Information on stability for . (Moderate) Monitor for an increase in lorazepam-related adverse reactions and consider reducing the dose of lorazepam if concomitant use of lorazepam and pibrentasvir is necessary. 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 ombitasvir is necessary. Limit the use of mixed opiate agonists/antagonists with benzodiazepines to only patients for whom alternative treatment options are inadequate. 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. Diversity in pharmacy residency recruitment. 1999;17(4):333-337. doi:10.1016/s0735-6757(99)90079-7. Use caution with this combination. Specific maximum dosage information not available; the dose required is dependent on route of administration, indication, and clinical response. Administer immediately; do not store for future use.Storage: Protect from light. 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. Avoid opiate cough medications in patients taking benzodiazepines. Consider the benefits of appropriate anesthesia in pregnant women against the potential risks, especially for procedures that may last more than 3 hours or if multiple procedures are required prior to delivery. (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. The peak plasma level of lorazepam from a 2 mg dose is approximately 20 ng/mL. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Oliceridine: (Major) Concomitant use of oliceridine with lorazepam may cause respiratory depression, hypotension, profound sedation, and death. . Advise patients to seek immediate medical attention if they experience symptoms such as trouble breathing. 2 to 4 mg IM every 30 to 60 minutes as needed. Risperidone: (Moderate) Due to the primary CNS effects of risperidone, caution should be used when risperidone is given in combination with other centrally acting medications including anxiolytics, sedatives, and hypnotics. Convulsions/seizures may be more common in patients with pre-existing seizure disorders or who are taking other drugs that lower the convulsive threshold such as antidepressants. The duration of the sedative effect is approximately 6 to 12 hours for most patients. Initiate with lower dosages and carefully monitor for sedation and other adverse effects. Oxazepam: 5-11 hours. 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. In a sample of about 3500 patients treated for anxiety, the most frequent adverse reaction to lorazepam was sedation (15.9%), followed by dizziness (6.9%), weakness (4.2%), and unsteadiness (3.4%). Ramelteon use with hypnotics of any kind is considered duplicative therapy and these drugs are generally not co-administered. Prescription drug expenditures: An employer perspective. 12 years: Up to 10 mg/day PO for anxiety disorders; 4 mg/day PO for insomnia. . Caution should be exercised when using these agents concurrently. Lorazepam Macure . 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. 0.05 to 0.1 mg/kg/dose (Max: 2 mg/dose) IM every 30 to 60 minutes as needed.[64934]. The sedative effects of injectable benzodiazepines may add to the CNS depressive state seen in the postictal stage. Educate patients about the risks and symptoms of respiratory depression and sedation. 4 Consult your health care practitioner if any other prescription or over-the-counter . 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. Lorazepam first became available in the US in 1977 by Wyeth Pharmaceuticals. Lorazepam is an UGT substrate and gemfibrozil is an UGT inhibitor. The 1 mg capsules contain tartrazine, which may cause allergic-type reactions in susceptible patients. 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. If oxycodone is initiated in a patient taking a benzodiazepine, reduce dosages and titrate to clinical response. 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. Tramadol; Acetaminophen: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Thanks for your help. Limited data available; 0.025 to 0.05 mg/kg/dose PO every 6 hours as needed for management of anticipatory nausea/vomiting. (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. Max: 10 mg/day PO. Lorazepam (brand names: Ativan, Lorazepam Intensol) is a benzodiazepine medication used to treat behavior problems such as anxiety, fears, and phobias. May continue lorazepam for 24 to 48 hours if initially effective and needed. Coadminstration of lorazepam with valproic acid causes increased plasma concentrations and reduced clearance of lorazepam. Max: 10 mg/day PO. Use caution with this combination. official website and that any information you provide is encrypted Acetaminophen; Diphenhydramine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. A similar study measured the stability of lorazepam 4 mg/mL for emergency use under refrigeration, at room temperature, and in a helicopter (mean 11.8 C) for up to 4 months (see Table 4). Use caution with this combination. Concurrent use of zolpidem with other sedative-hypnotics, including other zolpidem products, at bedtime or the middle of the night is not recommended. Diazepam: 20-80 hours. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. [8], [1] Institute for Safe Medication Practices. . . Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. Barbiturates: (Moderate) Additive CNS and/or respiratory depression may occur with concurrent use. It is not intended to be a substitute for the exercise of professional judgment. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. 2 mg IV every 30 to 60 minutes as needed. Brimonidine; Brinzolamide: (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. Administer the morning after the day of discontinuation of a lorazepam immediate-release (IR) product. Max: 2 mg/day PO, unless documentation of need for higher doses is provided. There is a possibility of interaction with valerian at normal prescription dosages of anxiolytics, sedatives, and hypnotics (including barbiturates and benzodiazepines). Pyrilamine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. 