Q: I am over 80 years of age and in good health. The only problem I have had the last 15 years is sleeping. My doctor prescribed lorazepam at one milligram. I would need half of one for 10 years perhaps twice a week. Lately I have used half of a pill every second night. Are there any serious side effects? It is the only prescription I take.
A: You are very fortunate at the age of 80 to only have to take one type of medication. That means you have no high blood pressure and no significant arthritis. I expect you will live to 100.
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Lorazepam, more commonly known by its trade name, Ativan, is a minor tranquilizer of the benzodiazepine family. It is not a sleeping pill, but many people take it to help them sleep on an occasional basis. Some people take them when travelling and sleeping in strange surroundings. Shift workers may use them to be able to sleep during the day.
There are no serious long-term side effects, but there is a risk of drug dependence. That means that, as in your case, you eventually need to take higher doses to have the same effect, and there could be withdrawal symptoms if the drug is suddenly stopped.
Hospitals and long-term care facilities do not like using this drug in older patients, because they believe that by making the person drowsy, it may increase the risk of falls and fractures.
However, in your case, you are used to taking lorazepam for many years and have hardly increased the dose. If it works for you, I think it best that you continue as you have been. It would be hard to stop without withdrawal symptoms such as not sleeping and increased anxiety and agitation.
The alternatives to tranquilizers, such as sleeping pills, are also addictive, perhaps even more so. Small doses of tricyclic antidepressants such as Elavil are sometimes used before bedtime to help a person sleep, but they have other side effects such as dry mouth and eyes, and they can be hard on the heart in older individuals.
Skin turning bluish
Q: The same person asks: I have navy blue colouring under my eyes and over the bridge of my nose. Does this indicate any problem?
A: As I said before, you appear to be a healthy person for your age of 80 plus. As you get older, the skin thins, particularly in the exposed areas such as face and hands, and what you are seeing is the small veins and capillaries showing through the skin. There is nothing to worry about.
Clare Rowson is a retired medical doctor with a practice near Belleville, Ont. Her columns are intended for general information only. Individuals are encouraged to also seek the advice of their own doctor regarding medical questions and
treatments.
