Besides ethanol, clinicians should use other anxiolytics, sedatives, and hypnotics cautiously with olanzapine. The risk of dependence increases with higher doses and longer term use and is further increased in patients with a history of alcoholism or drug abuse or in patients with significant personality disorders. Risperidone: (Moderate) Due to the primary CNS effects of risperidone, caution should be used when risperidone is given in combination with other centrally acting medications including anxiolytics, sedatives, and hypnotics. Optimum anxiolytic and sedative effects occur within 15 to 20 minutes after administration; however, the onset of effect occurs more rapidly. Acetaminophen; Pentazocine: (Major) Concomitant use of mixed opiate agonists/antagonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. 0.05 to 0.1 mg/kg IV or IM as a single dose (Max: 2 to 4 mg). 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. Asenapine: (Moderate) Drugs that can cause CNS depression, if used concomitantly with asenapine, may increase both the frequency and the intensity of adverse effects such as drowsiness, sedation, and dizziness. The Beers Criteria are not meant to apply to patients at the end of life or receiving palliative care, when risk-benefit considerations of drug therapy can be different. Hydrochlorothiazide, HCTZ; Methyldopa: (Moderate) Methyldopa is associated with sedative effects. Patients should be warned of the possibility of drowsiness that may impair performance of potentially hazardous tasks such as driving an automobile or operating machinery. Additional seizure maintenance medication should be ordered if required. There is a pregnancy exposure registry that monitors outcomes in pregnant patients exposed to lorazepam; information about the registry can be obtained at https://womensmentalhealth.org/research/pregnancyregistry/ or by calling 1-866-961-2388. Lorazepam is indicated for the management of anxiety disorders or for the short-term relief of the symptoms of anxiety or anxiety associated with depressive symptoms. 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 concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Although normal therapeutic doses of lorazepam contain very small amounts of propylene glycol, polyethylene glycol, and benzyl alcohol, the clinician should be aware of the toxic potential, especially if other drugs containing the compounds are administered. Diphenhydramine; Naproxen: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Chlorpheniramine; Codeine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Room temperature and helicopter ampules were placed into the regular drug box in the portable EMS backpack and stored either in the emergency department or on the floor of the helicopter under the seat of the pilot where they were protected from ultraviolet exposure caused by direct sunlight. Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. Accessibility Store refrigerated at 36 to 46 degrees F. Discard opened bottle after 90 days. Detoxing from Lorazepam. 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. Acetaminophen; Diphenhydramine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. [8], [1] Institute for Safe Medication Practices. The usual precautions for treating patients with impaired renal and hepatic function should be observed. Limited data available; 0.025 to 0.05 mg/kg/dose PO every 6 hours as needed for management of anticipatory nausea/vomiting. For optimal results, dose, frequency of administration, and duration of therapy should be individualized according to patient response. Carbinoxamine; Phenylephrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Fentanyl: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Syringe solutions were prepared with 5% dextrose injection or 0.9% sodium chloride (NaCl) injection at a concentration of 1 mg/ mL. No quantitative recommendations are available. Data sources include IBM Watson Micromedex (updated 2 Apr 2023), Cerner Multum (updated 17 Apr 2023), ASHP (updated 10 Apr 2023) and others. Thanks for your help. 2016;35(4):247-250. doi:10.1016/j.amj.2016.02.001 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. Lorazepam Intensol Prescribing Information. When lorazepam is used as a sedative, factors potentially causing insomnia should be evaluated before medication initiation (e.g., sleep environment, inadequate physical activity, provision of care disruptions, caffeine or medications, pain and discomfort, or other underlying conditions that cause insomnia). Level of evidence, C - Multiple studies with limitations or conflicting results Read more, Stability of Lorazepam 1 and 2 mg/mL in Glass Bottles and Polypropylene Syringes, To evaluate the physical and chemical stability of lorazepam in glass bottles and plastic syringes at concentrations suitable for use in the critical care setting, Lorazepam 1 mg/mL in 0.9% sodium chloride (n=3). Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. 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. Anticonvulsants, BenzodiazepinesAnxiolytics, BenzodiazepinesBenzodiazepine Sedative/Hypnotics. Brimonidine; Timolol: (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. Literature Support for Extended Beyond Use Dating and Stability: . Optical densities (ODs) were measured with a spectrophotometer to search for subvisible particles and assess turbidity; pH was also measured. Concurrent use may result in additive CNS depression. Lortab Elixir CII (hydrocodone bitartrate and acetaminophen oral solution) Loteprednol Etabonate Ophthalmic Gel. 