Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. AU - Vallerand,April Hazard, 30 0 obj <> endobj Enter your email below and we'll resend your username to you. Median Tmax was 14 hours (range 7 to 24 hours) following a single 3 mg dose of the extended-release capsules. Coadminstration of lorazepam with valproic acid causes increased plasma concentrations and reduced clearance of lorazepam. Educate patients about the risks and symptoms of respiratory depression and sedation. Administer the morning after the day of discontinuation of a lorazepam immediate-release (IR) product. Butorphanol: (Major) Concomitant use of mixed opiate agonists/antagonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Metyrapone: (Moderate) Metyrapone may cause dizziness and/or drowsiness. Avoid prescribing opiate cough medications in patients taking benzodiazepines. Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. Educate patients about the risks and symptoms of respiratory depression and sedation. Separate multiple email address with a comma. Educate patients about the risks and symptoms of respiratory depression and sedation. COMT inhibitors: (Major) Concomitant administration of benzodiazepines with other drugs have CNS depressant properties, including COMT inhibitors, can potentiate the CNS effects of either agent. Lorazepam is an UGT substrate and dasabuvir is an UGT inhibitor. Concomitant administration resulted in increased impairment of attention, memory and coordination compared to the hypnotic agent alone. Quetiapine decreases lorazepam clearance by about 20%. If an increase is needed, discontinue the ER capsules and increase the dosage using lorazepam IR. The oral product prescribing labels recommend against the use of lorazepam in psychosis; however, benzodiazepines are commonly used in clinical practice for the acute management of psychosis and mania, as well as in the treatment of extrapyramidal symptoms associated with antipsychotics. Molindone: (Moderate) Consistent with the pharmacology of molindone, additive effects may occur with other CNS active drugs such as anticonvulsants. Administration of the extended-release capsules with a high-fat and high calorie meal delayed median Tmax by approximately 2 hours and did not affect overall drug exposure. There's more to see -- the rest of this topic is available only to subscribers. Taking 7.5 mirtazapine for sleep while tapering 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. 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. Codeine; Guaifenesin: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. RN2NpN )lbV 3: (KF Monitor patients for decreased pressor effect if these agents are administered concomitantly. Lorazepam is an UGT substrate and glecaprevir is an UGT inhibitor. Use an initial morphine; naltrexone dose of 20 mg/0.8 mg PO every 24 hours. 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. Dilutions not prepared in a sterile environment should not be stored; discard immediately. Colesevelam: (Moderate) Colesevelam may decrease the absorption of anticonvulsants. Skilled care residents: The federal Omnibus Budget Reconciliation Act (OBRA) regulates the use of anxiolytics in long-term care facility (LTCF) residents. Educate patients about the risks and symptoms of respiratory depression and sedation. (Moderate) Monitor for an increase in lorazepam-related adverse reactions and consider reducing the dose of lorazepam if concomitant use of lorazepam and pibrentasvir is necessary. 2 mg PO every 8 hours on days 1 and 2, then 1 mg PO every 8 hours on day 3, then 1 mg PO every 12 hours on day 4, and then 1 mg PO once daily at bedtime on day 5. May start 12 to 24 hours prior to chemotherapy. Each mL of sterile injection contains either 2.0 or 4.0 mg of lorazepam, 0.18 mL polyethylene glycol 400 in Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Lorazepam is an UGT substrate and pibrentasvir is an UGT inhibitor. Reduce injectable buprenorphine dose by 1/2, and for the buprenorphine transdermal patch, start therapy with the 5 mcg/hour patch. Educate patients about the risks and symptoms of respiratory depression and sedation. Davis AT Collection is a subscription Hydrocodone: (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. Increase gradually as needed and tolerated. Educate patients about the risks and symptoms of respiratory depression and sedation. 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. Handbook covers dosage, side effects, interactions, uses. ER -, Your free 1 year of online access expired. Vallerand, April Hazard., et al. 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 caution with this combination. If concurrent use is necessary, monitor for excessive sedation and somnolence. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. AU - Quiring,Courtney, 2 to 4 mg PO at bedtime as needed. Use caution with this combination. Brompheniramine; Carbetapentane; Phenylephrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Levocetirizine: (Moderate) Concurrent use of cetirizine/levocetirizine with benzodiazepines should generally be avoided. Usual dose range: 2 to 6 mg/day PO. As a thank-you for using our site, here's a discounted rate for renewal or upgrade. Therefore, psychotropic pharmacodynamic interactions could occur following concomitant administration of drugs with significant CNS activity. (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. Guaifenesin; Hydrocodone; Pseudoephedrine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Acetaminophen; Chlorpheniramine; Dextromethorphan: (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. 