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. Educate patients about the risks and symptoms of respiratory depression and sedation. Educate patients about the risks and symptoms of respiratory depression and sedation. Gabapentin: (Major) Concomitant use of benzodiazepines with gabapentin may cause excessive sedation, somnolence, and respiratory depression. Use caution with this combination. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. The room temperature samples appeared to be stored at a single emergency department in Belgium. Alternatively, 1.5 mg/m2 (Usual Max: 3 mg) IV can be given 45 minutes prior to initiation of chemotherapy. Cimetidine hydrochloride compatibility III: Room temperature stability in drug admixtures. Alternatively, 0.025 to 0.05 mg/kg/dose IV every 6 hours as needed for management of anticipatory or breakthrough nausea/vomiting. Lorazepam is conjugated by the liver via UDP-glucuronosyltransferase (UGT) to lorazepam glucuronide, an inactive metabolite. Brand Name Generic Name Stability, InUse, Room Temp Adlyxin Lixisenatide 14 days . Xanax Oral Concentrate ALPRAZolam Oral Concentrate . Lorazepam is an UGT substrate and probenecid is an UGT inhibitor. 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. Ethinyl Estradiol; Norgestrel: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. Excessive amounts of benzyl alcohol in neonates have been associated with hypotension, metabolic acidosis, and kernicterus. [2] Jahns BE, et al. Initially, 2 to 3 mg/day PO given in 2 to 3 divided doses. Prehospital Emergency Care. Meperidine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. As with all benzodiazepines, the use of lorazepam may worsen hepatic encephalopathy; therefore, lorazepam should be used with caution in patients with severe hepatic insufficiency and/or encephalopathy. Educate patients about the risks and symptoms of respiratory depression and sedation. Other pharmacokinetic studies have found lorazepam to be stable for up to 210 days at room temperature. 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. Doses of 0.025 mg/kg IV have been reported to be effective in reducing emesis and anxiety due to chemotherapy with minimal adverse effects. Administration of theophylline or aminophylline may reduce the sedative effects of benzodiazepines, including lorazepam. Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. 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. Ramelteon: (Moderate) Ramelteon is a sleep-promoting agent; therefore, additive pharmacodynamic effects are possible when combining ramelteon with benzodiazepines or other miscellaneous anxiolytics, sedatives, and hypnotics. The effect was reversible only when the treatment was withdrawn within two months of first observation of the phenomenon. Use caution with this combination. 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. When a medication is used to induce sleep, treat a sleep disorder, manage behavior, stabilize mood, or treat a psychiatric disorder, the facility should attempt periodic tapering of the medication or provide documentation of medical necessity in accordance with OBRA guidelines. Use caution with this combination. Lorazepam Intensol Oral Concentrate Drug Information. 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. Oxymorphone: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Pre-existing depression may emerge or worsen during use of benzodiazepines including lorazepam. Use of benzodiazepines, including lorazepam, may lead to physical and psychological dependence. Avoid prescribing opiate cough medications in patients taking benzodiazepines. Abrupt termination of treatment may be accompanied by withdrawal symptoms. 3 repeated excursions of 24 hours at 25C. Results of our survey on drug storage, stability, compatibility, and beyond use dating. For elderly or debilitated patients, an initial dosage of 1 mg/day to 2 mg/day in divided doses is recommended, to be adjusted as needed and tolerated. For fluid restricted patients, data suggest that a concentration of 0.5 mg/mL or 1 mg/mL is stable for up to 24 hours and may be used. If lorazepam (tablets or concentrate) is used to treat insomnia, it is usually taken at bedtime. Studies in healthy volunteers show that in single high doses, lorazepam has a tranquilizing action on the central nervous system with usually no appreciable effect on the respiratory or cardiovascular systems. 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. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Cohen V, Jellinek SP, Teperikidis L, Berkovits E, Goldman WM. Additional seizure maintenance medication should be ordered if required. Codeine; Phenylephrine; Promethazine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. If oxycodone is initiated in a patient taking a benzodiazepine, reduce dosages and titrate to clinical response. Limit the use of mixed opiate agonists/antagonists with benzodiazepines to only patients for whom alternative treatment options are inadequate. Besides ethanol, clinicians should use other anxiolytics, sedatives, and hypnotics cautiously with olanzapine. [41537] [61572] Although commonly used off-label in the pediatric population, safe and effective use of immediate-release oral and parenteral lorazepam has not been established in pediatric patients younger than 12 years and 18 years, respectively. Diazepam: 20-80 hours. 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. Concurrent use may result in 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. If such therapy is initiated or discontinued, monitor the clinical response to the benzodiazepine. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. The sedative effects of injectable benzodiazepines may add to the CNS depressive state seen in the postictal stage. Metyrapone: (Moderate) Metyrapone may cause dizziness and/or drowsiness. Use only the calibrated dropper provided with this product. Acetaminophen; Pentazocine: (Major) Concomitant use of mixed opiate agonists/antagonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Do not freeze. 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. Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. Azelastine: (Moderate) Monitor for excessive sedation and somnolence during coadministration of azelastine and benzodiazepines. 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. 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 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. Usual adult dose range is 2 to 4 mg PO at bedtime as needed; use for more than 4 months has not been evaluated. Dexbrompheniramine: (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. Milnacipran: (Moderate) Concurrent use of many CNS-active drugs with milnacipran or levomilnacipran has not been evaluated by the manufacturer. Most adverse reactions to benzodiazepines, including CNS effects and respiratory depression, are dose dependent, with more severe effects occurring with high doses. 1 to 20 mg/hour continuous IV infusion. 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. Monitor patients for decreased pressor effect if these agents are administered concomitantly. Butabarbital: (Moderate) Additive CNS and/or respiratory depression may occur with concurrent use. 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. Patients should be advised that if they become pregnant, they should communicate with their physician about the desirability of discontinuing the drug. Carefully evaluate each syringe/bag before administration.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 or glass containers. Educate patients about the risks and symptoms of respiratory depression and sedation. Lorazepam is indicated for the management of anxiety disorders or for the short-term relief of the symptoms Meclizine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Consider alternatives to benzodiazepines for conditions such as anxiety or insomnia in patients receiving buprenorphine maintenance treatment. Plasma concentrations are proportional to the dose given. For a listing of Insulin Products and their. 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 (brand names: Ativan, Lorazepam Intensol) is a benzodiazepine medication used to treat behavior problems such as anxiety, fears, and phobias. 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 ombitasvir is an UGT inhibitor. Reserve concomitant use of these drugs for patients in whom alternative treatment options are inadequate. Each mL of Intensol for oral administration contains: Lorazepam Intensol contains: polyethylene glycol and propylene glycol. If 3 intermittent boluses of lorazepam are needed in a 6 hour time period, increase the infusion rate by 0.005 mg/kg/hour (50% of initial rate). Apraclonidine: (Minor) No specific drug interactions were identified with systemic agents and apraclonidine during clinical trials. Metoclopramide: (Minor) Combined use of metoclopramide and other CNS depressants, such as anxiolytics, sedatives, and hypnotics, can increase possible sedation. Bottles and syringes were stored at 22C under normal room light. Methadone: (Major) Concurrent use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. DISCONTINUATION: To discontinue, gradually taper the dose. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Recent case-control and cohort studies of benzodiazepine use during pregnancy have not confirmed increased risks of congenital malformations previously reported with early studies of benzodiazepines, including diazepam and chlordiazepoxide. Lorazepam is an UGT substrate and glecaprevir is an UGT inhibitor. 2013;17(1):1-7. doi:10.3109/10903127.2012.722177 We kept ativan in the regular pyxis. Dexbrompheniramine; Pseudoephedrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Advise patients as to the possible impairment of mental and/or physical abilities required for the performance of hazardous tasks, such as driving a car or operating other complex or dangerous machinery. Lorazepam belongs to a class of medications called benzodiazepines. 1 mg IV as a single dose, initially; may repeat dose after 5 minutes if chest pain persists. Share MJ, Harrison RD, Folstad J, Fleming RA. Suspensions were extemporaneously prepared at a . Lorazepam is an UGT substrate and erlotinib is an UGT inhibitor. How do I store lorazepam? Educate patients about the risks and symptoms of respiratory depression and sedation. Yuhas EM, Lofton FT, Rosenberg HA et al. Range: 1 to 10 mg/day PO. 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. 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. 2020;55(3):188-192. doi:10.1177/0018578719836649 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. Triprolidine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Reduce injectable buprenorphine dose by 1/2, and for the buprenorphine transdermal patch, start therapy with the 5 mcg/hour patch. [4,5], Prefilled disposable single-use glass syringes with lorazepam 2 mg/mL were studied in instrumented boxes in an emergency medicine environment (variations in ambient temperature). 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. Am J Hosp Pharm. Dextromethorphan; Guaifenesin; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. Storage: Refrigerate between 2 to 8C (36 to 46F). Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. Medically reviewed by Drugs.com. Literature Support for Extended Beyond Use Dating and Stability: . The dependence potential is reduced when lorazepam is used at the appropriate dose for short-term treatment. Tramadol; Acetaminophen: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death.
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