Treatment of Acute Onset Increased Anxiety with Panic

Pharmacological Intervention

The American Society of Clinical Oncology recommends administering lorazepam 1 mg subcutaneously or intravenously immediately for acute agitation and panic, with a maximum dose of 2 mg, and also recommends lower doses for older or frail patients 1
The American Society of Clinical Oncology suggests an alternative treatment of midazolam 2.5 mg subcutaneously or intravenously every 1 hour as needed, with a maximum dose of 5 mg, and recommends lower doses for elderly, frail, or COPD patients 1

The European Society of Cardiology recommends providing reassurance to the patient and family members, as anxiety is a natural response, and ensuring a calm environment and removing triggering stimuli when possible 2, 3
The European Society of Cardiology suggests administering oxygen at a rate of 2-4 L/min if the patient is breathless or shows signs of respiratory distress 2, 3

The American Society of Clinical Oncology warns of an increased risk of falls with benzodiazepine use, particularly in elderly patients, and notes that benzodiazepines may paradoxically cause agitation, anxiety, or delirium in some patients 1
The American Society of Clinical Oncology advises that benzodiazepines are contraindicated in severe pulmonary insufficiency, severe liver disease, and myasthenia gravis, unless the patient is imminently dying 1
The European Society of Cardiology notes that respiratory depression may occur with benzodiazepine use, particularly when combined with opioids, and recommends having naloxone available 2, 3

The American Academy of Child and Adolescent Psychiatry recommends SSRIs or SNRIs as first-line treatment for ongoing panic disorder, with medications such as sertraline, escitalopram, fluoxetine, or venlafaxine extended release 4
The American Academy of Child and Adolescent Psychiatry suggests offering cognitive behavioral therapy (CBT) as it demonstrates efficacy for panic disorder with a small to medium effect size 4
The National Comprehensive Cancer Network recommends using alprazolam 0.25-0.5 mg orally three times daily as initial dosing for anxiety, with a limit of 2-4 weeks for benzodiazepine use to minimize dependence risk 5

The World Health Organization recommends psychological treatment based on Cognitive Behavioral Therapy (CBT) principles for individuals concerned about prior panic attacks 6, 7
For acute agitation in emergency settings, the American Academy of Pediatrics and other organizations recommend benzodiazepines (lorazepam or midazolam) as effective monotherapy 8, 9

Benzodiazepines, such as lorazepam or midazolam, are recommended for acute agitation in emergency settings, due to their rapid onset of action and effectiveness in immediately controlling symptoms 8, 9