Oxycodone: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Teduglutide has direct effects on the gut that may increase benzodiazepine exposure by improving oral absorption. 0000008826 00000 n Use caution with this combination. Maprotiline may lower the seizure threshold, so when benzodiazepines are used for anticonvulsant effects the patient should be monitored for desired clinical outcomes. :T. Safinamide: (Moderate) Dopaminergic medications, including safinamide, may cause a sudden onset of somnolence which sometimes has resulted in motor vehicle accidents. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. It is a nearly white powder almost insoluble in water. Each Ativan (lorazepam) tablet, to be taken orally, contains 0.5 mg, 1 mg, or 2 mg of lorazepam. The inactive ingredients present are lactose monohydrate, magnesium stearate, microcrystalline cellulose, polacriline potassium. CLINICAL PHARMACOLOGY 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. Monitor patients for decreased pressor effect if these agents are administered concomitantly. 0000055702 00000 n Educate patients about the risks and symptoms of respiratory depression and sedation. Want to regain access to Nursing Central? Both cases suggest additive pharmacodynamic effects. Vallerand AHA, Sanoski CAC, Quiring CC. 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. Consider alternatives to benzodiazepines for conditions such as anxiety or insomnia during methadone maintenance treatment. Specifically, sodium oxybate use is contraindicated in patients being treated with sedative hypnotic drugs. Monitor patients for decreased pressor effect if these agents are administered concomitantly. Use caution with this combination. A published sedation protocol for pediatric mechanically ventilated patients recommends an initial infusion rate of 0.01 mg/kg/hour IV. Although oral formulations of olanzapine and benzodiazepines may be used together, additive effects on respiratory depression and/or CNS depression are possible. Skeletal Muscle Relaxants: (Moderate) Concomitant use of skeletal muscle relaxants with benzodiazepines can result in additive CNS depression. If an increase is needed, discontinue the ER capsules and increase the dosage using lorazepam IR. to a friend, relative, colleague or yourself. Have patients swallow the ER capsules whole.If patient has difficulty swallowing: Contents of the ER capsules may be sprinkled over a tablespoon of cool applesauce and consumed without chewing. Efficacy of long-term use (more than 4 months) for anxiety disorders has not been evaluated. 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. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Explore these free sample topics: -- The first section of this topic is shown below --, -- To view the remaining sections of this topic, please log in or purchase a subscription --. Norethindrone; Ethinyl Estradiol: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. 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. Esketamine: (Major) Closely monitor patients receiving esketamine and benzodiazepines for sedation and other CNS depressant effects. 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. Continuous IV InfusionNOTE: Lorazepam is not FDA-approved for administration by continuous IV infusion.Use of glass or polyolefin containers is recommended; polypropylene syringes have also been used. A1 - Sanoski,Cynthia A, 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 some cases, the dosages of the CNS depressants may need to be reduced. 0.04 to 0.05 mg/kg IV as a single dose administered 30 minutes prior to chemotherapy. Caution should be used when vigabatrin is given in combination with benzodiazepines. An initial infusion rate of 0.025 to 0.05 mg/kg/hour IV is recommended by some experts. endstream endobj 41 0 obj<> endobj 42 0 obj<>stream Vallerand, A. H., Sanoski, C. A., & Quiring, C. (2023). Acetaminophen; Pamabrom; Pyrilamine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. 0000000016 00000 n After 30 days, you will automatically be upgraded to a 1-year subscription at a discounted rate of $29.95, Type your tag names separated by a space and hit enter. 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 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. trailer 0.05 mg/kg/dose IV every 2 to 8 hours as needed (Max initial dose: 2 mg). 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. xref Monitor patients for decreased pressor effect if these agents are administered concomitantly. Meperidine; Promethazine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. (Major) Avoid concomitant use of medications formulated with alcohol and extended-release lorazepam capsules. 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. 2. There are no adequate data on the effects lorazepam use during human pregnancy. Erlotinib: (Moderate) Monitor for an increase in lorazepam-related adverse reactions and consider reducing the dose of lorazepam if concomitant use of lorazepam and erlotinib is necessary. Immediate-release tablets and solution: Lorazepam is readily absorbed following an oral dose, with an absolute bioavailability of 90% reported following administration of immediate-release tablets. Log in using your existing username and password to start your free, 30-day trial of the app, 3. Use caution when combining melatonin with benzodiazepines for other uses. Cetirizine; Pseudoephedrine: (Moderate) Concurrent use of cetirizine/levocetirizine with benzodiazepines should generally be avoided. DISCONTINUATION: To discontinue, gradually taper the dose. Aldesleukin, IL-2: (Moderate) Aldesleukin, IL-2 may affect CNS function significantly. Coadministration may increase the risk of CNS depressant-related side effects. I have trouble sleeping every time I lower the dose. <<9DAF66121683604EAC562925FEC14E44>]>> Tetrabenazine: (Moderate) Concurrent use of tetrabenazine and drugs that can cause CNS depression, such as benzodiazepines, can increase both the frequency and the intensity of adverse effects such as drowsiness, sedation, dizziness, and orthostatic hypotension. Brompheniramine; Pseudoephedrine; Dextromethorphan: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. There's more to see -- the rest of this topic is available only to subscribers. Use caution with this combination. Consequently, appropriate precautions (e.g., limiting the total prescription size and increased monitoring for suicidal ideation) should be considered. Concurrent use may result in additive CNS depression. (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. ER -, Your free 1 year of online access expired. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. (Moderate) Monitor for an increase in lorazepam-related adverse reactions and consider reducing the dose of lorazepam if concomitant use of lorazepam and ombitasvir is necessary. Educate patients about the risks and symptoms of respiratory depression and sedation. Chlorpheniramine; Phenylephrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Aspirin, ASA; Caffeine; Orphenadrine: (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. Coadminstration of lorazepam with valproic acid causes increased plasma concentrations and reduced clearance of lorazepam. Acetaminophen; Caffeine; Dihydrocodeine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. If tapentadol is initiated in a patient taking a benzodiazepine, a reduced initial dosage of tapentadol is recommended. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Carefully monitor respiratory status and oxygen saturation in at risk patients. Monitor patients for decreased pressor effect if these agents are administered concomitantly. Use caution with this combination. Alternatively, 1.5 mg/m2 (Usual Max: 3 mg) IV can be given 45 minutes prior to initiation of chemotherapy. Reduce injectable buprenorphine dose by 1/2, and for the buprenorphine transdermal patch, start therapy with the 5 mcg/hour patch. 0000002773 00000 n In addition, hypercarbia and hypoxia can occur after lorazepam administration. Max: 10 mg/day PO. 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. Not a Member? 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 concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. 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. Lorazepam is not recommended for use in patients with primary depressive disorder, as preexisting depression may emerge or worsen during the use of benzodiazepines. Consider alternatives to benzodiazepines for conditions such as anxiety or insomnia in patients receiving buprenorphine maintenance treatment. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. WebStudy Description: An open-label, multi-center study to evaluate the single dose pharmacokinetics of intravenous lorazepam in pediatric patients aged 3 months to less than 18 years treated for status epilepticus (SE) or with a history of SE. Melatonin: (Major) Use caution when combining melatonin with the benzodiazepines; when the benzodiazepine is used for sleep, co-use of melatonin should be avoided. Clonidine: (Moderate) Clonidine has CNS depressive effects and can potentiate the actions of other CNS depressants including benzodiazepines. Educate patients about the risks and symptoms of respiratory depression and sedation. 0000000016 00000 n IV PushDilute lorazepam with an equal volume of compatible diluent (0.9% Sodium Chloride Injection, 5% Dextrose Injection or Sterile Water for Injection) immediately prior to use. Limit the use of mixed opiate agonists/antagonists with benzodiazepines to only patients for whom alternative treatment options are inadequate. Pyrimethamine: (Moderate) Mild hepatotoxicity has been reported when pyrimethamine was coadministered with lorazepam. DP - Unbound Medicine 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. Because any alcohol use may increase the risk for CNS and respiratory depressant effects, ethanol ingestion during use is not recommended. Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. Avoid opiate cough medications in patients taking benzodiazepines. Use with caution. 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. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. 2 mg PO every 30 to 60 minutes as needed. As a thank-you for using our site, here's a discounted rate for renewal or upgrade. 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. Even that low dose is difficult to get off of. If morphine is initiated in a patient taking a benzodiazepine, reduce initial dosages and titrate to clinical response. Mirtazapine: (Moderate) Monitor for unusual drowsiness and sedation during coadministration of benzodiazepines and mirtazapine due to the risk for additive CNS depression. (Moderate) Additive CNS and/or respiratory depression may occur with concurrent use. Use caution with this combination. Ethynodiol Diacetate; Ethinyl Estradiol: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. Advise patients to seek immediate medical attention if they experience symptoms such as trouble breathing. Concurrent use of zolpidem with other sedative-hypnotics, including other zolpidem products, at bedtime or the middle of the night is not recommended. Concurrent use may result in additive CNS depression. Codeine; Promethazine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Consider the benefits of appropriate anesthesia in young children against the potential risks, especially for procedures that may last more than 3 hours or if multiple procedures are required during the first 3 years of life. F.A. Use caution with this combination. In general, all benzodiazepines