Chlorpheniramine; Dextromethorphan; Pseudoephedrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Diphenoxylate; Atropine: (Moderate) Concomitant administration of benzodiazepines with CNS-depressant drugs, such as diphenoxylate/difenoxin, can potentiate the CNS effects of either agent. Lorazepam is an UGT substrate and glecaprevir is an UGT inhibitor. 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. 2 mg PO every 6 hours as needed on days 1 and 2, then 1 mg PO every 8 hours as needed on day 3, and then 1 mg PO every 12 hours as needed on days 4 and 5. 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. Amobarbital: (Moderate) Additive CNS and/or respiratory depression may occur with concurrent use. 1 mg IV as a single dose, initially; may repeat dose after 5 minutes if chest pain persists. 2013;17(1):1-7. Lorazepam is a benzodiazepine that works in the brain to relieve symptoms of anxiety. Pentazocine: (Major) Concomitant use of mixed opiate agonists/antagonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. As with all benzodiazepines, the use of lorazepam may worsen hepatic encephalopathy; therefore, lorazepam should be used with caution in patients with severe hepatic insufficiency and/or encephalopathy. Educate patients about the risks and symptoms of excessive CNS depression and respiratory depression. [63534], Oral and parenteral intermediate-acting benzodiazepine with no active metabolitesApproved for anxiety, status epilepticus, perioperative sedation or amnesia induction, and the short-term treatment of insomnia in adults; several off-label usesAvoid coadministration with opioids if possible due to potential for profound sedation, respiratory depression, coma, and death, Ativan/Lorazepam Intramuscular Inj Sol: 1mL, 2mg, 4mgAtivan/Lorazepam Intravenous Inj Sol: 1mL, 2mg, 4mgAtivan/Lorazepam Oral Tab: 0.5mg, 1mg, 2mgLorazepam Oral Sol: 1mL, 2mgLoreev XR Oral Cap ER: 1mg, 1.5mg, 2mg, 3mg. Ativan Oral Concentrate LORazepam Oral Concentrate Store inuse bottle in refrigerator. Alternatively, 1.5 mg/m2 (Usual Max: 3 mg) IV can be given 45 minutes prior to initiation of chemotherapy. Lorazepam glucuronide has no demonstrable CNS activity in animals. Use caution with this combination. Diazepam: 20-80 hours. Clonidine: (Moderate) Clonidine has CNS depressive effects and can potentiate the actions of other CNS depressants including benzodiazepines. Doxylamine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Codeine; Guaifenesin: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Prescribers should re-assess patients for drowsiness or sleepiness regularly throughout treatment, especially since events may occur well after the start of treatment. However, ISMP does not make recommendations regarding the extension of beyond-use dates outside of manufacturer-approved recommendations. Lorazepam intensol oral concentrate (liquid) - Off-label information indicates stable when maintained at continuous room temperature 77 o F for 30 days. Although oral formulations of olanzapine and benzodiazepines may be used together, additive effects on respiratory depression and/or CNS depression are possible. Therefore, these patients should be monitored frequently and have their dosage adjusted carefully according to patient response; the initial dosage should not exceed 2 mg. Paradoxical reactions have been occasionally reported during benzodiazepine use. Limit the use of mixed opiate agonists/antagonists with benzodiazepines to only patients for whom alternative treatment options are inadequate. When ambient storage temperatures are 30C or less, ambulances carrying lorazepam should be restocked every 30 to 60 days. To reduce the risk of acute withdrawal reactions, use a gradual taper to reduce the dosage or to discontinue benzodiazepines. As with other benzodiazepines, periodic blood counts and liver-function tests are recommended for patients on long-term therapy. If tapentadol is initiated in a patient taking a benzodiazepine, a reduced initial dosage of tapentadol is recommended. Tramadol: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Monitor neonates exposed to benzodiazepines during pregnancy, labor, or obstetric delivery for signs of sedation, respiratory depression, or lethargy, and manage accordingly. The clinical significance of this is unknown. 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. Concurrent use may result in additive CNS depression. Ativan vs Xanax - What is the difference? Skilled care residents: The federal Omnibus Budget Reconciliation Act (OBRA) regulates the use of anxiolytics in long-term care facility (LTCF) residents. No evidence of carcinogenic potential emerged in rats during an 18-month study with lorazepam. The Vd is smaller in neonates and slightly larger in non-neonatal pediatric patients. 2007 Aug 15;64(16):1711-5. doi: 10.2146/ajhp060262. Propofol: (Moderate) Concomitant administration 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. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. All Background Generic name: lorazepam For these, standard refrigeration is not appropriate. 