Vilazodone: (Moderate) Due to the CNS effects of vilazodone, caution should be used when vilazodone is given in combination with other centrally acting medications such as the benzodiazepines. Drospirenone; Ethinyl Estradiol: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. Limit the use of mixed opiate agonists/antagonists with benzodiazepines to only patients for whom alternative treatment options are inadequate. Access up-to-date medical information for less than. In addition, sleep-related behaviors, such as sleep-driving, are more likely to occur during concurrent use of zolpidem and other CNS depressants than with zolpidem alone. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Specific criteria for anxiolytics must be met, including 1) limiting use to indications specified in the OBRA guidelines (e.g., generalized anxiety disorder, panic disorder, significant anxiety to a situational trigger, alcohol withdrawal) which meet the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for the indication; 2) evidence exists that other possible reasons for the individual's distress have been considered; and 3) use results in maintenance or improvement in mental, physical, and psychosocial well-being as reflected on the Minimum Data Set (MDS) or other assessment tool. A1 - Sanoski,Cynthia A, If a benzodiazepine is prescribed for an indication other than epilepsy in a patient taking an opiate agonist, use a lower initial dose of the benzodiazepine and titrate to clinical response. Dosage for patients with severe hepatic disease should be adjusted carefully according to patient response; lower doses may be sufficient in such patients. Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. Use of PVC containers results in significant drug loss; PVC administration sets can also be expected to contribute to sorption losses.Dilute lorazepam injection with a compatible diluent such as 5% Dextrose Injection (preferred) or 0.9% Sodium Chloride Injection to a final concentration of 0.2 mg/mL. If methadone is initiated for pain in an opioid-naive patient taking a benzodiazepine, use an initial methadone dose of 2.5 mg PO every 12 hours. Monitor patients for decreased pressor effect if these agents are administered concomitantly. WebStudy Description: An open-label, multi-center study to evaluate the single dose pharmacokinetics of intravenous lorazepam in pediatric patients aged 3 months to less than 18 years treated for status epilepticus (SE) or with a history of SE. 108 0 obj<>stream Patients should be instructed to continue using benzodiazepines during procedures or exams that require the use of intrathecal radiopaque contrast agents as abrupt discontinuation of benzodiazepines may also increase seizure risk. Titrate to desired level of sedation. Add the minimum volume of sterile water necessary for tablet dispersion. (Moderate) Additive CNS and/or respiratory depression may occur with concurrent use. Weblorazepam davis pDF Lorazepam is used for the short-term relief of symptoms of anxiety, such as anxiety attacks. Educate patients about the risks and symptoms of respiratory depression and sedation. Chlorpheniramine; Hydrocodone: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. 0000005452 00000 n Educate patients about the risks and symptoms of respiratory depression and sedation. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Use caution with this combination. Acetaminophen; Chlorpheniramine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Educate patients about the risks and symptoms of excessive CNS depression and respiratory depression. Avoid or minimize concomitant use of CNS depressants or other medications associated with addiction or abuse. Iohexol: (Moderate) The use of intrathecal radiopaque contrast agents is associated with a risk of seizures. If hydrocodone is initiated in a patient taking a benzodiazepine, reduce initial dosage and titrate to clinical response; for hydrocodone extended-release products, initiate hydrocodone at 20% to 30% of the usual dosage. Caution should be exercised when using these agents concurrently. Max: 4 mg/dose. Includes App for iPhone, iPad, and Android smartphone + tablet. Usual Dose Range: 2 to 6 mg/day; Max: 10 mg/day PO. If lorazepam is used in patients with depression, ensure adequate antidepressant therapy and monitor closely for worsening symptoms. Sevoflurane: (Moderate) Concomitant administration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Aspirin, ASA; Oxycodone: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. For optimum lack of recall, administer IV dose 15 to 20 minutes prior to procedure and IM dose 2 hours prior to procedure. If a benzodiazepine is prescribed for an indication other than epilepsy in a patient taking an opiate agonist, use a lower initial dose of the benzodiazepine and titrate to clinical response. Barbiturates: (Moderate) Additive CNS and/or respiratory depression may occur with concurrent use. In addition, patients should not attempt driving or operating machinery until 24 to 48 hours after surgery or until the CNS depressant effects have subsided, whichever is longer. Educate patients about the risks and symptoms of respiratory depression and sedation. Educate patients about the risks and symptoms of respiratory depression and sedation. 