Lorazepam for Anticipatory Chemotherapy Anxiety — SCE Palliative Medicine MCQ

Correct answer: A — Lorazepam 0.5–1mg the night before and morning of chemotherapy

Lorazepam is the evidence-based choice for anticipatory chemotherapy anxiety in UK practice. Short-acting benzodiazepines have rapid onset (15–30 minutes) and are ideal for predictable, episodic anxiety. Multiple NHS cancer antiemetic guidelines recommend lorazepam 0.5–1mg given the evening before and on the morning of chemotherapy to address both the conditioned anxiety response and associated nausea. Option D (codeine) is inappropriate—opioids can worsen nausea and are not anxiolytics. Option B (haloperidol) is more antipsychotic than anxiolytic; while haloperidol is used in some guidelines for anticipatory symptoms, lower doses (1.5mg) are preferred and it is not first-line for anxiety. Option E (propranolol continuous) addresses somatic symptoms (tremor, tachycardia) but not the underlying anxiety or panic, and continuous dosing is unnecessary for cyclical, predictable anxiety. Option C (fluoxetine) has no role in acute anticipatory anxiety—SSRIs require 2–4 weeks for effect and are unsuitable for symptom onset only 2 days before treatment.

Reference: England NHS Midlands East, 'Network Guideline for the use of Anti-emetics in Adults Receiving Anti-Cancer Drug Therapy', section 5.3.3 Anticipatory Nausea and Vomiting, 2018. https://www.england.nhs.uk/mids-east/wp-content/uploads/sites/7/2018/04/use-of-anti-emetics-in-adults-receiving-anti-cancer-drug-therapy.pdf