WebRoute/Dosage. Lorazepam dosage should be modified based on clinical response and degree of hepatic impairment; a smaller dosage may be sufficient for patients with severe insufficiency. Patients should be monitored more closely for hypotension if nitroglycerin is used concurrently with benzodiazepines. wG xR^[ochg`>b$*~ :Eb~,m,-,Y*6X[F=3Y~d tizf6~`{v.Ng#{}}jc1X6fm;'_9 r:8q:O:8uJqnv=MmR 4 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. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Asenapine: (Moderate) Drugs that can cause CNS depression, if used concomitantly with asenapine, may increase both the frequency and the intensity of adverse effects such as drowsiness, sedation, and dizziness. Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. A "gasping syndrome" characterized by CNS depression, metabolic acidosis, and gasping respirations has been associated with benzyl alcohol dosages more than 99 mg/kg/day in neonates. Educate patients about the risks and symptoms of respiratory depression and sedation. Norethindrone; Ethinyl Estradiol: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. 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. Limited published data are available in the pediatric population. trailer
Lorazepam, and possibly other benzodiazepines, should be used cautiously in patients receiving loxapine. 0000005197 00000 n
xb```i\ cc`a4xq`1 cfLk2^eMab\`Y9N"Nykf46tH h)i:b4Y,Q!a6[CNbaP+" 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. Metyrosine: (Moderate) The concomitant administration of metyrosine with benzodiazepines can result in additive sedative effects. Because binding at the receptor is competitive and flumazenil has a much shorter duration of action than do most benzodiazepines, it is possible for the effects of flumazenil to dissipate sooner than the effects of the benzodiazepine. Levorphanol: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. 45 0 obj<>stream
Methohexital: (Moderate) Additive CNS and/or respiratory depression may occur with concurrent use. ID - 51455 A loading dose (i.e., 2 to 4 mg IV) is generally required. Guaifenesin; Hydrocodone: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. WebI have been taking .5 lorazepam for over two and a half years. Segesterone Acetate; Ethinyl Estradiol: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. 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. Caution should be used when vigabatrin is given in combination with benzodiazepines. [25032] A single dose should not exceed 4 mg IV. The Vd is smaller in neonates and slightly larger in non-neonatal pediatric patients. Educate patients about the risks and symptoms of respiratory depression and sedation. Use of more than 2 hypnotics should be avoided due to the additive CNS depressant and complex sleep-related behaviors that may occur. The risk of next-day impairment, including impaired driving, is increased if daridorexant is taken with other CNS depressants. Norethindrone; Ethinyl Estradiol; Ferrous fumarate: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. Amobarbital: (Moderate) Additive CNS and/or respiratory depression may occur with concurrent use. 0000023582 00000 n
If concurrent use is necessary, initiate pregabalin at the lowest recommended dose and monitor patients for symptoms of respiratory depression and sedation. Concurrent administration of lorazepam with a UGT inhibitor may result in increased plasma concentrations, reduced clearance, and prolonged half-life of lorazepam. ET - 18 Mirtazapine: (Moderate) Monitor for unusual drowsiness and sedation during coadministration of benzodiazepines and mirtazapine due to the risk for additive CNS depression. 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. Ethynodiol Diacetate; Ethinyl Estradiol: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. In a study of 4 lactating women, concentrations of free lorazepam in breast milk 4 hours after a single 3.5 mg oral dose were found to be 8 to 9 ng/mL, which accounted for 14.8% to 25.7% of the mother's plasma concentration. ER -, Your free 1 year of online access expired. In general, lorazepam dose selection for the geriatric adult should be cautious, starting at the low end of the dosage range. Droperidol: (Major) Droperidol administration is associated with an established risk for QT prolongation and torsades de pointes. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. n3kGz=[==B0FX'+tG,}/Hh8mW2p[AiAN#8$X?AKHI{!7. Monitor patients for decreased pressor effect if these agents are administered concomitantly. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Avoid opiate cough medications in patients taking benzodiazepines. (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. 0000055702 00000 n
Patients with a history of a seizure disorder should not be withdrawn abruptly from benzodiazepines due to the risk of precipitating seizures; status epilepticus has also been reported. 0000000016 00000 n
Educate patients about the risks and symptoms of respiratory depression and sedation. Additive CNS depression may occur. Monitor neonates exposed to benzodiazepines during pregnancy, labor, or obstetric delivery for signs of sedation, respiratory depression, or lethargy, and manage accordingly. 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. No quantitative recommendations are available. 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. RN2NpN )lbV 3: (KF Initially, use a low dosage (i.e., 1 to 2 mg PO) and titrate slowly in the geriatric patient. 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. Lorazepam can be considered when a benzodiazepine is required in patients with hepatic disease due to the low hepatic extraction, glucuronidation as the primary metabolic pathway, and lack of active metabolites. Carbinoxamine; Dextromethorphan; Pseudoephedrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Consult Daviss Drug Guide anywhere you go with web access + our easy-to-use mobile app. nQt}MA0alSx k&^>0|>_',G! 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. %PDF-1.6
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Use caution with this combination. The federal Omnibus Budget Reconciliation Act (OBRA) regulates medication use in residents of long-term care facilities (LTCFs). Avoid prescribing opiate cough medications in patients taking benzodiazepines. Because lorazepam can cause drowsiness and a decreased level of consciousness, there is a higher risk of falls, particularly in the elderly, with the potential for subsequent severe injuries. Dicyclomine: (Moderate) Dicyclomine can cause drowsiness, so it should be used cautiously in patients receiving CNS depressants like benzodiazepines. Methyldopa can potentiate the effects of CNS depressants such as barbiturates, benzodiazepines, opiate agonists, or phenothiazines when administered concomitantly. 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. F.A. Follow with water. Hydrocodone: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. 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. Concurrent use may result in additive CNS depression. Pentazocine: (Major) Concomitant use of mixed opiate agonists/antagonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Guanfacine: (Moderate) Guanfacine has been associated with sedative effects and can potentiate the actions of other CNS depressants including benzodiazepines. Concurrent use may result in additive CNS depression. Lorazepam dosage should be modified depending on clinical response and degree of renal impairment. Dilutions not prepared in a sterile environment should not be stored; discard immediately. Lorazepam is excreted into human breast milk in low concentrations. Acetaminophen; Pamabrom; Pyrilamine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Prescribers should re-assess patients for drowsiness or sleepiness regularly throughout treatment, especially since events may occur well after the start of treatment. Infuse over 15 to 20 minutes. document.write(new Date().getFullYear()) PDR, LLC. Although oral formulations of olanzapine and benzodiazepines may be used together, additive effects on respiratory depression and/or CNS depression are possible. Educate patients about the risks and symptoms of respiratory depression and sedation. Use lowest effective 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. (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. Measure sodium bicarbonate concentrations at baseline and periodically during dichlorphenamide treatment. WebRead this chapter of Davis's Drug Guide for Rehabilitation Professionals online now, exclusively on F.A. Increase gradually as needed and tolerated. Sedating H1-blockers: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Use caution with this combination. 0000003285 00000 n
Use caution with this combination. 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. Acetaminophen; Aspirin; Diphenhydramine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Separate multiple email address with a comma. May continue lorazepam for 24 to 48 hours if initially effective and needed. 0000003552 00000 n
No patient should get out of bed unassisted within 8 hours of lorazepam injection. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. If metabolic acidosis occurs or persists, consider reducing the dose or discontinuing dichlorphenamide therapy. 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 to 4 mg IM every 30 to 60 minutes as needed. The duration of the sedative effect is approximately 6 to 12 hours for most patients. 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. 0000001412 00000 n
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