Skilled care residents: The federal Omnibus Budget Reconciliation Act (OBRA) regulates the use of anxiolytics in long-term care facility (LTCF) residents. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Use caution with this combination. 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. [41537] [52904] [52949] Repeated or lengthy use of general anesthetic and sedation drugs during surgeries or procedures in neonates, infants, and children younger than 3 years, including in utero exposure during the third trimester, may have negative effects on brain development. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Clobazam: (Major) Use clobazam with other benzodiazepines with caution due to the risk for additive CNS depression. 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. 0000002340 00000 n WebI have been taking .5 lorazepam for over two and a half years. Monitor patients for decreased pressor effect if these agents are administered concomitantly. 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. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Use caution with this combination. 10 mg/day PO; maximum IM and IV dose highly variable dependent upon indication. No quantitative recommendations are available. Etomidate: (Moderate) Concomitant administration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. 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. All sleep medications should be used in accordance with approved product labeling. Infuse over 15 to 20 minutes. 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. Educate patients about the risks and symptoms of respiratory depression and sedation. Avoid opiate cough medications in patients taking benzodiazepines. %PDF-1.6 % 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 --. [64020]Lorazepam stability is very specific to the product used and is concentration-dependent. Acetaminophen; Aspirin; Diphenhydramine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. 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. It may be appropriate to delay certain procedures if doing so will not jeopardize the health of the child and/or mother. Risk factors for the development of prolonged QT syndrome may include the use of benzodiazepines. Sufentanil: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. The severity of this interaction may be increased when additional CNS depressants are given. In older pediatric patients, the daily dosage for anxiety disorders is typically divided into 2 to 3 doses and should not exceed 10 mg/day in those 12 years and older. We do not record any personal information entered above. Handbook covers dosage, side effects, interactions, uses. 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. 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. Acetaminophen; Diphenhydramine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Use caution when combining melatonin with benzodiazepines for other uses. Avoid prescribing opiate cough medications in patients taking benzodiazepines. Lorazepam is an UGT substrate and pibrentasvir is an UGT inhibitor. If the extended-release tapentadol tablets are used concurrently with a benzodiazepine, use an initial tapentadol dose of 50 mg PO every 12 hours. F.A. Educate patients about the risks and symptoms of respiratory depression and sedation. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Maprotiline: (Moderate) Benzodiazepines or other CNS depressants should be combined cautiously with maprotiline because they could cause additive depressant effects and possible respiratory depression or hypotension. Oliceridine: (Major) Concomitant use of oliceridine with lorazepam may cause respiratory depression, hypotension, profound sedation, and death. When a higher dosage is needed, the evening dose should be increased before the daytime doses. Promethazine; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Quetiapine decreases lorazepam clearance by about 20%. 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. The concurrent use of eszopiclone with other anxiolytics, sedatives, and hypnotics at bedtime or in the middle of the night is not recommended. The use of sedating medications for individuals with diagnosed sleep apnea requires careful assessment, documented clinical rationale, and close monitoring. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. 0000004698 00000 n Butorphanol: (Major) Concomitant use of mixed opiate agonists/antagonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Initially, use a low dosage (i.e., 1 to 2 mg PO) and titrate slowly in the geriatric patient. Desflurane: (Moderate) Concurrent use with benzodiazepines can decrease the minimum alveolar concentration (MAC) of desflurane needed to produce anesthesia. Lorazepam injection is contraindicated in premature neonates. Enter your email below and we'll resend your username to you. 0000002898 00000 n 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. In: * Article titles in AMA citation format should be in sentence-case, You can cancel anytime within the 30-day trial, or continue using Davis's Drug Guide to begin a 1-year subscription ($39.95). Limit the use of mixed opiate agonists/antagonists with benzodiazepines to only patients for whom alternative treatment options are inadequate. If the sleep agent is used routinely and is beyond the manufacturer's recommendations for duration of use, the facility should attempt a quarterly taper, unless clinically contraindicated as defined in the OBRA guidelines. DB - Nursing Central Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. Skilled care residents: The federal Omnibus Budget Reconciliation Act (OBRA) regulates the use of anxiolytics in long-term care facility (LTCF) residents. Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. Olanzapine: (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. 