0000003285 00000 n It is approximately 85% protein-bound. Max: 4 mg/dose. Send the page "" There are exceptions that may warrant the use of an anxiolytic such as a long-acting benzodiazepine for withdrawal from a short-acting benzodiazepine, use for neuromuscular syndromes (e.g., tardive dyskinesia, restless legs syndrome, seizure disorder, cerebral palsy), or end of life care. 0000006670 00000 n Nabilone: (Major) Nabilone should not be taken with benzodiazepines or other sedative/hypnotic agents because these substances can potentiate the central nervous system effects of nabilone. Davis AT Collection is a subscription Use caution with this combination. The risk of next-day impairment, including impaired driving, is increased if daridorexant is taken with other CNS depressants. 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. The severity of this interaction may be increased when additional CNS depressants are given. Dosage not available for anxiety disorders; however, lorazepam 0.025 to 0.05 mg/kg/dose PO as needed (no more frequently than every 4 hours) has been used in burn patients with anxiety related to being in the hospital, dressing changes, etc. Zolpidem: (Major) Concomitant administration of benzodiazepines with zolpidem 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. If levorphanol is initiated in a patient taking a benzodiazepine, reduce the initial dose of levorphanol by approximately 50% or more. Desogestrel; Ethinyl Estradiol: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. Methyldopa can potentiate the effects of CNS depressants such as barbiturates, benzodiazepines, opiate agonists, or phenothiazines when administered concomitantly. Monitor patients for decreased pressor effect if these agents are administered concomitantly. Due to CNS depressive effects, patients should be cautioned against driving or operating machinery until they know how lorazepam may affect them. [64020]Lorazepam stability is very specific to the product used and is concentration-dependent. Meperidine; Promethazine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Monitor patients for decreased pressor effect if these agents are administered concomitantly. 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. 0000003779 00000 n Trihexyphenidyl: (Moderate) CNS depressants, such as anxiolytics, sedatives, and hypnotics, can increase the sedative effects of trihexyphenidyl. Type your tag names separated by a space and hit enter. Initially, 2 to 3 mg/day PO given in 2 to 3 divided doses. 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. (Moderate) Additive CNS and/or respiratory depression may occur with concurrent use. Davis PT Collection is a subscription 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. Lofexidine: (Moderate) Monitor for excessive hypotension and sedation during coadministration of lofexidine and benzodiazepines. Use caution with this combination. Pentazocine: (Major) Concomitant use of mixed opiate agonists/antagonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Some formulations of lorazepam injection also contain benzyl alcohol and are contraindicated in patients with known benzyl alcohol hypersensitivity. Once adequate response is achieved, resume treatment with the ER capsules. Perampanel: (Moderate) Patients taking benzodiazepines with perampanel may experience increased CNS depression. We do not record any personal information entered above. 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. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. PB - F.A. 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. Monitor patients for decreased pressor effect if these agents are administered concomitantly. endstream endobj 82 0 obj<> endobj 83 0 obj<> endobj 84 0 obj<>/ProcSet[/PDF/Text]/ExtGState<>>> endobj 85 0 obj<> endobj 86 0 obj<> endobj 87 0 obj<> endobj 88 0 obj<> endobj 89 0 obj<> endobj 90 0 obj<> endobj 91 0 obj<> endobj 92 0 obj<>stream 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. Cyclizine: (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. Codeine; Promethazine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. UR - https://nursing.unboundmedicine.com/nursingcentral/view/Davis-Drug-Guide/51455/all/Ativan In patients treated with methadone for opioid use disorder, cessation of benzodiazepines or other CNS depressants is preferred in most cases. (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. Besides ethanol, clinicians should use other anxiolytics, sedatives, and hypnotics cautiously with olanzapine. Extended-release (ER) capsules: Pharmacokinetics of the extended-release capsules are dose proportional over the dose range of 1 to 3 mg. Steady-state is usually achieved following 5 days of administration. Hydrocodone; Pseudoephedrine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Coadministration of lorazepam with probenecid may cause a more rapid onset or prolonged effect of lorazepam due to increased half-life and decreased total clearance. Clonidine: (Moderate) Clonidine has CNS depressive effects and can potentiate the actions of other CNS depressants 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. Limit the use of opioid pain medication with lorazepam to only patients for whom alternative treatment options are inadequate. Also, droperidol and benzodiazepines can both cause CNS depression. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. F.A. Methohexital: (Moderate) Additive CNS and/or respiratory depression may occur with concurrent use. Prescribers should re-assess patients for drowsiness or sleepiness regularly throughout treatment, especially since events may occur well after the start of treatment. Brompheniramine; Dextromethorphan; Phenylephrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. 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. Add Ora-Plus and Ora-Sweet to bring the suspension to a concentration of 1 mg/mL (i.e., QS to a total volume of 360 mL). Limit the use of mixed opiate agonists/antagonists with benzodiazepines to only patients for whom alternative treatment options are inadequate. Injectable lorazepam is contraindicated for intraarterial administration due to the possibility of arteriospasm and resultant gangrene that may require amputation. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Avoid opiate cough medications in patients taking benzodiazepines. 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. Dosage adjustments may be necessary when administered together because of potentially additive CNS effects. (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. xref 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. Iohexol: (Moderate) The use of intrathecal radiopaque contrast agents is associated with a risk of seizures. Dexmedetomidine: (Moderate) Concurrent use of dexmedetomidine and benzodiazepines may result in additive CNS 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. %%EOF Monitor patients for decreased pressor effect if these agents are administered concomitantly. Brompheniramine: (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. Consume all the sprinkled contents within 2 hours. Safety and efficacy have not been established. 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. 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 prescribing opiate cough medications in patients taking benzodiazepines. A potential risk of abuse should not preclude appropriate treatment in any patient, but requires more intensive counseling and monitoring. Coadministration of lorazepam with probenecid may cause a more rapid onset or prolonged effect of lorazepam due to increased half-life and decreased total clearance. After administration of 4 mg IM to adult patients, peak concentrations of approximately 48 ng/mL are reached within 3 hours. Ventilatory support should also be available for the preanesthetic use of injectable benzodiazepines. Use caution with this combination. 0.05 to 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. 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. Educate patients about the risks and symptoms of respiratory depression and sedation. Benzhydrocodone; Acetaminophen: (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. Triprolidine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Concurrent use may result in additive CNS depression. Teduglutide has direct effects on the gut that may increase benzodiazepine exposure by improving oral absorption. 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. Use caution with this combination. Max: 4 mg/dose. Monitor patients for decreased pressor effect if these agents are administered concomitantly. xref Homatropine; Hydrocodone: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Davis PT Collection. Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. Atazanavir; Cobicistat: (Moderate) Monitor for an increase in lorazepam-related adverse reactions and consider reducing the dose of lorazepam if concomitant use of lorazepam and atazanavir is necessary. DP - Unbound Medicine If morphine is initiated in a patient taking a benzodiazepine, reduce initial dosages and titrate to clinical response. Desflurane: (Moderate) Concurrent use with benzodiazepines can decrease the minimum alveolar concentration (MAC) of desflurane needed to produce anesthesia. Extended-release Oral Capsules (e.g., Loreev XR)Administer in the morning with or without food.Do not crush or chew. Chlorpheniramine; Phenylephrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Theoretically, apraclonidine might potentiate the effects of CNS depressant drugs such as the anxiolytics, sedatives, and hypnotics, including barbiturates or benzodiazepines. Dose range: 0.02 to 0.09 mg/kg/dose. 12 years: Up to 10 mg/day PO for anxiety disorders; 4 mg/day PO for insomnia. Contraindicated for intraarterial administration due to increased half-life and decreased total clearance mixed opiate agonists/antagonists with benzodiazepines only... Increase benzodiazepine exposure by improving oral absorption dose range: 2 to 3 divided doses free 1 of... Cyclizine: ( Moderate ) metyrapone may cause a more rapid onset or prolonged effect phenylephrine. Eof monitor patients for whom alternative treatment options are inadequate ( Minor ) Ethinyl Estradiol may enhance the of! The minimum alveolar concentration ( MAC ) of either agent with benzodiazepines to only patients for decreased pressor effect these... Handbook covers dosage, side effects, patients should be cautioned against driving or operating machinery until they how. The desired clinical effect depression may occur well after the start of treatment the pharmacology of,. Coadminstration of lorazepam with probenecid may cause a more rapid onset or prolonged of. Due to increased half-life and decreased total clearance within 3 hours with this combination CNS. Including impaired driving, is increased if daridorexant is taken with other CNS depressants such as barbiturates, benzodiazepines opiate., opiate agonists, or phenothiazines when administered concomitantly pain medication with lorazepam to patients... 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