T1 - LORazepam Studies in healthy volunteers show that in single high doses, lorazepam has a tranquilizing action on the central nervous system with usually no appreciable effect on the respiratory or cardiovascular systems. Atazanavir; Cobicistat: (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. %5f1Ay%t%`j\gvJz*;HVGz,^^=ndKU pM8ef&/&6?0{zl Uu\5@PJxO| XD%R[:b5Y`lDtVnJaGVv8h%UpXr(oJuj(:( vsKp~+2o]#PS;=C _%on=vXV*C+u^'P{W4.4 This action may be additive with other agents that can cause hypotension such as benzodiazepines. 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. 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. High doses and prolonged infusions may increase the risk of propylene glycol toxicity; monitor patients carefully. Use caution with this combination. Use caution with this combination. An in vitro study demonstrated significant increases in lorazepam release from the extended-release capsule 2 hours post-dose with approximately 91%-95% and 37 -42% of drug release in the presence of 40% and 20% alcohol, respectively. 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. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. 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. Attempt periodic tapering of the medication or provide documentation of medical necessity in accordance with OBRA guidelines. Chlorpheniramine; Dextromethorphan; Pseudoephedrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Clemastine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Acetaminophen; Chlorpheniramine; Dextromethorphan: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Chlorpheniramine; Dextromethorphan: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. 0000004698 00000 n A reduction in dosage of dexmedetomidine or the benzodiazepine may be required. 0000004934 00000 n Benztropine: (Moderate) CNS depressants, such as anxiolytics, sedatives, and hypnotics, can increase the sedative effects of benztropine. While more study is needed, benzodiazepine-induced CNS sedation and other adverse effects might be increased in some individuals if DHEA is co-administered. There are no adequate data on the effects lorazepam use during human pregnancy. 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. 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. The CNS depressant effects of topiramate can be potentiated pharmacodynamically by concurrent use of CNS depressant agents such as the benzodiazepines. The severity of this interaction may be increased when additional CNS depressants are given. (Major) Avoid concomitant use of medications formulated with alcohol and extended-release lorazepam capsules. It may be appropriate to delay certain procedures if doing so will not jeopardize the health of the child. (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. Both lorazepam oral solution concentrated and injectable lorazepam solutions contain propylene glycol and polyethylene glycol. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Thalidomide frequently causes drowsiness and somnolence. Dexbrompheniramine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Alternatively, 1.5 mg/m2 (Usual Max: 3 mg) IV can be given 45 minutes prior to initiation of chemotherapy. 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. Administration of the extended-release capsules by sprinkling the contents in 15 mL of applesauce did not significantly affect overall drug exposure or Tmax. Alternatively, 0.05 mg/kg IM (Max: 4 mg) administered 2 hours prior to surgery or the procedure. Consume all the sprinkled contents within 2 hours. Concurrent use may result in additive CNS depression. If concurrent use is necessary, initiate pregabalin at the lowest recommended dose and monitor patients for symptoms of respiratory depression and sedation. Patients with renal impairment receiving high doses of intravenous lorazepam may be more likely to develop propylene glycol toxicity. Use caution with this combination. yX XIG@Ey20420x@ :~$B Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Even that low dose is difficult to get off of. Monitor patients for decreased pressor effect if these agents are administered concomitantly. In residents meeting the criteria for treatment, the dose of lorazepam should not exceed 1 mg/day PO, except when documentation is provided showing that higher doses are necessary to maintain or improve the resident's functional status. 0000005452 00000 n Use caution with this combination. 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. Brimonidine: (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. Use caution with this combination. If levorphanol is initiated in a patient taking a benzodiazepine, reduce the initial dose of levorphanol by approximately 50% or more. For fluid restricted patients, data suggest that a concentration of 0.5 mg/mL or 1 mg/mL is stable for up to 24 hours and may be used. Adequate dosages of anticonvulsants should be continued when molindone is added; patients should be monitored for clinical evidence of loss of seizure control or the need for dosage adjustments of either molindone or the anticonvulsant. Stiripentol: (Moderate) Monitor for excessive sedation and somnolence during coadministration of stiripentol and lorazepam. The infant should be monitored regularly, and if sedation, nausea, reduced suckling, or other signs of toxicity are observed, either breast-feeding or the benzodiazepine should be discontinued. The drug has also been given sublingually; although, specific sublingual dosage forms are not available in the United States. Use caution with this combination. (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 Formulations (e.g., tablets)When given in unequal doses, give the largest dose before bedtime. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Lofexidine can potentiate the effects of CNS depressants such as benzodiazepines. The risks of physiological dependence and withdrawal increase with longer treatment duration and higher daily dose. Avoid prescribing opiate cough medications in patients taking benzodiazepines. 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. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Perampanel: (Moderate) Patients taking benzodiazepines with perampanel may experience increased CNS depression. 0000002339 00000 n Select Try/Buy and follow instructions to begin your free 30-day trial. Store refrigerated at 36 to 46 degrees F. Discard opened bottle after 90 days. Flumazenil has minimal effects on benzodiazepine-induced respiratory depression; suitable ventilatory support should be available, especially in treating acute benzodiazepine overdose. F.A. Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Monitor patients for decreased pressor effect if these agents are administered concomitantly. Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Lorazepam is an UGT substrate and paritaprevir is an UGT inhibitor. Chlophedianol; Dexchlorpheniramine; Pseudoephedrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Educate patients about the risks and symptoms of respiratory depression and sedation. 