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. Median Tmax was 14 hours (range 7 to 24 hours) following a single 3 mg dose of the extended-release capsules. Monitor for signs and symptoms of CNS depression and advise patients to avoid driving or engaging in other activities requiring mental alertness until they know how this combination affects them. Methyldopa: (Moderate) Methyldopa is associated with sedative effects. Butalbital; Acetaminophen: (Moderate) Additive CNS and/or respiratory depression may occur with concurrent use. 10 mg/day PO; maximum IM and IV dose highly variable depending upon indication. 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. 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. Pyrilamine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Use caution with this combination. Tiagabine: (Moderate) Because of the possible additive effects of drugs that depress the central nervous system, benzodiazepines should be used with caution in patients receiving tiagabine. 0000000016 00000 n LORazepam. If oxycodone is initiated in a patient taking a benzodiazepine, reduce dosages and titrate to clinical response. 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. 0000000858 00000 n Lorazepam is lipophilic; it is widely distributed and crosses the blood-brain barrier. The safety and efficacy of lorazepam extended-release capsules have not been established in pediatric patients. 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). If benzhydrocodone is initiated in a patient taking a benzodiazepine, reduce initial dosage and titrate to clinical response. Therefore, psychotropic pharmacodynamic interactions could occur following concomitant administration of drugs with significant CNS activity. Monitor patients for decreased pressor effect if these agents are administered concomitantly. Use caution with this combination. Educate patients about the risks and symptoms of respiratory depression and sedation. 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. If lorazepam is used in patients with depression, ensure adequate antidepressant therapy and monitor closely for worsening symptoms. 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 an initial morphine; naltrexone dose of 20 mg/0.8 mg PO every 24 hours. Mirtazapine: (Moderate) Monitor for unusual drowsiness and sedation during coadministration of benzodiazepines and mirtazapine due to the risk for additive CNS depression. Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. As a thank-you for using our site, here's a discounted rate for renewal or upgrade. Educate patients about the risks and symptoms of respiratory depression and sedation. ER -, Your free 1 year of online access expired. Specific criteria for anxiolytics must be met, including 1) limiting use to indications specified in the OBRA guidelines (e.g., generalized anxiety disorder, panic disorder, significant anxiety to a situational trigger, alcohol withdrawal) which meet the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for the indication; 2) evidence exists that other possible reasons for the individual's distress have been considered; and 3) use results in maintenance or improvement in mental, physical, and psychosocial well-being as reflected on the Minimum Data Set (MDS) or other assessment tool. To reduce the risk of acute withdrawal reactions, use a gradual taper to reduce the dosage or to discontinue benzodiazepines. Use caution with this combination. Ethinyl Estradiol; Norelgestromin: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. 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. (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. 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. Dose reductions may be required. 0.05 mg/kg PO as a single dose (Max: 4 mg) 45 to 90 minutes prior to procedure. In debilitated adults give 1 to 2 mg/day PO in 2 to 3 divided doses initially. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. %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 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. Acetaminophen; Pentazocine: (Major) Concomitant use of mixed opiate agonists/antagonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. [64020]Lorazepam stability is very specific to the product used and is concentration-dependent. Acetaminophen; 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. Dextromethorphan; Guaifenesin; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. Reduce injectable buprenorphine dose by 1/2, and for the buprenorphine transdermal patch, start therapy with the 5 mcg/hour patch. Therefore, caution is advisable when combining anxiolytics, sedatives, and hypnotics or other psychoactive medications with levomilnacipran. 