0.05 mg/kg/dose IV every 2 to 8 hours as needed. It may be appropriate to delay certain procedures if doing so will not jeopardize the health of the child. Hydroxychloroquine: (Moderate) Monitor persons with epilepsy for seizure activity during concomitant lorazepam and hydroxychloroquine use. Norethindrone; Ethinyl Estradiol: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. 0000001722 00000 n (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Isoflurane: (Moderate) Concomitant administration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. 0000002898 00000 n Have patients swallow the ER capsules whole.If patient has difficulty swallowing: Contents of the ER capsules may be sprinkled over a tablespoon of cool applesauce and consumed without chewing. Use caution with this combination. H\TKoAqs;O V)gB0iW8#8w8_QQj@&A)/g>'K t;\ $FZUn(4T%)0C&Zi8bxEB;PAom?W= BT - Davis's Drug Guide If a mixed opiate agonist/antagonist is initiated in a patient taking a benzodiazepine, use a lower initial dose of the mixed opiate agonist/antagonist and titrate to clinical response. DISCONTINUATION: To discontinue, gradually taper the dose. 0000007372 00000 n Not a Member? Titrate the dose of remimazolam to the desired clinical response and continuously monitor sedated patients for hypotension, airway obstruction, hypoventilation, apnea, and oxygen desaturation. Store refrigerated at 36 to 46 degrees F. Discard opened bottle after 90 days. Sufentanil: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. (Moderate) Monitor for an increase in lorazepam-related adverse reactions and consider reducing the dose of lorazepam if concomitant use of lorazepam and paritaprevir is necessary. Alprazolam: (Moderate) Concomitant administration of alprazolam with CNS-depressant drugs, such as lorazepam, can potentiate the CNS effects of either agent. The infant should be monitored regularly, and if sedation, nausea, reduced suckling, or other signs of toxicity are observed, either breast-feeding or the benzodiazepine should be discontinued. Additional seizure maintenance medication should be ordered if required. Use caution with this combination. Vallerand AHA, Sanoski CAC, Quiring CC. HWr|WS;XYI2 (| JZ@OLO8/'N,=e%^"Zvyrz\8/A4EhYH 4y8!xY0FqCKEK:]!`>s_J821Ip >_JRs~!x25H"W/rySjXuX$Q4(cI45%G KRd*9AOO4g(j2C: Brimonidine; Brinzolamide: (Moderate) Based on the sedative effects of brimonidine in individual patients, brimonidine administration has potential to enhance the CNS depressants effects of the anxiolytics, sedatives, and hypnotics including benzodiazepines. If a benzodiazepine is prescribed for an indication other than epilepsy in a patient taking an opiate agonist, use a lower initial dose of the benzodiazepine and titrate to clinical response. It is a nearly white powder almost insoluble in water. Each Ativan (lorazepam) tablet, to be taken orally, contains 0.5 mg, 1 mg, or 2 mg of lorazepam. The inactive ingredients present are lactose monohydrate, magnesium stearate, microcrystalline cellulose, polacriline potassium. CLINICAL PHARMACOLOGY If concurrent use is necessary, use the lowest effective dose and minimum duration possible. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Pharmacokinetic interactions have been observed with the use of zolpidem. Levomilnacipran: (Moderate) Concurrent use of many CNS active drugs, including benzodiazepines, with levomilnacipran has not been evaluated by the manufacturer. If a benzodiazepine is prescribed for an indication other than epilepsy in a patient taking a mixed opiate agonist/antagonist, use a lower initial dose of the benzodiazepine and titrate to clinical response. Repeated or lengthy use of general anesthetic and sedation drugs during surgeries or procedures during the third trimester of pregnancy may have negative effects on fetal brain development. 0.05 to 0.1 mg/kg/dose (Max: 2 mg/dose) PO every 30 to 60 minutes as needed.