, passing it on to their children.

There are several complications of PKD. High blood pressure, if left untreated, increases the risk of heart disease and stroke. Loss of kidney function and kidney failure can occur as the cysts grow larger, increasing pressure and causing normal kidney tissue to heal. About half of all people with this condition will have kidney failure by the age of 60. Women with PKD are at greater risk of developing preeclampsia (a pregnancy disorder). The development of hepatic cysts increases with age. Brain aneurysm is more likely in people with PKD, especially in those under the age of 50. About a quarter develop mitral valve prolapse, a type of heart valve abnormality. Chronic back or side pain can occur. And, finally, diverticulosis is more common in people with PKD.

Although the disease is incurable, many symptoms can be treated as they arise. Blood pressure can be controlled with diet, exercise, and medication. Pain can be treated with over-the-counter and prescription pain relievers as needed. Urinary tract and kidney infections should be treated promptly with antibiotics. Kidney failure can be managed with dialysis and / or transplant.

Drinking plenty of fluids, eating a healthy diet low in salt, exercising regularly, stopping smoking, maintaining a healthy weight, and taking medications prescribed or recommended by your doctor are important in staying as healthy as possible. as long as possible. possible.

First-degree family members (siblings, parents, and children) should be tested to determine if they also have the disorder. People with PKD should consult a genetic counselor before having children to determine the risk of passing on the genetic abnormalities that lead to the disease.

Your son may also benefit from joining a local support group. He can keep up to date with the latest treatment advancements, learn more about his condition and connect with other people with the disease in his community by visiting the PKD Foundation website, www.PKDCure.org. This organization has been around since 1982 and works with researchers to find new drugs, treatments and a possible cure. It has also helped raise awareness and generate millions of dollars for PKD research.

Dr Peter Gott is a retired physician. Contact Dr Gott by writing to Dr Gott c / o United Media, 200 Madison Ave., 4th fl., New York, NY 10016.