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. Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. Lurasidone: (Moderate) Due to the CNS effects of lurasidone, caution should be used when lurasidone is given in combination with other centrally acting medications such as anxiolytics, sedatives, and hypnotics, including benzodiazepines. Crystallization was also detected after 7 days in syringes at room temperature, 3 days in bottles at 5 3C, and 2 days in bottles at room temperature. Chlorthalidone; Clonidine: (Moderate) Clonidine has CNS depressive effects and can potentiate the actions of other CNS depressants including benzodiazepines. (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. Food: (Major) Advise patients to avoid cannabis use while taking CNS depressants due to the risk for additive CNS depression and potential for other cognitive adverse reactions. Median Tmax was 14 hours (range 7 to 24 hours) following a single 3 mg dose of the extended-release capsules. If a mixed opiate agonist/antagonist is initiated for pain in a patient taking a benzodiazepine, use a lower initial dose of the mixed opiate agonist/antagonist and titrate to clinical response. 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. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. The required dosage is highly variable and should be titrated to desired degree of sedation. Hydrocodone; Ibuprofen: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Small decreases in blood pressure and hypotension may occur but are usually not clinically significant, probably being related to the relief of anxiety produced by lorazepam. 0.044 mg/kg IV (Max: 2 mg) 15 to 20 minutes prior to surgery or the procedure. 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. Educate patients about the risks and symptoms of respiratory depression and sedation. Use caution with this combination. This action may be additive with other agents that can cause hypotension such as benzodiazepines. Lorazepam injectable Ativan Injectable Yes Intact vials should be refrigerated; 60 days at room temp Lorazepam Intensol oral solution ATIVAN YES 90 days after opening; keep refrigerated Therefore, in the management of overdosage, it should be borne in mind that multiple agents may have been taken. Desogestrel; Ethinyl Estradiol: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. Use an initial morphine; naltrexone dose of 20 mg/0.8 mg PO every 24 hours. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Pharmacokinetic interactions have been observed with the use of zolpidem. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Azelastine; Fluticasone: (Moderate) Monitor for excessive sedation and somnolence during coadministration of azelastine and benzodiazepines. (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. Lorazepam 1 and 2 mg/mL in 5% dextrose injection was stable for 28 hours at room temperature in glass bottles when the 2 mg/mL and 4 mg/mL lorazepam preparations, respectively, were used. Cimetidine hydrochloride compatibility III: Room temperature stability in drug admixtures. Increase gradually as needed and tolerated. Ramelteon use with hypnotics of any kind is considered duplicative therapy and these drugs are generally not co-administered. Lorazepam is not recommended for use in patients with primary depressive disorder, as preexisting depression may emerge or worsen during the use of benzodiazepines. Aldesleukin, IL-2: (Moderate) Aldesleukin, IL-2 may affect CNS function significantly. storage of the drug, lorazepam concentration did not substantially degrade over a 60-day period; lorazepam stored in an oven kept at 37 C experienced signicant degradation, suggesting that lorazepam's stability is heat-sensitive.4 Midazolam is thought to be stable at room temperature, but the heat stability and degrada- 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. recommended to be stored at controlled-room temperature. Use carton to protect contents from light. 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. Dose range: 0.025 to 0.1 mg/kg/dose. Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. Segesterone Acetate; Ethinyl Estradiol: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. Lorazepam is an UGT substrate and probenecid is an UGT inhibitor. 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. Chlorpheniramine; Codeine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. rebound insomnia) can appear following cessation of recommended doses after as little as one week of therapy. Literature Support for Extended Beyond Use Dating and Stability: . Use caution with this combination. Usual adult dose range is 2 to 4 mg PO at bedtime as needed; use for more than 4 months has not been evaluated. Acetaminophen; Hydrocodone: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. 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. Use caution with this combination. Intensity of sedation and orthostatic hypotension were greater with the combination of oral aripiprazole and lorazepam compared to aripiprazole alone.
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