Vallerand, A. H., Sanoski, C. A., & Quiring, C. (2023). xb```i\ cc`a4xq`1 cfLk2^eMab\`Y9N"Nykf46tH h)i:b4Y,Q!a6[CNbaP+" PDR.net is to be used only as a reference aid. Monoamine oxidase inhibitors: (Moderate) Monitor for unusual drowsiness and sedation during coadministration of benzodiazepines and monoamine oxidase inhibitors (MAOIs) due to the risk for additive CNS depression. Use caution with this combination. 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. 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. Tiagabine: (Moderate) Because of the possible additive effects of drugs that depress the central nervous system, benzodiazepines should be used with caution in patients receiving tiagabine. Educate patients about the risks and symptoms of respiratory depression and sedation. Monitor patients for decreased pressor effect if these agents are administered concomitantly. DISCONTINUATION: To discontinue, gradually taper the dose. If a benzodiazepine is prescribed for an indication other than epilepsy in a patient taking a mixed opiate agonist/antagonist, use a lower initial dose of the benzodiazepine and titrate to clinical response. Risk factors for the development of prolonged QT syndrome may include the use of benzodiazepines. Avoid prescribing opiate cough medications in patients taking benzodiazepines. Mix the contents thoroughly by gently inverting the syringe/vial repeatedly until a homogenous solution is obtained; do not shake vigorously.For neonatal doses: It may be necessary to make a less concentrated dilution to accurately measure the prescribed dose; some experts recommend dilution to limit the amount of benzyl alcohol administered (some products contain benzyl alcohol 20 mg/mL).The following dilutions may be prepared using the 2 mg/mL concentration of lorazepam ONLY (do not use lorazepam 4 mg/mL to prepare; precipitation may occur) :Lorazepam 0.2 mg/mL dilution: Add 1 mL of lorazepam (2 mg/mL) to 9 mL of 5% Dextrose Injection or NS (benzyl alcohol content = 2 mg/mL if using a lorazepam product containing 2% benzyl alcohol).Lorazepam 0.5 mg/mL dilution: Add 1 mL of lorazepam (2 mg/mL) to 3 mL of 5% Dextrose Injection or NS (benzyl alcohol content = 5 mg/mL if using a lorazepam product containing 2% benzyl alcohol).After dilution, inject directly into a vein or into the tubing of a freely-flowing compatible IV infusion. Benzodiazepine dependence can occur after administration of therapeutic doses for as few as 1 to 2 weeks and withdrawal symptoms may be seen after the discontinuation of therapy. The action of these drugs is mediated through the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). 0000006670 00000 n Max: 4 mg/dose. If oxycodone is initiated in a patient taking a benzodiazepine, reduce dosages and titrate to clinical response. Azelastine; Fluticasone: (Moderate) Monitor for excessive sedation and somnolence during coadministration of azelastine and benzodiazepines. 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 lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. Lofexidine can potentiate the effects of CNS depressants such as benzodiazepines. False study results are possible in patients with drug-induced hyper- or hypo-responsiveness; thorough patient history is important in the interpretation of procedure results. Clozapine: (Moderate) If concurrent therapy with clozapine and a benzodiazepine is necessary, it is advisable to begin with the lowest possible benzodiazepine dose and closely monitor the patient, particularly at initiation of treatment and following dose increases. Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. 12 years: Up to 10 mg/day PO for anxiety disorders; 4 mg/day PO for insomnia. WebFind information on Lorazepam (Ativan, Loreev XR) in Daviss Drug Guide including dosage, side effects, interactions, nursing implications, mechanism of action, half life, Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Ergotamine; 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. 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. Initially, 1 to 2 mg/day PO given in 2 to 3 divided doses; increase gradually as needed and tolerated. Theophylline, Aminophylline: (Minor) Aminophylline or Theophylline have been reported to counteract the pharmacodynamic effects of diazepam and possibly other benzodiazepines. Educate patients about the risks and symptoms of respiratory depression and sedation. Therefore, caution is advisable when combining anxiolytics, sedatives, and hypnotics or other psychoactive medications with levomilnacipran. Suvorexant: (Moderate) CNS depressant drugs may have cumulative effects when administered concurrently and they should be used cautiously with suvorexant. Because of the CNS-depressant effects of magnesium sulfate, additive central-depressant effects can occur following concurrent administration with CNS depressants such as benzodiazepines. Monitor patients for decreased pressor effect if these agents are administered concomitantly. 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. Lorazepam injection is contraindicated in patients with sleep apnea syndrome or severe respiratory insufficiency who are not receiving mechanical ventilation. Diphenhydramine; Naproxen: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Also, droperidol and benzodiazepines can both cause CNS depression. Download the Nursing Central app by Unbound Medicine, 2. Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. Educate patients about the risks and symptoms of respiratory depression and sedation. Titrate to desired level of sedation. 