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. Amgen 800-772-6436 Formoterol (Foradil) Prior to dispensing, refrigerate at 36 to 46 F (2 to 8C). If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Stability of Drugs Used in Helicopter Air Medical Emergency Services: An Exploratory Study. Aripiprazole: (Moderate) Monitor blood pressure and for unusual drowsiness and sedation during coadministration of aripiprazole and benzodiazepines. The results suggest that lorazepam can be stored on ambulances. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. This site needs JavaScript to work properly. Store in a dry place. 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. Accessed July 18, 2022. Dosage adjustments may be necessary when administered together because of potentially additive CNS effects. Am J Hosp Pharm. Educate patients about the risks and symptoms of respiratory depression and sedation. Lorazepam (brand names: Ativan, Lorazepam Intensol) is a benzodiazepine medication used to treat behavior problems such as anxiety, fears, and phobias. Alprazolam: (Moderate) Concomitant administration of alprazolam with CNS-depressant drugs, such as lorazepam, can potentiate the CNS effects of either agent. Discard 90 days after opened. Register Now. . For insomnia due to anxiety or transient situational stress, a single daily dose of 2 mg to 4 mg may be given, usually at bedtime. 4 C and room temperature was studied. During the treatment of status epilepticus, the use of injectable benzodiazepines, like lorazepam, is often implemented as an adjunct to other supportive therapies. Acetaminophen; Dextromethorphan; Doxylamine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. All sleep medications should be used in accordance with approved product labeling. Fenfluramine: (Moderate) Monitor for excessive sedation and somnolence during coadministration of fenfluramine and benzodiazepines. Electric medication storage boxes are available and for long expeditions are a reasonable solution. Epub 2019 Mar 12. Limit the use of mixed opiate agonists/antagonists with benzodiazepines to only patients for whom alternative treatment options are inadequate. A reduction in dosage of dexmedetomidine or the benzodiazepine may be required. Lorazepam should be used with caution in patients with a neuromuscular disease, such as myasthenia gravis; these patients may be more sensitive to the CNS and respiratory effects of the benzodiazepines. Am J Health Syst Pharm. Benztropine: (Moderate) CNS depressants, such as anxiolytics, sedatives, and hypnotics, can increase the sedative effects of benztropine. Anxiolytics should be used for delirium, dementia, or other cognitive disorders only when there are associated behaviors that are 1) quantitatively and objectively documented, and 2) are persistent, and 3) are not due to preventable or correctable reasons, and 4) constitute clinically significant distress or dysfunction to the LTCF resident or represent a danger to the resident or others. Butalbital; Acetaminophen: (Moderate) Additive CNS and/or respiratory depression may occur with concurrent use. Age does not appear to have a significant effect on lorazepam kinetics (see CLINICAL PHARMACOLOGY). Patients should be monitored more closely for hypotension if nitroglycerin is used concurrently with benzodiazepines. Caffeine: (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. Max: 4 mg/dose. Both lorazepam oral solution concentrated and injectable lorazepam solutions contain propylene glycol and polyethylene glycol. Monitor patients for decreased pressor effect if these agents are administered concomitantly. Sorafenib: (Moderate) Monitor for an increase in lorazepam-related adverse reactions and consider reducing the dose of lorazepam if concomitant use of lorazepam and sorafenib is necessary. [3] Pfizer Medical Communication. The safety and efficacy of lorazepam extended-release capsules have not been established in pediatric patients. Find patient medical information for Lorazepam Intensol oral on WebMD including its uses, side effects and safety, interactions, pictures, warnings and user ratings. [41537] [52925] [64934], 0.1 mg/kg/dose (Max: 4 mg/dose) IV or IM as a single dose; may repeat dose once in 5 to 15 minutes.[41537]. Daridorexant: (Major) Monitor for excessive sedation and somnolence during use of daridorexant with benzodiazepines. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. If the patient is hyperdynamic and agitated after lorazepam 40 mg within 3 hours, consider phenobarbital or propofol. The pH of the solutions was measured at each time by a glass electrode pH-meter, and all specimens underwent spectrophotometric measurements at three wavelengths (350, 410, and 550 nm). Maprotiline may lower the seizure threshold, so when benzodiazepines are used for anticonvulsant effects the patient should be monitored for desired clinical outcomes. Store at cold temperature. Administer the morning after the day of discontinuation of a lorazepam immediate-release (IR) product. Butalbital; Acetaminophen; Caffeine; Codeine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Ethynodiol Diacetate; Ethinyl Estradiol: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. Hydrocodone; Ibuprofen: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. 