Indinavir: (Moderate) Monitor for an increase in lorazepam-related adverse reactions and consider reducing the dose of lorazepam if concomitant use of lorazepam and indinavir is necessary. Alfentanil: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Due to a prolonged half-life, neonates may require doses at less frequent intervals (e.g., every 6 to 8 hours) compared to children and adolescents. Phenothiazines: (Major) Limit dosage and duration of benzodiazepines during concomitant phenothiazine use and monitor for unusual drowsiness and sedation due to the risk for additive CNS depression. 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. Methscopolamine: (Moderate) CNS depression can be increased when methscopolamine is combined with other CNS depressants such as any anxiolytics, sedatives, and hypnotics. 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. Limit the use of mixed opiate agonists/antagonists 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. Optimum anxiolytic and sedative effects occur within 15 to 20 minutes after administration; however, the onset of effect occurs more rapidly. Apraclonidine: (Minor) No specific drug interactions were identified with systemic agents and apraclonidine during clinical trials. Consume all the sprinkled contents within 2 hours. In more serious cases, and especially when other drugs or alcohol were ingested, symptoms may include ataxia, hypotonia, hypotension, cardiovascular depression, respiratory depression, hypnotic state, coma, 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. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Drugs that can cause CNS depression, if used concomitantly with vigabatrin, may increase both the frequency and the intensity of adverse effects such as drowsiness, sedation, and dizziness. Prehospital Emergency Care. Lorazepam | VCA Animal Hospitals There is a pregnancy exposure registry that monitors outcomes in pregnant patients exposed to lorazepam; information about the registry can be obtained at https://womensmentalhealth.org/research/pregnancyregistry/ or by calling 1-866-961-2388. Benzodiazepines | Johns Hopkins Psychiatry Guide Although oral formulations of olanzapine and benzodiazepines may be used together, additive effects on respiratory depression and/or CNS depression are possible. In patients treated with buprenorphine for opioid use disorder, cessation of benzodiazepines or other CNS depressants is preferred in most cases. (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. 1 Respondents reported that a single 3.5 mg vial of bortezomib costs $1,500-$2,500. Lorazepam - publications.ashp.org Cohen V, Jellinek SP, Teperikidis L, Berkovits E, Goldman WM. An initial infusion rate of 0.025 to 0.05 mg/kg/hour IV is recommended by some experts. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Generic name: lorazepam Meclizine: (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. 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. Educate patients about the risks and symptoms of respiratory depression and sedation. Air Med J. Lorazepam Intensol Oral Concentrate USP CIV 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. The concurrent use of eszopiclone with other anxiolytics, sedatives, and hypnotics at bedtime or in the middle of the night is not recommended. Xanax vs. Ativan: Dosage Info, Side Effects, and More - GoodRx 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 atazanavir is an UGT inhibitor. 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. Carefully monitor respiratory status and oxygen saturation in at risk patients. Avoid prescribing opiate cough medications in patients taking benzodiazepines. DISCONTINUATION: To discontinue, gradually taper the dose. Use caution with this combination. They're often prescribed only after first-choice anxiety medications, like selective serotonin reuptake inhibitors or serotonin-norepinephrine . This data suggest temperature is the main cause of degradation and the effect of vibrations is negligible. 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 Intensol: 2 mg/mL (30 mL) [alcohol free, dye free, sugar free; unflavored flavor] Generic: 2 mg/mL (30 mL) Solution, Injection: Ativan: 2 mg/mL (1 mL, 10 mL); 4 mg/mL (1 mL, 10 mL) [contains benzyl alcohol, polyethylene glycol, propylene glycol] Generic: 2 mg/mL (1 mL, 10 mL); 4 mg/mL (1 mL, 10 mL) Tablet, Oral: Ativan: 0.5 mg Addiction-prone individuals (such as drug addicts or alcoholics) should be under careful surveillance when receiving lorazepam or other psychotropic agents. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. 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. Ropinirole: (Moderate) Concomitant use of ropinirole with other CNS depressants can potentiate the sedation effects of ropinirole. 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. The use of benzodiazepines exposes users to risks of abuse, misuse, and addiction, which can lead to overdose or death. Monitor patients who take benzodiazepines with another CNS depressant for symptoms of excess sedation. The time taken for the original concentration of potassium clavulanate to drop to 90% of its value at room temperature of 20C is 2 days (Mehta et al., 2008). Monitoring of the anticonvulsant serum concentration is recommended. Average dose: 14 mg/hour. Compounded Oral Suspension (1 mg/mL)Place 180 lorazepam 2 mg tablets in a 12-ounce amber glass bottle. It may be appropriate to delay certain procedures if doing so will not jeopardize the health of the child. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Lorazepam And Propranolol Taken Together You may experience tremor reduction hours after taking a single mg dose of the short-acting formulation. Azelastine; Fluticasone: (Moderate) Monitor for excessive sedation and somnolence during coadministration of azelastine and benzodiazepines. Amgen 800-772-6436 Formoterol (Foradil) Prior to dispensing, refrigerate at 36 to 46 F (2 to 8C). Educate patients about the risks and symptoms of respiratory depression and sedation. Risk factors for the development of prolonged QT syndrome may include the use of 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. Use caution with this combination. 