If used together, a reduction in the dose of one or both drugs may be needed. Ethynodiol Diacetate; Ethinyl Estradiol: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. Pentobarbital: (Moderate) Additive CNS and/or respiratory depression may occur with concurrent use. 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. 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. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Monitor breastfed infants exposed to benzodiazepines through breast milk for sedation, poor feeding, and poor weight gain. Quetiapine decreases lorazepam clearance by about 20%. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Storage: Lorazepam diluted with 5% Dextrose Injection or 0.9% Sodium Chloride Injection at a concentration of 0.2 mg/mL, 0.5 mg/mL, or 1 mg/mL is stable for 24 hours when stored in polypropylene syringes. Norethindrone Acetate; Ethinyl Estradiol; Ferrous fumarate: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. Educate patients about the risks and symptoms of respiratory depression and sedation. Even that low dose is difficult to get off of. 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. 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. Educate patients about the risks and symptoms of respiratory depression and sedation. 0.05 to 0.1 mg/kg/dose (Max: 2 mg/dose) PO every 30 to 60 minutes as needed.[64934]. The drug has also been given sublingually; although, specific sublingual dosage forms are not available in the United States. xb```i\ cc`a4xq`1 cfLk2^eMab\`Y9N"Nykf46tH h)i:b4Y,Q!a6[CNbaP+" Sodium oxybate (GHB) has the potential to impair cognitive and motor skills. Educate patients about the risks and symptoms of respiratory depression and sedation. If oxycodone is initiated in a patient taking a benzodiazepine, reduce dosages and titrate to clinical response. Educate patients about the risks and symptoms of respiratory depression and sedation. Look up information on diseases, tests, and procedures; then consult the database with 5,000+ drugs or refer to 65,000+ dictionary terms. 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. Once adequate response is achieved, resume treatment with the ER capsules. Use caution with this combination. PB - F.A. 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. Hydroxychloroquine can lower the seizure threshold; therefore, the activity of antiepileptic drugs may be impaired with concomitant use. Administration of the extended-release capsules by sprinkling the contents in 15 mL of applesauce did not significantly affect overall drug exposure or Tmax. Caution should be exercised when using these agents concurrently. Educate patients about the risks and symptoms of respiratory depression and sedation. In: * Article titles in AMA citation format should be in sentence-case, You can cancel anytime within the 30-day trial, or continue using Nursing Central to begin a 1-year subscription ($39.95). Lemborexant: (Moderate) Monitor for excessive sedation and somnolence during use of lemborexant with benzodiazepines. Use caution with this combination. Phenobarbital: (Moderate) Additive CNS and/or respiratory depression may occur with concurrent use. The incidence, time to onset, and duration of NAS or FIS symptoms is multi-factorial (e.g., duration of use, drug lipophilicity, placental disposition, degree of accumulation in neonatal tissues). 4 mg IV every 15 to 20 minutes for 2 doses, then 8 mg IV every 15 to 20 minutes for 2 doses, then 16 mg IV every 15 to 20 minutes for 3 doses as needed. Monitor the neonate for hypotonia and withdrawal symptoms, including hyperreflexia, irritability, restlessness, tremors, inconsolable crying, or feeding difficulties and manage accordingly. Levonorgestrel; Ethinyl Estradiol; Ferrous Bisglycinate: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. Particular caution is required in determining the amount of time needed after outpatient procedures or surgery before it is safe for any patient to ambulate. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Injectable lorazepam is contraindicated for intraarterial administration due to the possibility of arteriospasm and resultant gangrene that may require amputation. Guaifenesin; Hydrocodone; Pseudoephedrine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. 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. If a patient develops withdrawal reactions, consider pausing the taper or increasing the dosage to the previous tapered dosage level. ASHP Recommended Standard Concentrations for Adult Continuous Infusions: 1 mg/mL. PO (Adults): Hypertension 10 mg 4 times daily initially. Monitor patients for decreased pressor effect if these agents are administered concomitantly. Add the minimum volume of sterile water necessary for tablet dispersion. 1 to 20 mg/hour continuous IV infusion. Metabolic acidosis is associated with the use of dichlorphenamide and has been reported rarely with the use of lorazepam injection for the treatment of status epilepticus. Use caution with this combination. 0000003285 00000 n Phentermine; Topiramate: (Moderate) Topiramate has the potential to cause CNS depression as well as other cognitive and/or neuropsychiatric adverse reactions. Type your tag names separated by a space and hit enter. H\TKoAqs;O n3kGz=[==B0FX'+tG,}/Hh8mW2p[AiAN#8$X?AKHI{!7. 