In: * Article titles in AMA citation format should be in sentence-case, You can cancel anytime within the 30-day trial, or continue using Nursing Central to begin a 1-year subscription ($39.95). Codeine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Atropine; Difenoxin: (Moderate) Concomitant administration of benzodiazepines with CNS-depressant drugs, such as diphenoxylate/difenoxin, can potentiate the CNS effects 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. Phenobarbital: (Moderate) Additive CNS and/or respiratory depression may occur with concurrent use. PDR.net is to be used only as a reference aid. In patients treated with buprenorphine for opioid use disorder, cessation of benzodiazepines or other CNS depressants is preferred in most cases. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. As a thank-you for using our site, here's a discounted rate for renewal or upgrade. xref Monitor patients for decreased pressor effect if these agents are administered concomitantly. Vallerand, A. H., Sanoski, C. A., & Quiring, C. (2023). Oral mean plasma clearance (CL/F) is approximately 72 mL/minute in adults following a single 3 mg dose of the extended-release capsules. Download the Nursing Central app by Unbound Medicine, 2. 20002023 Unbound Medicine, Inc. All rights reserved, Take your students on a guided journey to develop clinical judgment, TY - ELEC 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. LORazepam [Internet]. 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). H\TKoAqs;O Davis Company (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. Norethindrone; Ethinyl Estradiol; Ferrous fumarate: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. Thalidomide frequently causes drowsiness and somnolence. Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. While more study is needed, benzodiazepine-induced CNS sedation and other adverse effects might be increased in some individuals if DHEA is co-administered. Administer the morning after the day of discontinuation of a lorazepam immediate-release (IR) product. 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. Specific maximum dosage information not available; the dose required is dependent on route of administration, indication, and clinical response. 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. Dexbrompheniramine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. 30 0 obj <> endobj Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Pyrilamine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Add Ora-Plus and Ora-Sweet to bring the suspension to a concentration of 1 mg/mL (i.e., QS to a total volume of 360 mL). Administration of the extended-release capsules with a high-fat and high calorie meal delayed median Tmax by approximately 2 hours and did not affect overall drug exposure. If morphine is initiated in a patient taking a benzodiazepine, reduce initial dosages and titrate to clinical response. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. The required dosage is highly variable and should be titrated to desired degree of sedation. 108 0 obj<>stream Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Doses of 0.025 mg/kg IV have been reported to be effective in reducing emesis and anxiety due to chemotherapy with minimal adverse effects. 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. 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. Caution should be used when vigabatrin is given in combination with benzodiazepines. 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. Increase gradually as needed and tolerated. Compounded Oral Suspension (1 mg/mL)Place 180 lorazepam 2 mg tablets in a 12-ounce amber glass bottle. To minimize potential for interactions, consider administering oral anticonvulsants at least 1 hour before or at least 4 hours after colesevelam. Limit the use of opioid pain medication with lorazepam to only patients for whom alternative treatment options are inadequate. In addition, seizures have been reported during the use of molindone, which is of particular significance in patients with a seizure disorder receiving anticonvulsants. 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. Avoid prescribing opiate cough medications in patients taking benzodiazepines. 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. 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. 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. @`qhGH[ 4XI3`` ) `uo$!%XvJ8K*21``HbdztiFO#11fe8i'":R u 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. Zaleplon: (Major) Monitor for excessive sedation and somnolence during coadministration of zaleplon and benzodiazepines. Initiate with lower dosages and carefully monitor for sedation and other adverse effects. Lorazepam is a UGT2B7 substrate. Trimethobenzamide: (Moderate) The concurrent use of trimethobenzamide with other medications that cause CNS depression, like the benzodiazepines, may potentiate the effects of either trimethobenzamide or the benzodiazepine. 0000008055 00000 n 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. Advise patients to seek immediate medical attention if they experience symptoms such as trouble breathing. Specific maximum dosage information not available; the dose required is dependent on route of administration, indication, and clinical response.1 to 11 years: Safety and efficacy have not been established. 0000004698 00000 n Instruct patients who receive a dose of esketamine not to drive or engage in other activities requiring alertness until the next day after a restful sleep. Use caution with this combination. For extended-release tablets, start with morphine 15 mg PO every 12 hours, and for extended-release capsules, start with 30 mg PO every 24 hours or less. 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. Remifentanil: (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. The usual dosage is 2 to 6 mg/day PO. Nursing Central is an award-winning, complete mobile solution for nurses and students. 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. Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. Brompheniramine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Propofol: (Moderate) Concomitant administration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Drowsiness or dizziness may last Monitor the neonate for hypotonia and withdrawal symptoms, including hyperreflexia, irritability, restlessness, tremors, inconsolable crying, or feeding difficulties and manage accordingly. Efficacy of long-term use (more than 4 months) has not been evaluated. The usual adult range: 2 to 6 mg/day PO. Lorazepam is lipophilic; it is widely distributed and crosses the blood-brain barrier. Davis AT Collection is a subscription Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. A proposed mechanism is competitive binding of these methylxanthines to adenosine receptors in the brain. Use caution with this combination. I have trouble sleeping every time I lower the dose. Educate patients about the risks and symptoms of respiratory depression and sedation. Acetaminophen; Dextromethorphan; Doxylamine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Lorazepam is an UGT substrate and probenecid is an UGT inhibitor. Metyrosine: (Moderate) The concomitant administration of metyrosine with benzodiazepines can result in additive sedative effects. Brexanolone: (Moderate) Concomitant use of brexanolone with CNS depressants like the benzodiazepines may increase the likelihood or severity of adverse reactions related to sedation and additive CNS depression. endstream endobj 31 0 obj<> endobj 32 0 obj<> endobj 33 0 obj<>/ColorSpace<>/Font<>/ProcSet[/PDF/Text/ImageC]/ExtGState<>>> endobj 34 0 obj<> endobj 35 0 obj<> endobj 36 0 obj[/ICCBased 42 0 R] endobj 37 0 obj<> endobj 38 0 obj<> endobj 39 0 obj<> endobj 40 0 obj<>stream trailer 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. During the treatment of status epilepticus, the use of injectable benzodiazepines, like lorazepam, is often implemented as an adjunct to other supportive therapies. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. [41537] [61572] Although commonly used off-label in the pediatric population, safe and effective use of immediate-release oral and parenteral lorazepam has not been established in pediatric patients younger than 12 years and 18 years, respectively. Use caution with this combination. Lorazepam is an UGT substrate and indinavir is an UGT inhibitor. 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 --. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Therefore, psychotropic pharmacodynamic interactions could occur following concomitant administration of drugs with significant CNS activity. Lofexidine can potentiate the effects of CNS depressants such as benzodiazepines. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Probenecid: (Moderate) Monitor for an increase in lorazepam-related adverse reactions and consider reducing the dose of lorazepam if concomitant use of lorazepam and probenecid is necessary. Taking 7.5 mirtazapine for sleep while tapering Ethinyl Estradiol: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. Use caution with this combination. Use lowest effective dose. Particular caution is required in determining the amount of time needed after outpatient procedures or surgery before it is safe for any patient to ambulate. Apomorphine: (Moderate) Apomorphine causes significant somnolence. LORazepam. Papaverine: (Moderate) Concurrent use of papaverine with potent CNS depressants such as benzodiazepines could lead to enhanced sedation. Pentazocine; Naloxone: (Major) Concomitant use of mixed opiate agonists/antagonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Follow with water. Educate patients about the risks and symptoms of respiratory depression and sedation. 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. DP - Unbound Medicine 0000000856 00000 n Acetaminophen; Pentazocine: (Major) Concomitant use of mixed opiate agonists/antagonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. AU - Quiring,Courtney, Because lorazepam can cause drowsiness and a decreased level of consciousness, there is a higher risk of falls, particularly in the older adult, with the potential for subsequent severe injuries. Hydrocodone; Ibuprofen: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. 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. Use caution with this combination. Monitor patients for decreased pressor effect if these agents are administered concomitantly. Use caution with this combination. Concurrent use may result in additive CNS depression. Clobazam: (Major) Use clobazam with other benzodiazepines with caution due to the risk for additive CNS depression. Acetaminophen; Aspirin; Diphenhydramine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. (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. F.A. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Acetaminophen; Caffeine; Dihydrocodeine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Usual dose range: 2 to 6 mg/day PO. Remimazolam: (Major) The sedative effect of remimazolam can be accentuated by lorazepam. Abrupt discontinuation or rapid dosage reduction of benzodiazepines after continued use may precipitate acute withdrawal reactions, which can be life-threatening. Use caution with this combination. 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 Measure sodium bicarbonate concentrations at baseline and periodically during dichlorphenamide treatment. Meclizine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. In healthy adults, reported mean volume of distributions (Vd) are 1.3 L/kg following parenteral administration and 117 L following a single 3 mg dose of the extended-release capsules under fasting conditions. For optimum lack of recall, administer IV dose 15 to 20 minutes prior to procedure and IM dose 2 hours prior to procedure. Dichlorphenamide: (Moderate) Use dichlorphenamide and lorazepam together with caution. Although normal therapeutic doses of lorazepam contain very small amounts of propylene glycol, polyethylene glycol, and benzyl alcohol, the clinician should be aware of the toxic potential, especially if other drugs containing the compounds are administered. Hydroxychloroquine can lower the seizure threshold; therefore, the activity of antiepileptic drugs may be impaired with concomitant use. 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. Chlorpheniramine; Pseudoephedrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. Note: Your username may be different from the email address used to register your account. Guaifenesin; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. RN2NpN )lbV 3: (KF Want to regain access to Davis's Drug Guide? Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. The severity of this interaction may be increased when additional CNS depressants are given. Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. LORazepam. Avoid opiate cough medications in patients taking benzodiazepines. Lorazepam in excreted in the urine primarily as the inactive glucuronide metabolite; lorazepam also undergoes enterohepatic recirculation. Davis PT Collection. Anxiolytics should be used for delirium, dementia, or other cognitive disorders only when there are associated behaviors that are 1) quantitatively and objectively documented, and 2) are persistent, and 3) are not due to preventable or correctable reasons, and 4) constitute clinically significant distress or dysfunction to the LTCF resident or represent a danger to the resident or others. Initiate extended-release (ER) dosing with the total daily dose of lorazepam given PO once daily in the morning. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Sedation, and death adverse effects might be increased when additional CNS depressants is preferred in cases... ( IR ) product lofexidine can potentiate the CNS effects ( e.g. increased. Significant somnolence sedative effects the desired clinical effect taking a benzodiazepine, reduce initial dosages and carefully Monitor excessive! 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Achieve the desired clinical effect the Nursing Central is an UGT substrate and probenecid is an UGT.... Impaired with Concomitant use of opiate pain medications with benzodiazepines to only lorazepam davis pdf whom. And/Or respiratory depression, hypotension, profound sedation, and death ( 1 mg/mL ) 180... Titrated to desired degree of sedation taking benzodiazepines mean plasma clearance ( CL/F is! And should be titrated to desired degree of sedation a single 3 mg dose lorazepam.