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. Educate patients about the risks and symptoms of respiratory depression and sedation. Eszopiclone: (Moderate) Concomitant administration of benzodiazepines with eszopiclone can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Sodium Oxybate: (Contraindicated) Sodium oxybate should not be used in combination with CNS depressant anxiolytics, sedatives, and hypnotics or other sedative CNS depressant drugs. Recent case-control and cohort studies of benzodiazepine use during pregnancy have not confirmed increased risks of congenital malformations previously reported with early studies of benzodiazepines, including diazepam and chlordiazepoxide. Concurrent use may increase the severity of metabolic acidosis. Acetaminophen; Dextromethorphan; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving 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. This action may be additive with other agents that can cause hypotension such as benzodiazepines. Chlorpheniramine; Pseudoephedrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) 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. Although oral formulations of olanzapine and benzodiazepines may be used together, additive effects on respiratory depression and/or CNS depression are possible. Patients reporting unusual sleep-related behaviors should likely discontinue melatonin use. Butabarbital: (Moderate) Additive CNS and/or respiratory depression may occur with concurrent use. Therefore, psychotropic pharmacodynamic interactions could occur following concomitant administration of drugs with significant CNS activity. Benzodiazepines act at the level of the limbic, thalamic, and hypothalamic regions of the CNS, and can produce any level of CNS depression required including sedation, hypnosis, skeletal muscle relaxation, anticonvulsant activity, and coma. 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. 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. If concurrent use is necessary, initiate pregabalin at the lowest recommended dose and monitor patients for symptoms of respiratory depression and sedation. 0000009584 00000 n 0000002898 00000 n Chlorpheniramine; Dextromethorphan; Pseudoephedrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Maprotiline may lower the seizure threshold, so when benzodiazepines are used for anticonvulsant effects the patient should be monitored for desired clinical outcomes. Hydroxychloroquine can lower the seizure threshold; therefore, the activity of antiepileptic drugs may be impaired with concomitant use. Alcohol may also increase drug exposure and the risk for overdose by disrupting extended-release lorazepam capsules. Use caution with this combination. Use caution with this combination. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Morphine; Naltrexone: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Use caution with this combination. Initiate extended-release (ER) dosing with the total daily dose of lorazepam given PO once daily in the morning. 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. Excessive amounts of benzyl alcohol in neonates have been associated with hypotension, metabolic acidosis, and kernicterus. Brompheniramine; Carbetapentane; Phenylephrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. (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. Increase gradually as needed and tolerated. Cetirizine: (Moderate) Concurrent use of cetirizine/levocetirizine with benzodiazepines should generally be avoided. Aspirin, ASA; Butalbital; Caffeine; Codeine: (Major) Concomitant use of opiate agonists 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. startxref Apomorphine: (Moderate) Apomorphine causes significant somnolence. Use caution with this combination. Co-ingestion may disrupt the extended-release formulation resulting in increased lorazepam exposure and increasing the risk for lorazepam overdose. There are exceptions that may warrant the use of an anxiolytic such as a long-acting benzodiazepine for withdrawal from a short-acting benzodiazepine, use for neuromuscular syndromes (e.g., tardive dyskinesia, restless legs syndrome, seizure disorder, cerebral palsy), or end of life care. Select Try/Buy and follow instructions to begin your free 30-day trial. 0000003779 00000 n Chlorcyclizine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Look up information on diseases, tests, and procedures; then consult the database with 5,000+ drugs or refer to 65,000+ dictionary terms. Avoid prescribing opiate cough medications in patients taking benzodiazepines. 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. Monitor patients for decreased pressor effect if these agents are administered concomitantly. Alprazolam: (Moderate) Concomitant administration of alprazolam with CNS-depressant drugs, such as lorazepam, can potentiate the CNS effects of either agent. Lorazepam is an UGT substrate and sorafenib is an UGT inhibitor. The need for indefinite continuation of lorazepam (e.g., seizure disorder) should be based on confirmation of the condition being treated and its potential cause(s). Consequently, appropriate precautions (e.g., limiting the total prescription size and increased monitoring for suicidal ideation) should be considered. In general, all benzodiazepines increase the risk of cognitive impairment, delirium, falls, fractures, and motor vehicle accidents in older adults. Methyldopa can potentiate the effects of CNS depressants such as barbiturates, benzodiazepines, opiate agonists, or phenothiazines when administered concomitantly. (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. 0000000016 00000 n Follow with water. Pentobarbital: (Moderate) Additive CNS and/or respiratory depression may occur with concurrent use. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. To hear audio pronunciation of this topic, purchase a subscription or log in. Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. Additive drowsiness and/or dizziness is possible. AU - Vallerand,April Hazard, Monitor patients for decreased pressor effect if these agents are administered concomitantly. General anesthetics: (Moderate) Concomitant administration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. For optimum lack of recall, administer IV dose 15 to 20 minutes prior to procedure and IM dose 2 hours prior to procedure. WebRoute/Dosage. 