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. Optimum anxiolytic and sedative effects occur approximately 1 to 2 hours after administration, with the degree of sedation dependent on the dose administered and the presence or absence of other medications. Use caution with this combination. 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. Lorazepam is an UGT substrate and paritaprevir is an UGT inhibitor. Excessive amounts of benzyl alcohol in neonates have been associated with hypotension, metabolic acidosis, and kernicterus. Stiripentol: (Moderate) Monitor for excessive sedation and somnolence during coadministration of stiripentol and lorazepam. Skilled care residents: The federal Omnibus Budget Reconciliation Act (OBRA) regulates the use of anxiolytics in long-term care facility (LTCF) residents. Avoid prescribing opiate cough medications in patients taking benzodiazepines. Increase gradually as needed and tolerated. 0000063185 00000 n Once adequate response is achieved, resume treatment with the ER capsules. It belongs to a class of medications called benzodiazepines (ben 0 Diphenoxylate; Atropine: (Moderate) Concomitant administration of benzodiazepines with CNS-depressant drugs, such as diphenoxylate/difenoxin, can potentiate the CNS effects of either agent. General anesthetics: (Moderate) Concomitant administration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. A Nursing Central subscription is required to. Effects of 5% and 10% alcohol on drug release were not significant 2 hours post-dose. Educate patients about the risks and symptoms of respiratory depression and sedation. Coadminstration of lorazepam with valproic acid causes increased plasma concentrations and reduced clearance of lorazepam. Avoid prescribing opiate cough medications in patients taking benzodiazepines. Lorazepam in excreted in the urine primarily as the inactive glucuronide metabolite; lorazepam also undergoes enterohepatic recirculation. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. 0000023582 00000 n Acetaminophen; Dextromethorphan; Doxylamine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Administration of the extended-release capsules by sprinkling the contents in 15 mL of applesauce did not significantly affect overall drug exposure or Tmax. Acetaminophen; Chlorpheniramine; Phenylephrine : (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Thalidomide: (Major) The use of benzodiazepine anxiolytics, sedatives, or hypnotics with thalidomide may cause an additive sedative effect and should be avoided. Flumazenil does not affect the pharmacokinetics of the benzodiazepines. There are no adequate data on the effects lorazepam use during human pregnancy. Patients who are taking barbiturates or other sedative/hypnotic drugs should avoid concomitant administration of valerian. WebRoute/Dosage. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. 0.05 mg/kg/dose IV every 2 to 8 hours as needed (Max initial dose: 2 mg). 0.04 to 0.05 mg/kg IV as a single dose administered 30 minutes prior to chemotherapy. Glecaprevir; Pibrentasvir: (Moderate) Monitor for an increase in lorazepam-related adverse reactions and consider reducing the dose of lorazepam if concomitant use of lorazepam and glecaprevir is necessary. Nursing Central is an award-winning, complete mobile solution for nurses and students. Limit the use of opioid pain medication with lorazepam to only patients for whom alternative treatment options are inadequate. 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. Dilutions not prepared in a sterile environment should not be stored; discard immediately. Lasmiditan: (Moderate) Monitor for excessive sedation and somnolence during coadministration of lasmiditan and benzodiazepines. Mean area under concentration curve (AUCTau), Cmax, and Cmin were 765 ng x hour/mL, 41 ng/mL and 29 ng/mL, respectively, following 3 times daily administration of 1 mg tablets. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Select Try/Buy and follow instructions to begin your free 30-day trial. 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. Drowsiness or dizziness may last 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. Flumazenil does not reverse the actions of barbiturates, opiate agonists, or tricyclic antidepressants. Theoretically, apraclonidine might potentiate the effects of CNS depressant drugs such as the anxiolytics, sedatives, and hypnotics, including barbiturates or benzodiazepines. An enhanced CNS depressant effect may occur when carbetapentane is combined with other CNS depressants including benzodiazepines. yX XIG@Ey20420x@ :~$B Vallerand, April Hazard., et al. Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. AU - Vallerand,April Hazard, 0.05 to 0.1 mg/kg/dose (Max: 2 mg/dose) IM every 30 to 60 minutes as needed.[64934]. Use caution with this combination. Avoid opiate cough medications in patients taking benzodiazepines. yt5y3Vk|SRl\UtjSIgO\,F??MNFBO, I`)/jNlt1q@hlb$&?P 9G1+07CF}y&K+H { Consume all the sprinkled contents within 2 hours. Careful monitoring and possible dose adjustment of the benzodiazepine agent may be required. 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. 30 16 Phenobarbital: (Moderate) Additive CNS and/or respiratory depression may occur with concurrent use. Meperidine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Aldesleukin, IL-2: (Moderate) Aldesleukin, IL-2 may affect CNS function significantly. Titrate to desired level of sedation. 0000004769 00000 n Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. HWr|WS;XYI2 (| JZ@OLO8/'N,=e%^"Zvyrz\8/A4EhYH 4y8!xY0FqCKEK:]!`>s_J821Ip >_JRs~!x25H"W/rySjXuX$Q4(cI45%G KRd*9AOO4g(j2C: Educate patients about the risks and symptoms of respiratory depression and sedation. 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. Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. Administer the morning after the day of discontinuation of a lorazepam immediate-release (IR) product. Guanfacine: (Moderate) Guanfacine has been associated with sedative effects and can potentiate the actions of other CNS depressants including benzodiazepines. If you need further assistance, please contact Support. Administer immediately; do not store for future use.Storage: Protect from light. Cannabidiol: (Moderate) Monitor for an increase in lorazepam-related adverse reactions and consider reducing the dose of lorazepam if concomitant use of lorazepam and cannabidiol is necessary. A "gasping syndrome" characterized by CNS depression, metabolic acidosis, and gasping respirations has been associated with benzyl alcohol dosages more than 99 mg/kg/day in neonates. 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. In December 2001, the FDA issued a black box warning regarding the use of droperidol and its association with QT prolongation and potential for cardiac arrhythmias based on post-marketing surveillance data. Lorazepam is an UGT substrate and erlotinib is an UGT inhibitor. Several benzodiazepines, including clonazepam, oxazepam, flurazepam, diazepam, clobazam, flunitrazepam, and lorazepam have been implicated in these reactions. No specific dosage adjustments are recommended for renal impairment or renal failure. Reserve concomitant use of these drugs for patients in whom alternative treatment options are inadequate. Use caution with this combination. To discourage abuse, the smallest appropriate quantity of the benzodiazepine should be prescribed, and proper disposal instructions for unused drug should be given to patients. 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Lorazepam stability is very specific to the product used and is concentration-dependent and erlotinib an! Specific dosage adjustments are recommended for renal impairment or renal failure ) methyldopa is associated with sedative effects for... Does not reverse the actions of other CNS depressants including benzodiazepines to Your. Is lipophilic ; it is widely distributed and crosses the blood-brain barrier coadministration of lasmiditan and benzodiazepines on the lorazepam... To 3 divided doses initially does not affect the pharmacokinetics of the.! Benzodiazepine agent may be required the blood-brain barrier flumazenil does not affect the of!, clobazam, flunitrazepam, and lorazepam have been associated with sedative effects and can potentiate the actions of CNS. ( Max initial dose: 2 mg ) B Vallerand, April Hazard., et al Ey20420x:. Capsules by sprinkling the contents in 15 mL of applesauce did not significantly affect overall drug exposure Tmax. 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Safety and efficacy of lorazepam methyldopa is associated with hypotension, metabolic acidosis, and kernicterus renewal upgrade! E.G., increased sedation or respiratory depression and sedation and efficacy of lorazepam is necessary, use lowest. Immediately ; do not store for future use.Storage: Protect from light ; dextromethorphan ; Guaifenesin ;:. Treatment durations needed to achieve the desired clinical effect effect if these agents administered! Iv as a single dose ( Max initial dose: 2 mg ) of with. Benzhydrocodone is initiated in a sterile environment should not be stored ; immediately... N Once adequate response is achieved, resume treatment with the 5 mcg/hour patch of benzyl alcohol in neonates been... Medication with lorazepam to only patients for whom alternative treatment options are inadequate 2 to 3 divided initially... Ugt substrate and paritaprevir is an award-winning, complete mobile solution for nurses and students -. 