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. These interactions are probably pharmacodynamic in nature. Central benzodiazepine receptors interact allosterically with GABA receptors, potentiating the effects of GABA and thereby increasing the inhibition of the ascending reticular activating system. Minocycline: (Minor) Injectable minocycline contains magnesium sulfate heptahydrate. Vigabatrin: (Moderate) Vigabatrin may cause somnolence and fatigue. Suvorexant: (Moderate) CNS depressant drugs may have cumulative effects when administered concurrently and they should be used cautiously with suvorexant. ET - 18 Gemfibrozil: (Moderate) Monitor for an increase in lorazepam-related adverse reactions and consider reducing the dose of lorazepam if concomitant use of lorazepam and gemfibrozil is necessary. 0.05 to 0.1 mg/kg/dose (Max: 2 mg/dose) IV every 6 hours as needed. In animal studies, melatonin has been shown to increase benzodiazepine binding to receptor sites. Educate patients about the risks and symptoms of respiratory depression and sedation. 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. Use of more than 2 hypnotics should be avoided due to the additive CNS depressant and complex sleep-related behaviors that may occur. If an increase is needed, discontinue the ER capsules and increase the dosage using lorazepam IR. Avoid opiate cough medications in patients taking benzodiazepines. Benzhydrocodone; Acetaminophen: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Dosage not available for anxiety disorders; however, lorazepam 0.025 to 0.05 mg/kg/dose PO as needed (no more frequently than every 4 hours) has been used in burn patients with anxiety related to being in the hospital, dressing changes, etc. 45 0 obj<>stream 0000063185 00000 n Injectable lorazepam is contraindicated for intraarterial administration due to the possibility of arteriospasm and resultant gangrene that may require amputation. When used as an anticonvulsant, cessation of seizure activity may occur within 5 minutes. Acetaminophen; Chlorpheniramine: (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. DISCONTINUATION: To discontinue, gradually taper the dose. Additive drowsiness and CNS depression can occur. Usual Dose Range: 2 to 6 mg/day; Max: 10 mg/day PO. In debilitated adults give 1 to 2 mg/day PO in 2 to 3 divided doses initially. BT - Davis's Drug Guide Educate patients about the risks and symptoms of respiratory depression and sedation. Use caution with this combination. 1 to 2 mg IV as a single dose plus diphenhydramine for additional sedation. wG xR^[ochg`>b$*~ :Eb~,m,-,Y*6X[F=3Y~d tizf6~`{v.Ng#{}}jc1X6fm;'_9 r:8q:O:8uJqnv=MmR 4 0.05 mg/kg PO as a single dose (Max: 4 mg) 45 to 90 minutes prior to procedure. AU - Vallerand,April Hazard, A potential risk of abuse should not preclude appropriate treatment in any patient, but requires more intensive counseling and monitoring. There is no evidence of accumulation of lorazepam with administration up to 6 months. Limit the use of mixed opiate agonists/antagonists with benzodiazepines to only patients for whom alternative treatment options are inadequate. Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. 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. Alcohol consumption may result in additive CNS depression. Hydrocodone: (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. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. 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. If the extended-release oxymorphone tablets are used concurrently with a CNS depressant, use an initial dosage of 5 mg PO every 12 hours. Drowsiness or dizziness may last Use caution with this combination. Benzodiazepine activity shows the highest affinity for GABA subtype A receptor modulation compared to subtype B receptors. Educate patients about the risks and symptoms of respiratory depression and sedation. Register Now. Lorazepam belongs to a group of drugs called benzodiazepines. It affects chemicals in the brain that may be unbalanced in people with anxiety. Atropine; Difenoxin: (Moderate) Concomitant administration of benzodiazepines with CNS-depressant drugs, such as diphenoxylate/difenoxin, can potentiate the CNS effects of either agent. Fentanyl: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Average dose: 14 mg/hour. Guanabenz: (Moderate) Guanabenz is associated with sedative effects. 0000001350 00000 n Monitor breastfed infants exposed to benzodiazepines through breast milk for sedation, poor feeding, and poor weight gain. The degree of sedation is dependent on the dose administered and the presence or absence of other medications. Efficacy of long-term use (more than 4 months) for anxiety disorders has not been evaluated. Methyldopa can potentiate the effects of CNS depressants such as barbiturates, benzodiazepines, opiate agonists, or phenothiazines when administered concomitantly. 0000062954 00000 n 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. 0000006132 00000 n Metabolic acidosis is associated with the use of dichlorphenamide and has been reported rarely with the use of lorazepam injection for the treatment of status epilepticus. Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. Avoid opiate cough medications in patients taking benzodiazepines. 0.04 to 0.05 mg/kg IV as a single dose administered 30 minutes prior to chemotherapy. Max: 4 mg/dose. 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. Codeine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Lorazepam injection is contraindicated in premature neonates. Melatonin: (Major) Use caution when combining melatonin with the benzodiazepines; when the benzodiazepine is used for sleep, co-use of melatonin should be avoided. Monitor patients for decreased pressor effect if these agents are administered concomitantly. Vallerand AHA, Sanoski CAC, Quiring CC. In addition, hypercarbia and hypoxia can occur after lorazepam administration. Lorazepam in excreted in the urine primarily as the inactive glucuronide metabolite; lorazepam also undergoes enterohepatic recirculation. Educate patients about the risks and symptoms of respiratory depression and sedation. PB - F.A. Educate patients about the risks and symptoms of respiratory depression and sedation. Concurrent use may result in additive CNS depression. Davis Company Carefully monitor respiratory status and oxygen saturation in at risk patients. Cetirizine; Pseudoephedrine: (Moderate) Concurrent use of cetirizine/levocetirizine with benzodiazepines should generally be avoided. 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. A more rapid onset or prolonged effect of phenylephrine may be more likely to develop propylene glycol and glycol! Medication or provide documentation of medical necessity in accordance with OBRA guidelines administered concurrently and they be. 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