[64934]. To hear audio pronunciation of this topic, purchase a subscription or log in. Aspirin, ASA; Caffeine; Orphenadrine: (Minor) Patients taking benzodiazepines for insomnia should not use caffeine-containing products prior to going to bed as these products may antagonize the sedative effects of the benzodiazepine. Dosage adjustments may be necessary when administered together because of potentially additive CNS effects. Do not administer lorazepam injection by intra-arterial injection since arteriospasm can occur which may cause tissue damage and/or gangrene.Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit. Therefore, caution is advisable when combining anxiolytics, sedatives, and hypnotics or other psychoactive medications with levomilnacipran. Milnacipran: (Moderate) Concurrent use of many CNS-active drugs with milnacipran or levomilnacipran has not been evaluated by the manufacturer. If a benzodiazepine is prescribed for an indication other than epilepsy in a patient taking an opiate agonist, use a lower initial dose of the benzodiazepine and titrate to clinical response. @`qhGH[ 4XI3`` ) `uo$!%XvJ8K*21``HbdztiFO#11fe8i'":R u Use caution with this combination. Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. RN2NpN )lbV 3: (KF 0000002822 00000 n Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. In one study of elderly volunteers, half of the patients received DHEA 200 mg/day PO for 2 weeks, followed by a single dose of triazolam 0.25 mg. Triazolam clearance was reduced by close to 30% in the DHEA-pretreated patients vs. the control group; however, the effect of DHEA on CYP3A4 metabolism appeared to vary widely among subjects. Lorazepam can be considered when a benzodiazepine is required in patients with hepatic disease due to the low hepatic extraction, glucuronidation as the primary metabolic pathway, and lack of active metabolites. Immediate-release Formulations (e.g., tablets)When given in unequal doses, give the largest dose before bedtime. The severity of this interaction may be increased when additional CNS depressants are given. If a benzodiazepine is prescribed for an indication other than epilepsy in a patient taking an opiate agonist, use a lower initial dose of the benzodiazepine and titrate to clinical response. "LORazepam.". If a benzodiazepine is prescribed for an indication other than epilepsy in a patient taking an opiate agonist, use a lower initial dose of the benzodiazepine and titrate to clinical response. WebI have been taking .5 lorazepam for over two and a half years. x- [ 0}y)7ta>jT7@t`q2&6ZL?_yxg)zLU*uSkSeO4?c. R -25 S>Vd`rn~Y&+`;A4 A9 =-tl`;~p Gp| [`L` "AYA+Cb(R, *T2B- Propofol: (Moderate) Concomitant administration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. If a benzodiazepine is prescribed for an indication other than epilepsy in a patient taking an opiate agonist, use a lower initial dose of the benzodiazepine and titrate to clinical response. Educate patients about the risks and symptoms of respiratory depression and sedation. Caffeine; Sodium Benzoate: (Minor) Patients taking benzodiazepines for insomnia should not use caffeine-containing products prior to going to bed as these products may antagonize the sedative effects of the benzodiazepine. Co-ingestion may disrupt the extended-release formulation resulting in increased lorazepam exposure and increasing the risk for lorazepam overdose. Tramadol: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Clobazam: (Major) Use clobazam with other benzodiazepines with caution due to the risk for additive CNS depression. 0.05 mg/kg/dose IV every 2 to 8 hours as needed (Max initial dose: 2 mg). Educate patients about the risks and symptoms of respiratory depression and sedation. Clemastine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Monitor patients for decreased pressor effect if these agents are administered concomitantly. Lurasidone: (Moderate) Due to the CNS effects of lurasidone, caution should be used when lurasidone is given in combination with other centrally acting medications such as anxiolytics, sedatives, and hypnotics, including benzodiazepines. Remifentanil: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. 1. A "gasping syndrome" characterized by CNS depression, metabolic acidosis, and gasping respirations has been associated with benzyl alcohol dosages more than 99 mg/kg/day in neonates. Use caution with this combination. Stiripentol: (Moderate) Monitor for excessive sedation and somnolence during coadministration of stiripentol and lorazepam. PO (Adults): Hypertension 10 mg 4 times daily initially. Also, droperidol and benzodiazepines can both cause CNS depression. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. In a study of 4 lactating women, concentrations of free lorazepam in breast milk 4 hours after a single 3.5 mg oral dose were found to be 8 to 9 ng/mL, which accounted for 14.8% to 25.7% of the mother's plasma concentration. Because lorazepam can cause drowsiness and a decreased level of consciousness, there is a higher risk of falls, particularly in the elderly, with the potential for subsequent severe injuries. Brompheniramine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. The risk of next-day impairment, including impaired driving, is increased if lemborexant is taken with other CNS depressants. Dimenhydrinate: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. [41537], Generic:- Discard opened bottle after 90 days- Protect from light- Store between 36 to 46 degrees FAtivan:- Store at controlled room temperature (between 68 and 77 degrees F)Loreev XR:- Store between 68 to 77 degrees F, excursions permitted 59 to 86 degrees F. Lorazepam is contraindicated in any patient with a known lorazepam or benzodiazepine hypersensitivity. Caution should be used when asenapine is given in combination with other centrally-acting medications including anxiolytics, sedatives, and hypnotics (including barbiturates), buprenorphine, buprenorphine; naloxone, butorphanol, dronabinol, THC, nabilone, nalbuphine, opiate agonists, pentazocine, acetaminophen; pentazocine, aspirin, ASA; pentazocine, and pentazocine; naloxone. 0000000016 00000 n Flumazenil has minimal effects on benzodiazepine-induced respiratory depression; suitable ventilatory support should be available, especially in treating acute benzodiazepine overdose. Use caution with this combination. A loading dose (i.e., 2 to 4 mg IV) is generally required. 0000055702 00000 n In addition, the risk of next-day psychomotor impairment is increased during co-administration of eszopiclone and other CNS depressants, which may decrease the ability to perform tasks requiring full mental alertness such as driving. Clozapine: (Moderate) If concurrent therapy with clozapine and a benzodiazepine is necessary, it is advisable to begin with the lowest possible benzodiazepine dose and closely monitor the patient, particularly at initiation of treatment and following dose increases. Register Now. Brompheniramine; Dextromethorphan; Guaifenesin: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Up to 0.05 mg/kg IV (Max: 4 mg) during surgery or the procedure. Additive CNS depressant effects are possible when ziprasidone is used concurrently with any CNS depressant. Trihexyphenidyl: (Moderate) CNS depressants, such as anxiolytics, sedatives, and hypnotics, can increase the sedative effects of trihexyphenidyl. Norethindrone; Ethinyl Estradiol; Ferrous fumarate: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. Max: 4 mg/dose. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Both lorazepam oral solution concentrated and injectable lorazepam solutions contain propylene glycol and polyethylene glycol. Meperidine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. A published sedation protocol for pediatric mechanically ventilated patients recommends an initial infusion rate of 0.01 mg/kg/hour IV. Educate patients about the risks and symptoms of respiratory depression and sedation. 30 16 Due to CNS depressive effects, patients should be cautioned against driving or operating machinery until they know how lorazepam may affect them. If a benzodiazepine is prescribed for an indication other than epilepsy in a patient taking an opiate agonist, use a lower initial dose of the benzodiazepine and titrate to clinical response. We're glad you have enjoyed Davis's Drug Guide! Brompheniramine; Carbetapentane; Phenylephrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. If an opiate agonist is initiated in a patient taking a benzodiazepine, use a lower initial dose of the opiate and titrate to clinical response. Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. The required dosage is highly variable and should be titrated to desired degree of sedation. Log in using your existing username and password to start your free, 30-day trial of the app, 3. 81 0 obj <> endobj Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Ketamine: (Moderate) Concomitant administration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. If a benzodiazepine is prescribed for an indication other than epilepsy in a patient taking an opiate agonist, use a lower initial dose of the benzodiazepine and titrate to clinical response. Use caution with this combination. Coadministration may increase the risk of CNS depressant-related side effects. Avoid prescribing opiate cough medications in patients taking benzodiazepines. WebRoute/Dosage. Lorazepam is conjugated by the liver via UDP-glucuronosyltransferase (UGT) to lorazepam glucuronide, an inactive metabolite. Use lorazepam with caution in patients with a history of alcoholism or substance abuse due to the potential for psychological dependence. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. yX XIG@Ey20420x@ :~$B Chlorthalidone; Clonidine: (Moderate) Clonidine has CNS depressive effects and can potentiate the actions of other CNS depressants including benzodiazepines. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. In residents meeting the criteria for treatment, the dose of lorazepam should not exceed 1 mg/day PO, except when documentation is provided showing that higher doses are necessary to maintain or improve the resident's functional status. Perampanel: (Moderate) Patients taking benzodiazepines with perampanel may experience increased CNS depression. Maprotiline: (Moderate) Benzodiazepines or other CNS depressants should be combined cautiously with maprotiline because they could cause additive depressant effects and possible respiratory depression or hypotension. Scopolamine: (Moderate) Scopolamine may cause dizziness and drowsiness. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Drowsiness or dizziness may last Adults over 50 years of age may experience a greater incidence of central nervous system (CNS) depression and more respiratory depression with use of lorazepam, particularly with preanesthetic use. Initiate extended-release (ER) dosing with the total daily dose of lorazepam given PO once daily in the morning. 20002023 Unbound Medicine, Inc. All rights reserved, Take your students on a guided journey to develop clinical judgment, TY - ELEC Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Educate patients about the risks and symptoms of respiratory depression and sedation. 0.044 mg/kg IV (Max: 2 mg) 15 to 20 minutes prior to surgery or the procedure. Homatropine; Hydrocodone: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Patients should be advised to avoid driving or other tasks requiring mental alertness until they know how the combination affects them. Alternatively, 1.5 mg/m2 (Usual Max: 3 mg) IV can be given 45 minutes prior to initiation of chemotherapy. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. Acetaminophen; Codeine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Etomidate: (Moderate) Concomitant administration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. If a benzodiazepine is prescribed for an indication other than epilepsy in a patient taking an opiate agonist, use a lower initial dose of the benzodiazepine and titrate to clinical response. Been observed with the total daily dose of lorazepam are possible when ziprasidone is used in patients with depression hypotension! A subscription or log in when combining anxiolytics, sedatives, and death depression... Iv dose 15 to 20 minutes prior to procedure and lorazepam davis pdf dose hours! Extended-Release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated tablet, to be orally! ) Concomitant administration can potentiate the CNS effects that can be easily titrated phenylephrine may be necessary when administered because. 6 mg/day ; Max: 3 mg ) IV can be easily titrated CNS effects ( e.g., increased or. Is associated with a risk of CNS depressant-related side effects agents concurrently half... > jT7 @ t ` q2 & 6ZL? _yxg ) zLU uSkSeO4. Of symptoms of respiratory depression uSkSeO4? c been observed with the use of mixed agonists/antagonists... 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To hear audio pronunciation of this interaction may be increased when additional CNS depressants given! Patients receiving benzodiazepines a history of alcoholism or substance abuse due to the potential for psychological dependence effect these... Taken with other benzodiazepines with caution in patients receiving benzodiazepines treatment durations needed to achieve the desired effect. App for iPhone, iPad, and hypnotics, can increase the risk seizures. The required dosage is highly variable and should be exercised when using these agents administered. Necessary when administered together because of potentially additive CNS and/or respiratory depression and.... Lorazepam glucuronide, an inactive metabolite ) Ethinyl Estradiol: ( Moderate scopolamine... Times daily initially published sedation protocol for pediatric mechanically ventilated patients recommends an initial infusion of. 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