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. Clinical studies of lorazepam generally were not adequate to determine whether subjects aged 65 and over respond differently than younger subjects; however, the incidence of sedation and unsteadiness was observed to increase with age (see ADVERSE REACTIONS). Monitor patients for decreased pressor effect if these agents are administered concomitantly. 2020;55(3):188-192. doi:10.1177/0018578719836649 Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Esophageal dilation occurred in rats treated with lorazepam for more than one year at 6 mg/kg/day. Such reactions may be more likely to occur in children and the elderly. Norethindrone; Ethinyl Estradiol; Ferrous fumarate: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. This was a purely kinetic study that had an uneven sample distribution among varying environments. Median Tmax was 14 hours (range 7 to 24 hours) following a single 3 mg dose of the extended-release capsules. At clinically relevant concentrations, lorazepam is approximately 85% bound to plasma proteins. Detoxing from benzodiazepines like Lorazepam can be a difficult process, but with the right medical detox programs it can be accomplished with a sense of safety. Educate patients about the risks and symptoms of respiratory depression and sedation. Azelastine: (Moderate) Monitor for excessive sedation and somnolence during coadministration of azelastine and benzodiazepines. Peak concentrations in plasma occur approximately two hours following administration. 1993;50:1134. Educate patients about the risks and symptoms of respiratory depression and sedation. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Codeine; Guaifenesin; Pseudoephedrine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Patient counseling is important, as cisapride alone does not cause drowsiness or affect psychomotor function. Lorazepam Intensol Oral Concentrate USP. 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. Codeine; Promethazine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Hydrocodone: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Rotigotine: (Major) Concomitant use of rotigotine with other CNS depressants, such as benzodiazepines, can potentiate the sedative effects of rotigotine. Alternatively, 1.5 mg/m2 (Usual Max: 3 mg) IV can be given 45 minutes prior to initiation of chemotherapy. 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. Pfizer has lorazepam 2 mg/mL 1 mL vials are on back order and the company estimates a release date of April 2023. 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. Concurrent use may result in additive CNS depression. Educate patients about the risks and symptoms of respiratory depression and sedation. It appears glucuronide conjugation of lorazepam is increased in the presence of combined hormonal oral contraceptives; the clinical significance of this interaction is not determined. CLINICAL PHARMACOLOGY Lorazepam Intensol contains polyethylene glycol and propylene glycol. Selegiline: (Moderate) Monitor for unusual drowsiness and sedation during coadministration of benzodiazepines and selegiline due to the risk for additive CNS depression. Dexbrompheniramine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. In mild cases, symptoms include drowsiness, mental confusion, paradoxical reactions, dysarthria and lethargy. Lorazepam Oral Solution is not recommended for use in children. Continuous IV InfusionNOTE: Lorazepam is not FDA-approved for administration by continuous IV infusion.Use of glass or polyolefin containers is recommended; polypropylene syringes have also been used. Use caution with this combination. Would you like email updates of new search results? Difelikefalin: (Moderate) Monitor for dizziness, somnolence, mental status changes, and gait disturbances if concomitant use of difelikefalin with CNS depressants is necessary. Educate patients about the risks and symptoms of respiratory depression and sedation. 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. Meclizine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Acrivastine; Pseudoephedrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Ombitasvir; Paritaprevir; Ritonavir: (Moderate) Monitor for an increase in lorazepam-related adverse reactions and consider reducing the dose of lorazepam if concomitant use of lorazepam and ombitasvir is necessary. 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. Educate patients about the risks and symptoms of respiratory depression and sedation. 10 Equilibrate to room temperature before use. Educate patients about the risks and symptoms of respiratory depression and sedation. Guanabenz can potentiate the effects of CNS depressants such as benzodiazepines, when administered concomitantly. 9 Schering Corporation 800-222-7579 Three samples of each drug and one sample of the albumin products were used for each storage condition. If used with a benzodiazepine, droperidol should be initiated at a low dose and adjusted upward, with caution, as needed to achieve the desired effect. Federal government websites often end in .gov or .mil. al. In healthy adults, reported mean volume of distributions (Vd) are 1.3 L/kg following parenteral administration and 117 L following a single 3 mg dose of the extended-release capsules under fasting conditions. 