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. . Hosp Pharm. All rights reserved. Educate patients about the risks and symptoms of respiratory depression and sedation. Doses of other central-nervous-system-depressant drugs ordinarily should be reduced. Older adults have an increased sensitivity to benzodiazepines. Once adequate response is achieved, resume treatment with the ER capsules. Norgestimate; Ethinyl Estradiol: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. Lorazepam, and possibly other benzodiazepines, should be used cautiously in patients receiving loxapine. CNS depressants can potentiate the effects of stiripentol. 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. [41537] [52925] [64934], 0.1 mg/kg/dose (Max: 4 mg/dose) IV or IM as a single dose; may repeat dose once in 5 to 15 minutes.[41537]. 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. Therefore, caution is advisable when combining anxiolytics, sedatives, and hypnotics or other psychoactive medications with levomilnacipran. Molindone: (Moderate) Consistent with the pharmacology of molindone, additive effects may occur with other CNS active drugs such as anticonvulsants. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. Acetaminophen; Chlorpheniramine; Phenylephrine : (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. 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. 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. Use caution with this combination. Educate patients about the risks and symptoms of respiratory depression and sedation. 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. Consider alternatives to benzodiazepines for conditions such as anxiety or insomnia in patients receiving buprenorphine maintenance treatment. Consider alternatives to benzodiazepines for conditions such as anxiety or insomnia during methadone maintenance treatment. Educate patients about the risks and symptoms of respiratory depression and sedation. Effects of 5% and 10% alcohol on drug release were not significant 2 hours post-dose. 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 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. Zaleplon: (Major) Monitor for excessive sedation and somnolence during coadministration of zaleplon and benzodiazepines. Thalidomide: (Major) The use of benzodiazepine anxiolytics, sedatives, or hypnotics with thalidomide may cause an additive sedative effect and should be avoided. Consume all the sprinkled contents within 2 hours. Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. Conclusion: Ropinirole: (Moderate) Concomitant use of ropinirole with other CNS depressants can potentiate the sedation effects of ropinirole. Sincalide: (Moderate) Sincalide-induced gallbladder ejection fraction may be affected by benzodiazepines. Dimenhydrinate: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. In addition, patients should not attempt driving or operating machinery until 24 to 48 hours after surgery or until the CNS depressant effects have subsided, whichever is longer. Dosage for patients with severe hepatic disease should be adjusted carefully according to patient response; lower doses may be sufficient in such patients. Clemastine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. We do not record any personal information entered above. Use caution with this combination. Lorazepam clearance is significantly slower in neonates compared to adults; clearance in older children is dependent on the specific population and varies from slightly slower to slightly faster than that of adults. 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. 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. 0.05 to 0.1 mg/kg IV or IM as a single dose (Max: 2 to 4 mg). Quetiapine: (Moderate) Monitor for excessive sedation and somnolence during coadministration of alprazolam and quetiapine. Rotigotine: (Major) Concomitant use of rotigotine with other CNS depressants, such as benzodiazepines, can potentiate the sedative effects of rotigotine. In humans, blood levels obtained from umbilical cord blood indicate placental transfer of lorazepam and lorazepam glucuronide. Concurrent use may result in additive CNS depression. Throw away any liquid not used within 90 days. Reported elimination half-lives are 12 hours, 14 +/- 5 hours, and 20.2 +/- 7.2 hours for immediate-release oral formulations, the parenteral formulation, and the extended-release capsules, respectively. (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. Symptoms such as hypoactivity, hypotonia, hypothermia, respiratory depression, apnea, feeding problems, and impaired metabolic response to cold stress have been reported in neonates born of mothers who have received benzodiazepines during the late phase of pregnancy or at delivery. The benzodiazepine antagonist flumazenil may be used in hospitalized patients as an adjunct to, not as a substitute for, proper management of benzodiazepine overdose. Educate patients about the risks and symptoms of respiratory depression and sedation. (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. This data suggest temperature is the main cause of degradation and the effect of vibrations is negligible. Limit the use of mixed opiate agonists/antagonists with benzodiazepines to only patients for whom alternative treatment options are inadequate. 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 proposed mechanism is competitive binding of these methylxanthines to adenosine receptors in the brain. 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.