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. 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. Following a single 2-mg oral dose of 14 C-lorazepam to 8 healthy subjects, 884% of the administered dose was recovered in urine and 72% was recovered in feces. We kept ativan in the regular pyxis. PDF Stability of Refrigerated and Frozen Drugs - Care Plus Pharmacy In one study of elderly volunteers, half of the patients received DHEA 200 mg/day PO for 2 weeks, followed by a single dose of triazolam 0.25 mg. Triazolam clearance was reduced by close to 30% in the DHEA-pretreated patients vs. the control group; however, the effect of DHEA on CYP3A4 metabolism appeared to vary widely among subjects. For the 1 mg/mL solution, 20 mL of the 2 mg/mL lorazepam preparation and 20 mL of 5% dextrose injection were added to a 250 mL evacuated bottle. 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. Throw away any liquid not used within 90 days. Extended-release Oral Capsules (e.g., Loreev XR)Administer in the morning with or without food.Do not crush or chew. If used together, a reduction in the dose of one or both drugs may be needed. For Intermezzo brand of sublingual zolpidem tablets, reduce the dose to 1.75 mg/night. Cisapride: (Moderate) Cisapride may enhance the sedative effects of benzodiazepines. 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. When lorazepam is used as a sedative, factors potentially causing insomnia should be evaluated before medication initiation (e.g., sleep environment, inadequate physical activity, provision of care disruptions, caffeine or medications, pain and discomfort, or other underlying conditions that cause insomnia). Extension of expiration time for lorazepam injection at room temperature. Do not store in a bathroom. 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. Avoid prescribing opiate cough medications in patients taking benzodiazepines. In patients with depression, a possibility for suicide should be borne in mind; benzodiazepines should not be used in such patients without adequate antidepressant therapy. Use of benzodiazepines, including lorazepam, both used alone and in combination with other CNS depressants, may lead to potentially fatal respiratory depression (see PRECAUTIONS: Clinically Significant Drug Interactions). Avoid prescribing opiate cough medications in patients taking benzodiazepines. Lorazepam is not recommended for use in patients with primary depressive disorder, as preexisting depression may emerge or worsen during the use of benzodiazepines. Flumazenil does not affect the pharmacokinetics of the benzodiazepines. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. 2 mg IV every 30 to 60 minutes as needed. Am J Health Syst Pharm. These data suggest that the effect of the degradation of drugs caused by vibrations is negligible; temperature was observed as the main cause of drug degradation. No standard benzodiazepine tapering schedule is suitable for all patients; therefore, create a patient-specific plan to gradually reduce the dosage. 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. Educate patients about the risks and symptoms of respiratory depression and sedation. Lorazepam injection [prescribing information]. Subjects were stratified by age in each cohort. The clinical significance of the above findings is not known. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Lorazepam glucuronide is an inactive metabolite and is eliminated mainly by the kidneys. Use caution with this combination. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Lorazepam is a generic medication also available under the trade name Ativan. Brimonidine; Timolol: (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. Cyclizine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Lorazepam Intensol: Package Insert - Drugs.com The regressionanalysisfound a slight correlation with increasing temperature,suggesting that the degree of degradation is affected by the degree of exposure to higher temperatures. There is no evidence of accumulation of lorazepam on administration up to six months. Avoid opiate cough medications in patients taking benzodiazepines. During a 12-month period ending in June 2021, the prescribing information and published monographs from multiple pharmacy compendia were reviewed for all medications and biologic products approved by the US Food and Drug Administration (FDA) for human use since January 2000. Trihexyphenidyl: (Moderate) CNS depressants, such as anxiolytics, sedatives, and hypnotics, can increase the sedative effects of trihexyphenidyl. One mL of solution was withdrawn from each syringe and bottle on day 0 (day of preparation) and after 1, 2, 3, 4, and 7 days to perform physical stability testing. The risk of next-day impairment, including impaired driving, is increased if daridorexant is taken with other CNS depressants. 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 effects of probenecid and valproate on lorazepam may be due to inhibition of glucuronidation. Codeine; Guaifenesin: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Due to a prolonged half-life, infants may require doses at less frequent intervals (e.g., every 6 to 8 hours) compared to children and adolescents. Anticonvulsants, BenzodiazepinesAnxiolytics, BenzodiazepinesBenzodiazepine Sedative/Hypnotics. PROTECT FROM LIGHT. Olanzapine; Samidorphan: (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. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Acetaminophen; 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. Studies in healthy volunteers show that in single high doses lorazepam has a tranquilizing action on the central nervous system with no appreciable effect on the respiratory or cardiovascular systems. Extension of expiration time for lorazepam injection at room temperature. Additive CNS depression may occur. Methocarbamol: (Moderate) Concurrent use of benzodiazepines and other CNS active medications including skeletal muscle relaxants, can potentiate the CNS effects of either agent.