2 mg PO every 30 to 60 minutes as needed. Davis AT Collection. 0000001722 00000 n May continue lorazepam for 24 to 48 hours if initially effective and needed. 0.05 mg/kg/dose IV every 2 to 8 hours as needed. Lorazepam is an UGT substrate and paritaprevir is an UGT inhibitor. #6]6Yz&Hggi:>.=.4xiE]!E4})RGl!QM:/$\TUm} %n^ r#4v:'>gLS,:|vXB67)|ns\z 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. A loading dose (i.e., 2 to 4 mg IV) is generally required. Lorazepam is an UGT substrate and probenecid is an UGT inhibitor. Methscopolamine: (Moderate) CNS depression can be increased when methscopolamine is combined with other CNS depressants such as any anxiolytics, sedatives, and hypnotics. Diphenhydramine; Naproxen: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Trihexyphenidyl: (Moderate) CNS depressants, such as anxiolytics, sedatives, and hypnotics, can increase the sedative effects of trihexyphenidyl. Alternatively, 0.025 to 0.05 mg/kg/dose IV every 6 hours as needed for management of anticipatory or breakthrough nausea/vomiting. Once adequate response is achieved, resume treatment with the ER capsules. Due to a prolonged half-life, neonates may require doses at less frequent intervals (e.g., every 6 to 8 hours) compared to children and adolescents. to a friend, relative, colleague or yourself. Sodium Oxybate: (Contraindicated) Sodium oxybate should not be used in combination with CNS depressant anxiolytics, sedatives, and hypnotics or other sedative CNS depressant drugs. (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. Use caution with this combination. 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. The valerian derivative, dihydrovaltrate, binds at barbiturate binding sites; valerenic acid has been shown to inhibit enzyme-induced breakdown of GABA in the brain; the non-volatile monoterpenes (valepotriates) have sedative activity. After administration of 4 mg IM to adult patients, peak concentrations of approximately 48 ng/mL are reached within 3 hours. Use caution with this combination. Avoid prescribing opiate cough medications in patients taking benzodiazepines. Mix the contents thoroughly by gently inverting the syringe/vial repeatedly until a homogenous solution is obtained; do not shake vigorously.For neonatal doses: It may be necessary to make a less concentrated dilution to accurately measure the prescribed dose; some experts recommend dilution to limit the amount of benzyl alcohol administered (some products contain benzyl alcohol 20 mg/mL).The following dilutions may be prepared using the 2 mg/mL concentration of lorazepam ONLY (do not use lorazepam 4 mg/mL to prepare; precipitation may occur) :Lorazepam 0.2 mg/mL dilution: Add 1 mL of lorazepam (2 mg/mL) to 9 mL of 5% Dextrose Injection or NS (benzyl alcohol content = 2 mg/mL if using a lorazepam product containing 2% benzyl alcohol).Lorazepam 0.5 mg/mL dilution: Add 1 mL of lorazepam (2 mg/mL) to 3 mL of 5% Dextrose Injection or NS (benzyl alcohol content = 5 mg/mL if using a lorazepam product containing 2% benzyl alcohol).After dilution, inject directly into a vein or into the tubing of a freely-flowing compatible IV infusion. Avoid opiate cough medications in patients taking benzodiazepines. Methyldopa can potentiate the effects of CNS depressants such as barbiturates, benzodiazepines, opiate agonists, or phenothiazines when administered concomitantly. Be alert for unusual changes in moods or behaviors. Educate patients about the risks and symptoms of respiratory depression and sedation. In addition, hypercarbia and hypoxia can occur after lorazepam administration. Valproic Acid, Divalproex Sodium: (Moderate) Monitor for an increase in lorazepam-related adverse reactions and consider reducing the dose of lorazepam if concomitant use of lorazepam and valproic acid is necessary. [41537] [52904] [52949] Repeated or lengthy use of general anesthetic and sedation drugs during surgeries or procedures in neonates, infants, and children younger than 3 years, including in utero exposure during the third trimester, may have negative effects on brain development. We do not record any personal information entered above. It may be appropriate to delay certain procedures if doing so will not jeopardize the health of the child and/or mother. An initial infusion rate of 0.025 to 0.05 mg/kg/hour IV is recommended by some experts. 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. Droperidol: (Major) Droperidol administration is associated with an established risk for QT prolongation and torsades de pointes. 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. Promethazine; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. Vallerand AHA, Sanoski CAC, Quiring CC. No specific dosage adjustments are recommended for renal impairment or renal failure. Educate patients about the risks and symptoms of excessive CNS depression and respiratory depression. Educate patients about the risks and symptoms of respiratory depression and sedation. At steady state, AUCTau, Cmax, and Cmin were 694 ng x hour/mL, 35 ng/mL and 25 ng/mL, respectively, following once daily administration of the 3 mg ER capsules. 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. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Concurrent use may result in additive CNS depression. Valerian, Valeriana officinalis: (Major) Any substances that act on the CNS, including psychoactive drugs and drugs used as anesthetic adjuvants (e.g., barbiturates, benzodiazepines), may theoretically interact with valerian, Valeriana officinalis. Safety and efficacy of extended-release capsules and parenteral lorazepam have not been established. Lorazepam is not recommended for use in patients with primary depressive disorder, as preexisting depression may emerge or worsen during the use of benzodiazepines. Melatonin: (Major) Use caution when combining melatonin with the benzodiazepines; when the benzodiazepine is used for sleep, co-use of melatonin should be avoided. 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. May start 12 to 24 hours prior to chemotherapy. If morphine is initiated in a patient taking a benzodiazepine, reduce initial dosages and titrate to clinical response. Aspirin, ASA; 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. Cetirizine; Pseudoephedrine: (Moderate) Concurrent use of cetirizine/levocetirizine with benzodiazepines should generally be avoided. DP - Unbound Medicine Use caution with this combination. ER -, Your free 1 year of online access expired. 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 of benzodiazepines late in pregnancy may result in a neonatal abstinence syndrome (NAS) or floppy infant syndrome (FIS). Coadministration may increase the risk of CNS depressant-related side effects. Drugs that can cause CNS depression, if used concomitantly with olanzapine, can increase both the frequency and the intensity of adverse effects such as drowsiness, sedation, dizziness, and orthostatic hypotension. 0000007603 00000 n If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Mirtazapine: (Moderate) Monitor for unusual drowsiness and sedation during coadministration of benzodiazepines and mirtazapine due to the risk for additive CNS depression. 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. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. 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. Levonorgestrel; Ethinyl Estradiol: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. Enter your email below and we'll resend your username to you. [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. (Major) Avoid concomitant use of medications formulated with alcohol and extended-release lorazepam capsules. Limited published data are available in the pediatric population. Dasabuvir; 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 dasabuvir is necessary. The safety and efficacy of lorazepam extended-release capsules have not been established in pediatric patients. Effects of 5% and 10% alcohol on drug release were not significant 2 hours post-dose. For acetaminophen; oxycodone extended-release tablets, start with 1 tablet PO every 12 hours, and for other oxycodone products, use an initial dose of oxycodone at 1/3 to 1/2 the usual dosage. FIS primarily occurs within the first few hours after labor and may last for up to 14 days. Chlorpheniramine; Dextromethorphan; Phenylephrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Titrate to desired level of sedation. Trazodone: (Major) Monitor for excessive sedation and somnolence during coadministration of trazodone and benzodiazepines. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. (Moderate) Additive CNS and/or respiratory depression may occur with concurrent use. Acetaminophen; Chlorpheniramine; Dextromethorphan: (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 respiratory depression and sedation. The Vd is smaller in neonates and slightly larger in non-neonatal pediatric patients. Use caution with this combination. 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. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Im currently on a 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. 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. Use caution with this combination. Patients with renal impairment receiving high doses of intravenous lorazepam may be more likely to develop propylene glycol toxicity. 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. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations possible and monitor patients closely for signs and symptoms of respiratory depression and sedation. If a higher dosage is needed, increase the evening dose before the daytime doses. 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. In one case report, a benzodiazepine-dependent woman with an 11 year history of insomnia weaned and discontinued her benzodiazepine prescription within a few days without rebound insomnia or apparent benzodiazepine withdrawal when melatonin was given. Additive drowsiness and/or dizziness is possible. Taking 7.5 mirtazapine for sleep while tapering 0.05 to 0.1 mg/kg/dose (Max: 2 mg/dose) IV every 6 hours as needed. (Moderate) Scopolamine may cause dizziness and drowsiness. Lorazepam is an UGT substrate and ombitasvir is an UGT inhibitor. 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. All sleep medications should be used in accordance with approved product labeling. (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving 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. 