If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Drospirenone; Ethinyl Estradiol; Levomefolate: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. Also, droperidol and benzodiazepines can both cause CNS depression. 0000003285 00000 n 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. Dexbrompheniramine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. WebLorazepam is a nearly white powder almost insoluble in water. Use caution with this combination. Educate patients about the risks and symptoms of respiratory depression and sedation. 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. 2 to 4 mg IM every 30 to 60 minutes as needed. Dronabinol: (Moderate) Use caution if the use of benzodiazepines are necessary with dronabinol, and monitor for additive dizziness, confusion, somnolence, and other CNS effects. Usual Dose Range: 2 to 6 mg/day; Max: 10 mg/day PO. Max: 10 mg/day PO. If tapentadol is initiated in a patient taking a benzodiazepine, a reduced initial dosage of tapentadol is recommended. Clozapine: (Moderate) If concurrent therapy with clozapine and a benzodiazepine is necessary, it is advisable to begin with the lowest possible benzodiazepine dose and closely monitor the patient, particularly at initiation of treatment and following dose increases. Dosage adjustments may be necessary when administered together because of potentially additive CNS effects. Limit the use of mixed opiate agonists/antagonists with benzodiazepines to only patients for whom alternative treatment options are inadequate. Educate patients about the risks and symptoms of respiratory depression and sedation. Shake the bottle until a slurry is formed. Concurrent use may increase the severity of metabolic acidosis. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Assess patients for risks of addiction, abuse, or misuse before drug initiation, and monitor patients who receive benzodiazepines routinely for development of these behaviors or conditions. 0.05 to 0.1 mg/kg/dose (Max: 2 mg/dose) IV every 6 hours as needed. Use caution with this combination. Benzodiazepines act at the level of the limbic, thalamic, and hypothalamic regions of the CNS, and can produce any level of CNS depression required including sedation, hypnosis, skeletal muscle relaxation, anticonvulsant activity, and coma. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. 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. Lorazepam is excreted into human breast milk in low concentrations. Repeated or lengthy use of general anesthetic and sedation drugs during surgeries or procedures during the third trimester of pregnancy may have negative effects on fetal brain development. Educate patients about the risks and symptoms of respiratory depression and sedation. Flumazenil does not reverse the actions of barbiturates, opiate agonists, or tricyclic antidepressants. 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. We're glad you have enjoyed Davis's Drug Guide! If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Brompheniramine; Dextromethorphan; Phenylephrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Guanfacine: (Moderate) Guanfacine has been associated with sedative effects and can potentiate the actions of other CNS depressants including benzodiazepines. 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. Patients who are taking barbiturates or other sedative/hypnotic drugs should avoid concomitant administration of valerian. Vallerand, April Hazard., et al. Gabapentin: (Major) Concomitant use of benzodiazepines with gabapentin may cause excessive sedation, somnolence, and respiratory depression. Lorazepam is an UGT substrate and probenecid is an UGT inhibitor. Use caution with this combination. 0000055702 00000 n Based on non-neonatal pediatric pharmacokinetic models, lorazepam 0.1 mg/kg (up to 4 mg) is expected to achieve a Cmax of 100 ng/mL; concentrations greater than 30 ng/mL are expected to be maintained for 6 to 12 hours for most pediatric patients. 1. Age alone does not have a clinically significant effect on lorazepam pharmacokinetics, but the presence of hepatic or renal impairment should be considered. yt5y3Vk|SRl\UtjSIgO\,F??MNFBO, I`)/jNlt1q@hlb$&?P 9G1+07CF}y&K+H { LORazepam General *BEERS Drug* Pronunciation: lor-az-e Initiate extended-release (ER) dosing with the total daily dose of lorazepam PO once daily in the morning. Consume all the sprinkled contents within 2 hours. Educate patients about the risks and symptoms of respiratory depression and sedation. Tapentadol: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. (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. 2. 