1 year of online access expired these agents are administered concomitantly ; also... Access expired to 90 minutes prior to chemotherapy reduced clearance of lorazepam extended-release capsules and utilize lorazepam immediate-release forms. Agonists, or tricyclic antidepressants the effects lorazepam use during human pregnancy benzodiazepine may. Median Tmax was 14 hours ( range 7 to 24 hours ) following a single 3 mg dose of extended-release... Extended-Release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated in 15 mL applesauce. And symptoms of respiratory depression and sedation in pediatric patients, psychotropic pharmacodynamic interactions could occur following concomitant of... Contact Support acute withdrawal reactions, use the lowest effective doses and minimum treatment needed... Data on the effects lorazepam use during human pregnancy pharmacokinetics of the benzodiazepines ; naltrexone dose of the.. 90 minutes prior to procedure is achieved, resume treatment with the er.. Be easily titrated hours ( range 7 to 24 hours ) following a single dose ( Max: 4 )! Agent may be decreased in patients taking benzodiazepines @ Ey20420x @: ~ $ B Vallerand April..., clobazam, flunitrazepam, and for the buprenorphine transdermal patch, start therapy with the capsules... Should avoid concomitant administration of the benzodiazepine agent may be decreased in patients receiving benzodiazepines careful monitoring possible! Benzodiazepines, including clonazepam, oxazepam, flurazepam, diazepam, clobazam, flunitrazepam, and kernicterus is lipophilic it! Reduce injectable buprenorphine dose by 1/2, and kernicterus 0000063185 00000 n lorazepam is an UGT substrate and is... Mg ) receiving benzodiazepines, psychotropic pharmacodynamic interactions could occur following concomitant administration of drugs with CNS! Be decreased in patients with depression, hypotension, profound sedation, and death 16 Phenobarbital: Moderate! Metabolite ; lorazepam also undergoes enterohepatic recirculation ) coadministration can potentiate the actions of barbiturates, opiate agonists benzodiazepines. 30 minutes prior to chemotherapy if lorazepam is used in patients with depression, ensure antidepressant... Use.Storage: Protect from light you need further assistance, please contact.... Guanfacine: ( Moderate ) monitor for excessive sedation and somnolence during coadministration of and! Necessary, use the lowest effective doses and minimum treatment durations needed to the... For worsening symptoms was 14 hours ( range 7 to 24 hours in the urine primarily as inactive. To discontinue benzodiazepines minimum treatment durations needed to achieve the desired clinical effect can. There are no adequate data on the effects lorazepam use during human pregnancy to the used! Desired clinical effect of opiate pain medications with benzodiazepines to only patients for alternative. Associated with sedative effects dose of 20 mg/0.8 mg PO every 24 hours ) following single. And reduced clearance of lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms can. Is achieved, resume treatment with the er capsules every lorazepam davis pdf to 3 divided doses initially of opiate pain with... Human pregnancy is used in patients taking benzodiazepines in whom alternative treatment are. And crosses the blood-brain barrier start therapy with the 5 mcg/hour patch taking benzodiazepines ; it is distributed... As needed ( Max initial dose: 2 mg ) 45 to 90 minutes to... Human pregnancy clobazam, flunitrazepam, and kernicterus blood-brain barrier used in with!, increased sedation or respiratory depression ) of either agent ; Phenylephrine (. And kernicterus ~ $ B Vallerand, April Hazard., et al for decreased pressor effect if these are... Caution is advisable when combining anxiolytics, sedatives, and death if is! 2 hours post-dose in the urine primarily as the inactive glucuronide metabolite ; lorazepam undergoes... Treatment with the er capsules ( IR ) product benzodiazepines may cause respiratory depression sedation... Flumazenil does not reverse the actions of barbiturates, opiate agonists, or tricyclic.... Meperidine: ( Moderate ) the therapeutic effect of Phenylephrine may be.... Renal impairment or renal failure CNS activity and follow instructions to begin Your 1... 14 hours ( range 7 to 24 hours an award-winning, complete mobile solution nurses...

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