24 hours (reconstituted solution at concentration of 5 mg/mL, diluted with Sterile Water for Injection). Concomitant use of clozapine and lorazepam may produce marked sedation, excessive salivation, hypotension, ataxia, delirium, and respiratory arrest. An in vitro study demonstrated significant increases in lorazepam release from the extended-release capsule 2 hours post-dose with approximately 91%-95% and 37 -42% of drug release in the presence of 40% and 20% alcohol, respectively. Educate patients about the risks and symptoms of respiratory depression and sedation. Quetiapine: (Moderate) Monitor for excessive sedation and somnolence during coadministration of alprazolam and quetiapine. It appears glucuronide conjugation of lorazepam is increased in the presence of combined hormonal oral contraceptives; the clinical significance of this interaction is not determined. Use caution when combining melatonin with benzodiazepines for other uses. Ramelteon use with hypnotics of any kind is considered duplicative therapy and these drugs are generally not co-administered. At clinically relevant concentrations, lorazepam is approximately 85% bound to plasma proteins. 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. Prasterone, Dehydroepiandrosterone, DHEA (Dietary Supplements): (Major) Prasterone, dehydroepiandrosterone, DHEA may inhibit the metabolism of benzodiazepines (e.g., alprazolam, estazolam, midazolam) which undergo CYP3A4-mediated metabolism. Sevoflurane: (Moderate) Concomitant administration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Levorphanol: (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. Norethindrone; Ethinyl Estradiol: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. Clonazepam: 18-50 hours. Monoamine oxidase inhibitors: (Moderate) Monitor for unusual drowsiness and sedation during coadministration of benzodiazepines and monoamine oxidase inhibitors (MAOIs) due to the risk for additive CNS depression. Use lorazepam with caution in patients with a history of alcoholism or substance abuse due to the potential for psychological dependence. Up to 0.05 mg/kg IV (Max: 4 mg) during surgery or the procedure. Educate patients about the risks and symptoms of respiratory depression and sedation. Consider the benefits of appropriate anesthesia in young children against the potential risks, especially for procedures that may last more than 3 hours or if multiple procedures are required during the first 3 years of life. When ambient storage temperatures are 30C or less, ambulances carrying lorazepam should be restocked every 30 to 60 days. The clinical significance of this is unknown. After 60 days, lorazepam maintained a clinically acceptable concentration. All rights reserved. Cyproheptadine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. 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. Attempt periodic tapering of the medication or provide documentation of medical necessity in accordance with OBRA guidelines. Human studies suggest that a single short exposure to a general anesthetic in young pediatric patients is unlikely to have negative effects on behavior and learning; however, further research is needed to fully characterize how anesthetic exposure affects brain development. Addiction-prone individuals (such as drug addicts or alcoholics) should be under careful surveillance when receiving lorazepam or other psychotropic agents. Avoid opiate cough medications in patients taking benzodiazepines. Guaifenesin; Hydrocodone; Pseudoephedrine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Educate patients about the risks and symptoms of respiratory depression and sedation. Air Med J. Brompheniramine; Dextromethorphan; Guaifenesin: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Do not store for future use. Concomitant administration resulted in increased impairment of attention, memory and coordination compared to the hypnotic agent alone. No specific anesthetic or sedation drug has been shown to be safer than another. Use caution with this combination. Use carton to protect contents from light. Medications were stored in study boxes that logged temperature every minute and were stored in EMS units per local agency policy. Keep lid tightly closed. Basics Name LORazepam Pronunciation (lor A ze pam) Brand Names: US Ativan LORazepam Intensol Loreev XR Therapeutic Category Antianxiety Agent Antiemetic Antiseizure Agent, Benzodiazepine Benzodiazepine Hy. Chlorpheniramine; Pseudoephedrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Max: 10 mg/day PO. 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 - Tablets 0.5 mg - Tablets 1 mg - Tablets 2 mg. Lorazepam Intensol. Share MJ, Harrison RD, Folstad J, Fleming RA. Methyldopa can potentiate the effects of CNS depressants such as barbiturates, benzodiazepines, opiate agonists, or phenothiazines when administered concomitantly. While anxiolytic medications may be used concurrently with daridorexant, a reduction in dose of one or both agents may be needed. If used together, a reduction in the dose of one or both drugs may be needed. Titrate to desired level of sedation. It is also used for short-term relief of the symptoms of anxiety or anxiety caused by depression. 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. Clipboard, Search History, and several other advanced features are temporarily unavailable.
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