increase the risk of cognitive impairment, delirium, falls, fractures, and motor vehicle accidents in older adults. Avoid prescribing opiate cough medications in patients taking benzodiazepines. Specifically, sodium oxybate use is contraindicated in patients being treated with sedative hypnotic drugs. Patients should be instructed to continue using benzodiazepines during procedures or exams that require the use of intrathecal radiopaque contrast agents as abrupt discontinuation of benzodiazepines may also increase seizure risk. 45 0 obj<>stream Lorazepam is an UGT substrate and ombitasvir is an UGT inhibitor. Nitroglycerin: (Minor) Nitroglycerin can cause hypotension. Usual adult dose range is 2 to 4 mg PO at bedtime as needed; use for more than 4 months has not been evaluated. Daridorexant: (Major) Monitor for excessive sedation and somnolence during use of daridorexant with benzodiazepines. 0000001594 00000 n Use these drugs cautiously with MAOIs; warn patients to not drive or perform other hazardous activities until they know how a particular drug combination affects them. 0000002339 00000 n 2 mg PO every 6 hours as needed on days 1 and 2, then 1 mg PO every 8 hours as needed on day 3, and then 1 mg PO every 12 hours as needed on days 4 and 5. Monitor patients for decreased pressor effect if these agents are administered concomitantly. V)gB0iW8#8w8_QQj@&A)/g>'K t;\ $FZUn(4T%)0C&Zi8bxEB;PAom?W= Clobazam: (Major) Use clobazam with other benzodiazepines with caution due to the risk for additive CNS depression. DB - Nursing Central Educate patients about the risks and symptoms of respiratory depression and sedation. In. (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. Rasagiline: (Moderate) The CNS-depressant effects of MAOIs can be potentiated with concomitant administration of other drugs known to cause CNS depression including buprenorphine, butorphanol, dronabinol, THC, nabilone, nalbuphine, and anxiolytics, sedatives, and hypnotics. Educate patients about the risks and symptoms of respiratory depression and sedation. Besides ethanol, clinicians should use other anxiolytics, sedatives, and hypnotics cautiously with olanzapine. Due to CNS depressive effects, patients should be cautioned against driving or operating machinery until they know how lorazepam may affect them. Although oral formulations of olanzapine and benzodiazepines may be used together, additive effects on respiratory depression and/or CNS depression are possible. 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. WebLorazepam (Ativan, Loreev XR) | Daviss Drug Guide Davis's Drug Guide LORazepam General **BEERS Drug** Pronunciation: lor- az -e-pam To hear audio pronunciation of 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. Pentazocine; Naloxone: (Major) Concomitant use of mixed opiate agonists/antagonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. 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. Codeine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Hydrochlorothiazide, HCTZ; Methyldopa: (Moderate) Methyldopa is associated with sedative effects. Desflurane: (Moderate) Concurrent use with benzodiazepines can decrease the minimum alveolar concentration (MAC) of desflurane needed to produce anesthesia. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. 0000001211 00000 n 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. 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 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. (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Adults over 50 years of age may experience a greater incidence of central nervous system (CNS) depression and more respiratory depression with use of lorazepam, particularly with preanesthetic use. Remimazolam: (Major) The sedative effect of remimazolam can be accentuated by lorazepam. HyTSwoc [5laQIBHADED2mtFOE.c}088GNg9w '0 Jb Avoid opiate cough medications in patients taking benzodiazepines. Atazanavir: (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. Daviss Drug Guide for Nurses App + Web from F.A. Initially, 1 to 2 mg/day PO given in 2 to 3 divided doses; increase gradually as needed and tolerated. If no additional boluses are needed, consider reducing the infusion rate. 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. Do not administer lorazepam injection by intra-arterial injection since arteriospasm can occur which may cause tissue damage and/or gangrene.Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit. If used together, a reduction in the dose of one or both drugs may be needed. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Flumazenil does not affect the pharmacokinetics of the benzodiazepines. WebAs with other benzodiazepines, lorazepam causes CNS depression that may lead to respiratory effects and should be used with extreme caution in patients with significant Patients should be instructed to continue using benzodiazepines during procedures or exams that require the use of intrathecal radiopaque contrast agents as abrupt discontinuation of benzodiazepines may also increase seizure risk. Carbinoxamine; Dextromethorphan; Pseudoephedrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. The actions of other CNS depressants may need to be taken orally, contains mg! ) monitor for excessive sedation and somnolence during use is necessary, use the lowest effective doses and minimum durations! Protocol for pediatric mechanically ventilated patients recommends an initial infusion rate of 0.025 to 0.05 mg/kg/hour IV 00000 in! 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And extended-release lorazepam capsules dose by 1/2, and death IL-2: ( Moderate coadministration! Desflurane needed to achieve the desired clinical effect opiate cough medications in patients taking benzodiazepines respiratory depressant effects, ingestion!