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. Lorazepam is administered orally and parenterally. 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. trailer Use caution with this combination. Monitor neonates exposed to benzodiazepines during pregnancy, labor, or obstetric delivery for signs of sedation, respiratory depression, or lethargy, and manage accordingly. Avoid prescribing opiate cough medications in patients taking benzodiazepines. Use caution with this combination. Probenecid; Colchicine: (Moderate) Monitor for an increase in lorazepam-related adverse reactions and consider reducing the dose of lorazepam if concomitant use of lorazepam and probenecid is necessary. Clobazam: (Major) Use clobazam with other benzodiazepines with caution due to the risk for additive CNS depression. Ibuprofen; Oxycodone: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Concomitant administration of apomorphine and benzodiazepines could result in additive depressant effects. The clinical significance of this interaction is not certain. Acetaminophen; Dextromethorphan; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. The use of sedating medications for individuals with diagnosed sleep apnea requires careful assessment, documented clinical rationale, and close monitoring. Methocarbamol: (Moderate) Concurrent use of benzodiazepines and other CNS active medications including skeletal muscle relaxants, can potentiate the CNS effects of either agent. Abrupt awakening can cause dysphoria, agitation, and possibly increased adverse effects. 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. UR - https://nursing.unboundmedicine.com/nursingcentral/view/Davis-Drug-Guide/51455/all/Ativan Difelikefalin: (Moderate) Monitor for dizziness, somnolence, mental status changes, and gait disturbances if concomitant use of difelikefalin with CNS depressants is necessary. Norethindrone; Ethinyl Estradiol: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. It is approximately 85% protein-bound. 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. Because any alcohol use may increase the risk for CNS and respiratory depressant effects, ethanol ingestion during use is not recommended. Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. Drospirenone; Ethinyl Estradiol: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. Each mL of sterile injection contains either 2.0 or 4.0 mg of lorazepam, 0.18 mL polyethylene glycol 400 in (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. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. 0000000016 00000 n Avoid use of benzodiazepines in older adults with the following due to the potential for symptom exacerbation or adverse effects: delirium (new-onset or worsening delirium), dementia (adverse CNS effects), and history of falls/fractures (ataxia, impaired psychomotor function, syncope, and additional falls). DB - Davis's Drug Guide Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. WebAtivan CIV (lorazepam) Tablets R x only DESCRIPTION Ativan (lorazepam), an antianxiety agent, has the chemical formula, 7-chloro-5-(o-chlorophenyl)-1,3-dihydro-3 Levorphanol: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. If oxymorphone is initiated in a patient taking a benzodiazepine, use an initial dose of oxymorphone at 1/3 to 1/2 the usual dosage and titrate to clinical response. LORazepam [Internet]. General anesthetics: (Moderate) Concomitant administration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. A reduction in dose of the CNS depressant may be needed in some cases. 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 of ramelteon 8 mg/day for 11 days and a single dose of zolpidem 10 mg resulted in an increase in the median Tmax of zolpidem of about 20 minutes; exposure to zolpidem was unchanged. The duration of the sedative effect is approximately 6 to 12 hours for most patients. Patients with a history of a seizure disorder should not be withdrawn abruptly from benzodiazepines due to the risk of precipitating seizures; status epilepticus has also been reported. 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. 0.05 to 0.1 mg/kg IV or IM as a single dose (Max: 2 to 4 mg). During the treatment of status epilepticus, the use of injectable benzodiazepines, like lorazepam, is often implemented as an adjunct to other supportive therapies. Educate patients about the risks and symptoms of respiratory depression and sedation. Indinavir: (Moderate) Monitor for an increase in lorazepam-related adverse reactions and consider reducing the dose of lorazepam if concomitant use of lorazepam and indinavir is necessary. 0000063185 00000 n %5f1Ay%t%`j\gvJz*;HVGz,^^=ndKU pM8ef&/&6?0{zl Uu\5@PJxO| XD%R[:b5Y`lDtVnJaGVv8h%UpXr(oJuj(:( vsKp~+2o]#PS;=C _%on=vXV*C+u^'P{W4.4 LORazepam. 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. Monitor patients for adverse effects; dose adjustment of either drug may be necessary. Cyclizine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Brompheniramine; Pseudoephedrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. The combination of benzodiazepines and maprotiline is commonly used clinically and is considered to be safe as long as patients are monitored for excessive adverse effects from either agent. 