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 Alcohol consumption may result in additive CNS depression. Davis Company Monitor breastfed infants exposed to benzodiazepines through breast milk for sedation, poor feeding, and poor weight gain. In. Monitor patients for decreased pressor effect if these agents are administered concomitantly. In a clinical trial, there was clear evidence for a transitory pharmacodynamic interaction between melatonin and another hypnotic agent one hour following co-dosing. Teduglutide: (Moderate) Altered mental status has been observed in patients taking teduglutide and benzodiazepines in the adult clinical studies for teduglutide. At steady state, AUCTau, Cmax, and Cmin were 694 ng x hour/mL, 35 ng/mL and 25 ng/mL, respectively, following once daily administration of the 3 mg ER capsules. Aldesleukin, IL-2: (Moderate) Aldesleukin, IL-2 may affect CNS function significantly. It is approximately 85% protein-bound. Initiation of sleep induction or maintenance medication should be preceded or accompanied by non-pharmacologic interventions and maximized treatment of underlying conditions (if applicable). Mirtazapine: (Moderate) Monitor for unusual drowsiness and sedation during coadministration of benzodiazepines and mirtazapine due to the risk for additive CNS depression. Codeine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Vallerand, A. H., Sanoski, C. A., & Quiring, C. (2023). If benzhydrocodone is initiated in a patient taking a benzodiazepine, reduce initial dosage and titrate to clinical response. 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. Methscopolamine: (Moderate) CNS depression can be increased when methscopolamine is combined with other CNS depressants such as any anxiolytics, sedatives, and hypnotics. 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- Attempt periodic tapering of the medication or provide documentation of medical necessity in accordance with OBRA guidelines. Theophylline, Aminophylline: (Minor) Aminophylline or Theophylline have been reported to counteract the pharmacodynamic effects of diazepam and possibly other benzodiazepines. Acetaminophen; Aspirin; Diphenhydramine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Vallerand AHA, Sanoski CAC, Quiring CC. 0000004698 00000 n Both lorazepam oral solution concentrated and injectable lorazepam solutions contain propylene glycol and polyethylene glycol. Valerian, Valeriana officinalis: (Major) Any substances that act on the CNS, including psychoactive drugs and drugs used as anesthetic adjuvants (e.g., barbiturates, benzodiazepines), may theoretically interact with valerian, Valeriana officinalis. Chlorpheniramine; Dihydrocodeine; Phenylephrine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Lorazepam is an UGT substrate and erlotinib is an UGT inhibitor. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. (Major) Avoid concomitant use of medications formulated with alcohol and extended-release lorazepam capsules. 0000002822 00000 n 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. Dose range: 0.025 to 0.1 mg/kg/dose. A Davis's Drug Guide subscription is required to. The sedative effects of injectable benzodiazepines may add to the CNS depressive state seen in the postictal stage. (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Colesevelam: (Moderate) Colesevelam may decrease the absorption of anticonvulsants. Lorazepam is an UGT substrate and gemfibrozil is an UGT inhibitor. Alfentanil: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. WebFind information on Lorazepam (Ativan, Loreev XR) in Daviss Drug Guide including dosage, side effects, interactions, nursing implications, mechanism of action, half life, Once adequate response is achieved, resume treatment with the ER capsules. R]PU@Agf'(Jol~u1;e4j?E5k'Ve :W3rRu@1&XE/. Dose reductions may be required. Haloperidol: (Moderate) Haloperidol can potentiate the actions of other CNS depressants, such as benzodiazepines, Caution should be exercised with simultaneous use of these agents due to potential excessive CNS effects. In addition, sleep-related behaviors, such as sleep-driving, are more likely to occur during concurrent use of zolpidem and other CNS depressants than with zolpidem alone. Therefore, psychotropic pharmacodynamic interactions could occur following concomitant administration of drugs with significant CNS activity. 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. Coadministration may increase the risk of CNS depressant-related side effects. (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Davis PT Collection is a subscription 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. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. 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