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. Educate patients about the risks and symptoms of respiratory depression and sedation. 30 16 In one study, co-administration of lurasidone and midazolam increased the Cmax and AUC of midazolam by about 21% and 44%, respectively, compared to midazolam alone; however, dosage adjustment of midazolam based upon pharmacokinetic parameters is not required during concurrent use of lurasidone. Iloperidone: (Moderate) Drugs that can cause CNS depression, if used concomitantly with iloperidone, may increase both the frequency and the intensity of adverse effects such as drowsiness, sedation, and dizziness. xb```i\ cc`a4xq`1 cfLk2^eMab\`Y9N"Nykf46tH h)i:b4Y,Q!a6[CNbaP+" Vallerand, A. H., Sanoski, C. A., & Quiring, C. (2023). If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. 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. Even that low dose is difficult to get off of. Educate patients about the risks and symptoms of respiratory depression and sedation. Prasterone, Dehydroepiandrosterone, DHEA (Dietary Supplements): (Major) Prasterone, dehydroepiandrosterone, DHEA may inhibit the metabolism of benzodiazepines (e.g., alprazolam, estazolam, midazolam) which undergo CYP3A4-mediated metabolism. Lorazepam is an UGT substrate and ombitasvir 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. While anxiolytic medications may be used concurrently with lemborexant, a reduction in dose of one or both agents may be needed. Diphenhydramine; Naproxen: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Lorazepam should be used with caution in patients with a neuromuscular disease, such as myasthenia gravis; these patients may be more sensitive to the CNS and respiratory effects of the benzodiazepines. %%EOF Use caution with this combination. There is a possibility of interaction with valerian at normal prescription dosages of anxiolytics, sedatives, and hypnotics (including barbiturates and benzodiazepines). Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. 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. Lorazepam is an UGT substrate and ombitasvir is an UGT inhibitor. (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Benztropine: (Moderate) CNS depressants, such as anxiolytics, sedatives, and hypnotics, can increase the sedative effects of benztropine. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Selegiline: (Moderate) Monitor for unusual drowsiness and sedation during coadministration of benzodiazepines and selegiline due to the risk for additive CNS depression. Log in using your existing username and password to start your free, 30-day trial of the app, 3. Vallerand AHA, Sanoski CAC, Quiring CC. Sodium Oxybate: (Contraindicated) Sodium oxybate should not be used in combination with CNS depressant anxiolytics, sedatives, and hypnotics or other sedative CNS depressant drugs. Vallerand, A. H., Sanoski, C. A., & Quiring, C. (2023). Carbinoxamine; Dextromethorphan; Pseudoephedrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. 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. Consult Daviss Drug Guide anywhere you go with web access + our easy-to-use mobile app. 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 is an UGT substrate and glecaprevir is an UGT inhibitor. Im currently on a quarter tablet (.125 a night) As are you, Im determined to get off it and plan to be free in June. Davis and Unbound Medicine The risk of next-day impairment, including impaired driving, is increased if daridorexant is taken with other CNS depressants. Titrate dose to target clinical score. At least one case of sudden death was reported following intravenous administration of lorazepam to a patient receiving clozapine. Due to CNS depressive effects, patients should be cautioned against driving or operating machinery until they know how lorazepam may affect them. Therefore, caution is advisable when combining anxiolytics, sedatives, and hypnotics or other psychoactive medications with levomilnacipran. Use caution with this combination. Efficacy of long-term use (more than 4 months) for anxiety disorders has not been evaluated. Iopamidol: (Moderate) The use of intrathecal radiopaque contrast agents is associated with a risk of seizures. 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). If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Vigabatrin: (Moderate) Vigabatrin may cause somnolence and fatigue. Teduglutide: (Moderate) Altered mental status has been observed in patients taking teduglutide and benzodiazepines in the adult clinical studies for teduglutide. Patients who present for treatment may have an underlying psychological and/or physiological disturbance such as depression and should be thoroughly evaluated prior to initiation of the drug. Metyrosine: (Moderate) The concomitant administration of metyrosine with benzodiazepines can result in additive sedative effects. High doses and prolonged infusions may increase the risk of propylene glycol toxicity; monitor patients carefully. 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. These agents include the benzodiazepines. Levonorgestrel; Ethinyl Estradiol; Ferrous Bisglycinate: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. Concurrent use may result in additive CNS depression. In addition, hypercarbia and hypoxia can occur after lorazepam administration. 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. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. (Moderate) Additive CNS and/or respiratory depression may occur with concurrent use. Besides ethanol, clinicians should use other anxiolytics, sedatives, and hypnotics cautiously with olanzapine. 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. Loxapine: (Moderate) The combination of loxapine and lorazepam has been associated with acute respiratory depression, stupor, and/or hypotension in several patients. Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir: (Moderate) Monitor for an increase in lorazepam-related adverse reactions and consider reducing the dose of lorazepam if concomitant use of lorazepam and dasabuvir is necessary. Avoid opiate cough medications in patients taking benzodiazepines. Norgestimate; Ethinyl Estradiol: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. @`qhGH[ 4XI3`` ) `uo$!%XvJ8K*21``HbdztiFO#11fe8i'":R u If the patient is hyperdynamic and agitated after lorazepam 40 mg within 3 hours, consider phenobarbital or propofol. Enter your username below and we'll send you an email explaining how to change your password. Lorazepam injection is contraindicated in patients with sleep apnea syndrome or severe respiratory insufficiency who are not receiving mechanical ventilation. However, due to lack of data especially in patients with kidney failure, it is advisable to start with the lowest dosage and titrate to effectiveness and tolerance and monitor closely for excessive sedation or other adverse effects. The usual adult range: 2 to 6 mg/day PO. Monitor patients for decreased pressor effect if these agents are administered concomitantly. 4 mg IV every 15 to 20 minutes for 2 doses, then 8 mg IV every 15 to 20 minutes for 2 doses, then 16 mg IV every 15 to 20 minutes for 3 doses as needed. 0000000920 00000 n startxref 0000007603 00000 n confusion, aggression, hallucinations; sleep problems; vision changes; or. AU - Vallerand,April Hazard, Drowsiness or dizziness may last Ventilatory support should also be available for the preanesthetic use of injectable benzodiazepines. Educate patients about the risks and symptoms of respiratory depression and sedation. To minimize potential for interactions, consider administering oral anticonvulsants at least 1 hour before or at least 4 hours after colesevelam. If oxymorphone is initiated in a patient taking a benzodiazepine, use an initial dose of oxymorphone at 1/3 to 1/2 the usual dosage and titrate to clinical response. Avoid prescribing opiate cough medications in patients taking benzodiazepines. For example, the concomitant use of barbiturates and benzodiazepines increases sleep duration and may contribute to rapid onset, pronounced CNS depression, respiratory depression, or coma when combined with sodium oxybate. Use caution with this combination. 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. Drospirenone; Ethinyl Estradiol: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. 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 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. A reduction in dose of the CNS depressant may be needed in some cases. Dose reductions may be required. 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. Teduglutide has direct effects on the gut that may increase benzodiazepine exposure by improving oral absorption. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Because of possible additive effects, advise patients about the potential for increased somnolence during concurrent use of safinamide with other sedating medications, such as benzodiazepines. Tapentadol: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Guaifenesin; Hydrocodone: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Use an initial morphine; naltrexone dose of 20 mg/0.8 mg PO every 24 hours. Avoid prescribing opiate cough medications in patients taking benzodiazepines. Caffeine; Sodium Benzoate: (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. Use caution with this combination. Avoid opiate cough medications in patients taking benzodiazepines. Limit the use of mixed opiate agonists/antagonists with benzodiazepines to only patients for whom alternative treatment options are inadequate. x- [ 0}y)7ta>jT7@t`q2&6ZL?_yxg)zLU*uSkSeO4?c. R -25 S>Vd`rn~Y&+`;A4 A9 =-tl`;~p Gp| [`L` "AYA+Cb(R, *T2B- Subsequently, decrease the dosage more slowly. Nitroglycerin: (Minor) Nitroglycerin can cause hypotension. As with other benzodiazepines, lorazepam causes CNS depression that may lead to respiratory effects and should be used with extreme caution in patients with significant pulmonary disease such as respiratory insufficiency resulting from chronic lung disease (CLD), chronic obstructive pulmonary disease (COPD) or sleep apnea. Patients should be instructed to avoid situations where drowsiness may be a problem and not to take other medications that may cause drowsiness without adequate medical advice. Includes App for iPhone, iPad, and Android smartphone + tablet. Max: 4 mg/dose. Although oral formulations of olanzapine and benzodiazepines may be used together, additive effects on respiratory depression and/or CNS depression are possible. 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. An initial infusion rate of 0.025 to 0.05 mg/kg/hour IV is recommended by some experts. Butalbital; Acetaminophen: (Moderate) Additive CNS and/or respiratory depression may occur with concurrent use. Carefully monitor respiratory status and oxygen saturation in at risk patients. F.A. Aripiprazole: (Moderate) Monitor blood pressure and for unusual drowsiness and sedation during coadministration of aripiprazole and benzodiazepines. startxref 108 0 obj<>stream 0000003552 00000 n Calcium, Magnesium, Potassium, Sodium Oxybates: (Contraindicated) Sodium oxybate should not be used in combination with CNS depressant anxiolytics, sedatives, and hypnotics or other sedative CNS depressant drugs. 20 mg/0.8 mg PO ) and titrate slowly in the adult clinical for... Severity of this interaction may be decreased in patients with sleep apnea requires careful assessment, clinical! + tablet + our easy-to-use mobile app tapentadol dose of 20 mg/0.8 mg PO and!, magnesium stearate, microcrystalline cellulose, polacriline potassium side effects, interactions, consider oral... Than 4 months ) for anxiety disorders has not been evaluated can decrease the alveolar! Delay certain procedures if doing so will not jeopardize the health of child... 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