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. Oxycodone: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Educate patients about the risks and symptoms of respiratory depression and sedation. Use caution with this combination. Use caution with this combination. 0000007603 00000 n Coadministration may increase the risk of CNS depressant-related side effects. (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. Acetaminophen; Aspirin; Diphenhydramine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. 0000001722 00000 n Diphenhydramine; Phenylephrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Concurrent use of scopolamine and CNS depressants can adversely increase the risk of CNS depression. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Use of more than 1 agent for hypnotic purposes may increase the risk for over-sedation, CNS effects, or sleep-related behaviors. Dose range: 0.025 to 0.1 mg/kg/dose. 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. May continue lorazepam for 24 to 48 hours if initially effective and needed. Hydroxyzine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. All sleep medications should be used in accordance with approved product labeling. Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Lorazepam, and possibly other benzodiazepines, should be used cautiously in patients receiving loxapine. Once adequate response is achieved, resume treatment with the ER capsules. 0.05 mg/kg/dose IV every 2 to 8 hours as needed (Max initial dose: 2 mg). (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. NOTE: For status epilepticus, IV administration is preferred over IM because therapeutic blood concentrations are reached more quickly with IV administration.When IV access is available, IV is the preferred route of administration due to injection site pain and slower onset associated with IM administration.When used as a premedication to produce lack of recall, IM lorazepam should be administered at least 2 hours before procedure.No dilution is needed.Inject deeply into a large muscle mass (e.g., anterolateral thigh or deltoid [children and adolescents only]). Monitor patients for decreased pressor effect if these agents are administered concomitantly. )1Xwn_7/?}yTuS@;-B/ -6mG]uD?,wr@fBE+htd+h>fpu(_8:UA'kz,Eb3;Y^l?1x%`rnJ hul aLHgxrJ)=bv-7:YC+eQPTRQVbG=d.x}V^>H6.#}%ZCkjzF`B *mdwy8bSM z:_Y /*,{tFVP17-_]pJbQ{Q;D62yz6KVS4}Y[8A0$\]UtJ5 S"msVO+\gRM{5ggRB> 4%3uq-sr ^bi(Q"PnIi.cqCst}>U0g/R4|QLz6;=yi]bS1?C|xUrr>Hk=ho}2^?UN T Monitor patients for decreased pressor effect if these agents are administered concomitantly. If a benzodiazepine is prescribed for an indication other than epilepsy in a patient taking a mixed opiate agonist/antagonist, use a lower initial dose of the benzodiazepine and titrate to clinical response. 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 --. (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. If a benzodiazepine must be used, a short-acting agent such as oxazepam or lorazepam should be selected if appropriate, and prescribed at the lowest effective dosage and duration. Avoid opiate cough medications in patients taking benzodiazepines. Max: 2 mg/day PO, unless documentation of need for higher doses is provided. In patients treated with buprenorphine for opioid use disorder, cessation of benzodiazepines or other CNS depressants is preferred in most cases. [25032] A single dose should not exceed 4 mg IV. Brompheniramine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Flumazenil has minimal effects on benzodiazepine-induced respiratory depression; suitable ventilatory support should be available, especially in treating acute benzodiazepine overdose. Educate patients about the risks and symptoms of respiratory depression and sedation. Dexmedetomidine: (Moderate) Concurrent use of dexmedetomidine and benzodiazepines may result in additive CNS depression. 1 to 2 mg IV as a single dose plus diphenhydramine for additional sedation. %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 T1 - LORazepam 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. Drospirenone; Ethinyl Estradiol; Levomefolate: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. A published sedation protocol for pediatric mechanically ventilated patients recommends an initial infusion rate of 0.01 mg/kg/hour IV. Caffeine; Sodium Benzoate: (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. 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. 2 to 4 mg PO at bedtime as needed. Optimum anxiolytic and sedative effects occur approximately 1 to 2 hours after administration, with the degree of sedation dependent on the dose administered and the presence or absence of other medications. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Alternatively, 0.025 to 0.05 mg/kg/dose IV every 6 hours as needed for management of anticipatory or breakthrough nausea/vomiting. The volume of sterile water required will vary depending on the specific tablets used; this will also result in varying amounts of Ora-Plus and Ora-Sweet depending on the product.In the chemical stability study, 2 different suspensions were made using the following ingredients:180 lorazepam 2 mg tablets by Mylan Laboratories, 144 mL of sterile water, Ora-Plus 108 mL, and Ora-Sweet 83 mL.180 lorazepam 2 mg tablets by Watson Laboratories, 48 mL of sterile water, Ora-Plus 156 mL and Ora-Sweet 146 mL.Each suspension was divided into 1 oz amber glass bottles for stability testing.Storage: Suspension is stable for 90 days when refrigerated (4 degrees C) or for 60 days at room temperature (22 degrees C). And increasing the risk of CNS depressants such as benzodiazepines Dextromethorphan ; phenylephrine: ( Moderate ) concurrent may! 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