A Nursing Central subscription is required to. Educate patients about the risks and symptoms of respiratory depression and sedation. Methocarbamol: (Moderate) Concurrent use of benzodiazepines and other CNS active medications including skeletal muscle relaxants, can potentiate the CNS effects of either agent. Coadministration may increase the risk of CNS depressant-related side effects. Co-ingestion may disrupt the extended-release formulation resulting in increased lorazepam exposure and increasing the risk for lorazepam overdose. Educate patients about the risks and symptoms of respiratory depression and sedation. Limit the use of mixed opiate agonists/antagonists with benzodiazepines to only patients for whom alternative treatment options are inadequate. F.A. 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. 108 0 obj<>stream 0000002898 00000 n Limited published data are available in the pediatric population. Older adults have an increased sensitivity to benzodiazepines. Abrupt awakening can cause dysphoria, agitation, and possibly increased adverse effects. In a separate report, a woman taking lorazepam 2.5 mg PO twice daily for the first 5 days postpartum had milk concentrations of free and conjugated lorazepam of 12 and 35 mcg/L, respectively, at an unspecified time on day 5, and her infant showed no signs of sedation. Acetaminophen; 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. Levorphanol: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. 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. 0000006670 00000 n Use caution with this combination. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Reserve concomitant use of these drugs for patients in whom alternative treatment options are inadequate. Pramipexole: (Major) Concomitant administration of benzodiazepines with CNS-depressant drugs, including pramipexole, can potentiate the CNS effects. Dosage for patients with severe hepatic disease should be adjusted carefully according to patient response; lower doses may be sufficient in such patients. 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). Sedating H1-blockers: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. 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. (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. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. 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. Dexchlorpheniramine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. According to the Beers Criteria, benzodiazepines are considered potentially inappropriate medications (PIMs) in geriatric adults and avoidance is generally recommended, although some agents may be appropriate for seizures, rapid eye movement sleep disorders, benzodiazepine or ethanol withdrawal, severe generalized anxiety disorder, or peri-procedural anesthesia. Monitor patients for decreased pressor effect if these agents are administered concomitantly. Phenobarbital; Hyoscyamine; Atropine; Scopolamine: (Moderate) Additive CNS and/or respiratory depression may occur with concurrent use. Brexanolone: (Moderate) Concomitant use of brexanolone with CNS depressants like the benzodiazepines may increase the likelihood or severity of adverse reactions related to sedation and additive CNS depression. Titrate the dose of remimazolam to the desired clinical response and continuously monitor sedated patients for hypotension, airway obstruction, hypoventilation, apnea, and oxygen desaturation. Lasmiditan: (Moderate) Monitor for excessive sedation and somnolence during coadministration of lasmiditan and benzodiazepines. Brompheniramine; Carbetapentane; Phenylephrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Usual dose range: 2 to 6 mg/day PO. Avoid prescribing opiate cough medications in patients taking benzodiazepines. Additive drowsiness and/or dizziness is possible. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. LORazepam General *BEERS Drug* Pronunciation: lor-az-e 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. Lorazepam 1 mg extended-release capsules are contraindicated in patients with tartrazine dye hypersensitivity. 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. The action of these drugs is mediated through the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). Subsequently, decrease the dosage more slowly. Consider alternatives to benzodiazepines for conditions such as anxiety or insomnia in patients receiving buprenorphine maintenance treatment. Concurrent use may result in additive CNS depression. Buprenorphine: (Major) Concomitant use of mixed opiate agonists/antagonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Use caution with this combination. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Dose range: 0.02 to 0.1 mg/kg/dose. (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. Ventilatory support should also be available for the preanesthetic use of injectable benzodiazepines. Deutetrabenazine: (Moderate) Advise patients that concurrent use of deutetrabenazine and drugs that can cause CNS depression, such as lorazepam, may have additive effects and worsen drowsiness or sedation. Ramelteon use with hypnotics of any kind is considered duplicative therapy and these drugs are generally not co-administered. If concurrent use is necessary, monitor for excessive sedation and somnolence. Some patients may experience excessive sedation and impaired ability to perform tasks. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Initiation of sleep induction or maintenance medication should be preceded or accompanied by non-pharmacologic interventions and maximized treatment of underlying conditions (if applicable). The degree of sedation is dependent on the dose administered and the presence or absence of other medications. Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. While more study is needed, benzodiazepine-induced CNS sedation and other adverse effects might be increased in some individuals if DHEA is co-administered. Cariprazine: (Moderate) Due to the CNS effects of cariprazine, caution should be used when cariprazine is given in combination with other centrally-acting medications including benzodiazepines and other anxiolytics, sedatives, and hypnotics. Educate patients about the risks and symptoms of respiratory depression and sedation. Use caution with this combination. 1. Use caution with this combination. Exceptions to the OBRA provisions include: single dose sedative use for a dental or medical procedure or short-term sedative use during initiation of treatment for depression, pain, or other comorbid condition until symptoms improve or the underlying causative factor can be identified and/or effectively treated. Therefore, caution is advisable when combining anxiolytics, sedatives, and hypnotics or other psychoactive medications with levomilnacipran. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. Ergotamine; 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 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. 0.044 mg/kg IV (Max: 2 mg) 15 to 20 minutes prior to surgery or the procedure. False study results are possible in patients with drug-induced hyper- or hypo-responsiveness; thorough patient history is important in the interpretation of procedure results. If a benzodiazepine is required during pregnancy, avoid first trimester administration if possible, consider short-acting agents, limit treatment to the lowest effective dosage and duration, and discontinue the drug well before delivery. 0000002601 00000 n Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. %%EOF If no additional boluses are needed, consider reducing the infusion rate. In debilitated adults give 1 to 2 mg/day PO in 2 to 3 divided doses initially. 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. Specific maximum dosage information not available; the dose required is dependent on route of administration, indication, and clinical response. Affected cytochrome P450 isoenzymes and drug transporters: UGTLorazepam is a substrate of UDP-glucuronosyltransferase (UGT). Some formulations of lorazepam injection also contain benzyl alcohol and are contraindicated in patients with known benzyl alcohol hypersensitivity. Metyrosine: (Moderate) The concomitant administration of metyrosine with benzodiazepines can result in additive sedative effects. No patient should get out of bed unassisted within 8 hours of lorazepam injection. Brompheniramine; Dextromethorphan; Phenylephrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Educate patients about the risks and symptoms of excessive CNS depression and respiratory depression. This action may be additive with other agents that can cause hypotension such as benzodiazepines. Methscopolamine: (Moderate) CNS depression can be increased when methscopolamine is combined with other CNS depressants such as any anxiolytics, sedatives, and hypnotics. It is not intended to be a substitute for the exercise of professional judgment. Aspirin, ASA; Carisoprodol; Codeine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Loxapine: (Moderate) The combination of loxapine and lorazepam has been associated with acute respiratory depression, stupor, and/or hypotension in several patients. Chlophedianol; Dexbrompheniramine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Specifically, sodium oxybate use is contraindicated in patients being treated with sedative hypnotic drugs. These agents include the benzodiazepines. #6]6Yz&Hggi:>.=.4xiE]!E4})RGl!QM:/$\TUm} %n^ r#4v:'>gLS,:|vXB67)|ns\z Azelastine; Fluticasone: (Moderate) Monitor for excessive sedation and somnolence during coadministration of azelastine and benzodiazepines. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. A proposed mechanism is competitive binding of these methylxanthines to adenosine receptors in the brain. Trazodone: (Major) Monitor for excessive sedation and somnolence during coadministration of trazodone and 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. WebFind information on Lorazepam (Ativan, Loreev XR) in Daviss Drug Guide including dosage, side effects, interactions, nursing implications, mechanism of action, half life, 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. Log in using your existing username and password to start your free, 30-day trial of the app, 3. 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. Carbinoxamine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. dark urine, or jaundice (yellowing of the skin or eyes). Monitor patients for decreased pressor effect if these agents are administered concomitantly. Educate patients about the risks and symptoms of respiratory depression and sedation. 0000005197 00000 n Lorazepam is excreted into human breast milk in low concentrations. Olanzapine; Fluoxetine: (Major) Concurrent use of intramuscular olanzapine and parenteral benzodiazepines is not recommended due to the potential for adverse effects from the combination including excess sedation and/or cardiorespiratory depression. 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. T1 - LORazepam These interactions are probably pharmacodynamic in nature. 0000002822 00000 n Norethindrone; Ethinyl Estradiol; Ferrous fumarate: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. If used together, a reduction in the dose of one or both drugs may be needed. Mirtazapine: (Moderate) Monitor for unusual drowsiness and sedation during coadministration of benzodiazepines and mirtazapine due to the risk for additive CNS depression. Patients should not drive or operate heavy machinery until they know how the combination affects them. If a benzodiazepine is prescribed for an indication other than epilepsy in a patient taking an opiate agonist, use a lower initial dose of the benzodiazepine and titrate to clinical response. Limit the use of mixed opiate agonists/antagonists with benzodiazepines to only patients for whom alternative treatment options are inadequate. )1Xwn_7/?}yTuS@;-B/ -6mG]uD?,wr@fBE+htd+h>fpu(_8:UA'kz,Eb3;Y^l?1x%`rnJ hul aLHgxrJ)=bv-7:YC+eQPTRQVbG=d.x}V^>H6.#}%ZCkjzF`B *mdwy8bSM z:_Y /*,{tFVP17-_]pJbQ{Q;D62yz6KVS4}Y[8A0$\]UtJ5 S"msVO+\gRM{5ggRB> 4%3uq-sr ^bi(Q"PnIi.cqCst}>U0g/R4|QLz6;=yi]bS1?C|xUrr>Hk=ho}2^?UN T 20002023 Unbound Medicine, Inc. All rights reserved, TY - ELEC 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 FIS primarily occurs within the first few hours after labor and may last for up to 14 days. Use of PVC containers results in significant drug loss; PVC administration sets can also be expected to contribute to sorption losses.Dilute lorazepam injection with a compatible diluent such as 5% Dextrose Injection (preferred) or 0.9% Sodium Chloride Injection to a final concentration of 0.2 mg/mL. 2 to 4 mg PO at bedtime as needed. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Includes App for iPhone, iPad, and Android smartphone + tablet. If the patient is hyperdynamic and agitated after lorazepam 40 mg within 3 hours, consider phenobarbital or propofol. DISCONTINUATION: To discontinue, gradually taper the dose. Droperidol: (Major) Droperidol administration is associated with an established risk for QT prolongation and torsades de pointes. Educate patients about the risks and symptoms of respiratory depression and sedation. Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. As benzodiazepines published data are available in the dose app, 3 cytochrome P450 isoenzymes and drug transporters: is..., including pramipexole, can potentiate the CNS effects ( e.g., increased sedation respiratory... The risks and symptoms of respiratory depression, hypotension, profound sedation, and clinical response yellowing! 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