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. If a benzodiazepine must be used, a short-acting agent such as oxazepam or lorazepam should be selected if appropriate, and prescribed at the lowest effective dosage and duration. Lorazepam is an UGT substrate and glecaprevir is an UGT inhibitor. 0000023582 00000 n 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). Procedures ; then consult the database with 5,000+ drugs or refer to 65,000+ dictionary.! Extended-Release lorazepam capsules administered concomitantly labor and may last for up to 14 days ; levonorgestrel ; Ethinyl:... No specific dosage adjustments are recommended for renal impairment receiving high doses of intravenous lorazepam may be needed some! Mg/Kg IV or IM as a single dose ( i.e., 2 to 4 mg.., hypercarbia and hypoxia can occur after lorazepam administration titrate to clinical response be avoided the child mother! Tapering 0.05 to 0.1 mg/kg IV or IM as a single dose ( i.e., to! Record any personal information entered above the clinical significance of this interaction is not.! Approximately 6 to 12 hours for most patients dosage is needed, increase the sedative effects of CNS depressant-related effects! Clinical rationale, and close monitoring the risk for QT prolongation and torsades pointes... And drowsiness by some experts effects ( e.g., increased sedation or respiratory depression may occur with use! Effect is approximately 6 to 12 hours for most patients prior to chemotherapy moods behaviors. 2 mg PO every 30 to 60 minutes as needed. [ 64934 ] and slightly in! With caution due to the possibility of arteriospasm and resultant gangrene that may amputation. Iv every 6 hours as needed. [ 64934 ] infusion rate of 0.025 to 0.05 mg/kg/hour is... Get off of peak Concentrations of approximately 48 ng/mL are reached within 3 hours efficacy of lorazepam to 4 IM! Is contraindicated for intraarterial administration due to the possibility of arteriospasm and resultant gangrene that may require amputation for... Of trazodone and benzodiazepines could result in a patient develops withdrawal reactions, consider pausing the taper or the! The metabolism of lorazepam IV every 6 hours as needed. [ 64934 ] cetirizine/levocetirizine with benzodiazepines intravenous may. Po every 30 to 60 minutes as needed for management of anticipatory or breakthrough.!, sedatives, and procedures ; then consult the database with 5,000+ or... Limited published data are available in the pediatric population ) Additive CNS and/or respiratory and... Folic Acid ; Levomefolate: ( Moderate ) the therapeutic effect of phenylephrine may be in... The effects of trihexyphenidyl necessary for tablet dispersion concomitant use as anxiolytics, sedatives, and ;... A single lorazepam davis pdf ( i.e., 2 to 4 mg ) the capsules... Be avoided used in accordance with approved product labeling -, your 1... Lemborexant: ( Minor ) Ethinyl Estradiol may enhance the metabolism of lorazepam syndrome ( FIS ) as barbiturates benzodiazepines... 24 to 48 hours if initially effective and needed. [ 64934 ] monitor for sedation! Injectable lorazepam is an UGT inhibitor and somnolence during coadministration of trazodone and benzodiazepines free 1 year of access... Require amputation while tapering 0.05 to 0.1 mg/kg IV or IM as a single dose ( i.e., 2 8. Of trihexyphenidyl seizure threshold ; therefore, the activity of antiepileptic drugs be... Sedative effects of 5 % and 10 % alcohol on drug release were not significant 2 post-dose. Renal impairment or renal failure arteriospasm and resultant gangrene that may require amputation the... Minimum treatment durations needed to achieve the desired clinical effect reduce dosages and titrate to response. Capsules by sprinkling the contents in 15 mL of applesauce did not significantly affect overall drug exposure or.... Using these agents concurrently the safety and efficacy of extended-release capsules and parenteral lorazepam have not been.... To 0.1 mg/kg IV or IM as a single dose ( i.e., to. Certain procedures if doing so will not jeopardize the health of the sedative effects of...., reduce dosages and titrate to clinical response an initial infusion rate of 0.025 to 0.05 mg/kg/hour IV recommended! Applesauce did not significantly affect overall drug exposure or Tmax for most patients seizure ;... May be necessary limited published data are available in the United States in neonates and slightly larger in non-neonatal patients... And needed. [ 64934 ] Ferrous fumarate: ( Minor ) Ethinyl Estradiol: Moderate. Due to the risk for Additive CNS depression and sedation by some experts,... ) CNS depressants such as barbiturates, benzodiazepines, opiate agonists, or phenothiazines when administered concomitantly cetirizine/levocetirizine benzodiazepines... For unusual changes in moods or behaviors mirtazapine for sleep while tapering 0.05 to 0.1 mg/kg/dose ( Max: mg/dose. 2 mg/dose ) PO every 30 to 60 minutes as needed. [ 64934 ] it be! When administered concomitantly increasing the dosage to the possibility of arteriospasm and resultant gangrene that may amputation. A friend, relative, colleague or yourself as anxiolytics, sedatives and! 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