Use caution with this combination. 0000003285 00000 n Sincalide: (Moderate) Sincalide-induced gallbladder ejection fraction may be affected by benzodiazepines. Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. Hydrochlorothiazide, HCTZ; Methyldopa: (Moderate) Methyldopa is associated with sedative effects. 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. Lorazepam is an UGT substrate and dasabuvir is an UGT inhibitor. In older pediatric patients, the daily dosage for anxiety disorders is typically divided into 2 to 3 doses and should not exceed 10 mg/day in those 12 years and older. 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. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. 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. Titrate to desired level of sedation. HWr|WS;XYI2 (| JZ@OLO8/'N,=e%^"Zvyrz\8/A4EhYH 4y8!xY0FqCKEK:]!`>s_J821Ip >_JRs~!x25H"W/rySjXuX$Q4(cI45%G KRd*9AOO4g(j2C: H\TKoAqs;O In vitro data predicts inhibition of UGT2B7 by cannabidiol, potentially resulting in clinically significant interactions. Chlorpheniramine; Hydrocodone: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. 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. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. 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. Due to a prolonged half-life, neonates may require doses at less frequent intervals (e.g., every 6 to 8 hours) compared to children and adolescents. Additive drowsiness and/or dizziness is possible. 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. In addition, hypercarbia and hypoxia can occur after lorazepam administration. Use caution with this combination. Belladonna; Opium: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. 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. In: * Article titles in AMA citation format should be in sentence-case, You can cancel anytime within the 30-day trial, or continue using Nursing Central to begin a 1-year subscription ($39.95). 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. If a patient develops withdrawal reactions, consider pausing the taper or increasing the dosage to the previous tapered dosage level. LORazepam [Internet]. (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. Rasagiline: (Moderate) The CNS-depressant effects of MAOIs can be potentiated with concomitant administration of other drugs known to cause CNS depression including buprenorphine, butorphanol, dronabinol, THC, nabilone, nalbuphine, and anxiolytics, sedatives, and hypnotics. 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. 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. 0.05 to 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. WebLorazepam is a nearly white powder almost insoluble in water. Drowsiness or dizziness may last Avoid opiate cough medications in patients taking benzodiazepines. In addition, seizures have been reported during the use of molindone, which is of particular significance in patients with a seizure disorder receiving anticonvulsants. Increase gradually as needed and tolerated. Some formulations of lorazepam injection also contain benzyl alcohol and are contraindicated in patients with known benzyl alcohol hypersensitivity. Educate patients about the risks and symptoms of respiratory depression and sedation. 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. WebStudy Description: An open-label, multi-center study to evaluate the single dose pharmacokinetics of intravenous lorazepam in pediatric patients aged 3 months to less than 18 years treated for status epilepticus (SE) or with a history of SE. (Moderate) Additive CNS and/or respiratory depression may occur with concurrent use. Ropinirole: (Moderate) Concomitant use of ropinirole with other CNS depressants can potentiate the sedation effects of ropinirole. Concurrent use of scopolamine and CNS depressants can adversely increase the risk of CNS depression. Reduce injectable buprenorphine dose by 1/2, and for the buprenorphine transdermal patch, start therapy with the 5 mcg/hour patch. Drospirenone; Ethinyl Estradiol; Levomefolate: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. Use caution with this combination. 30 0 obj <> endobj Central benzodiazepine receptors interact allosterically with GABA receptors, potentiating the effects of GABA and thereby increasing the inhibition of the ascending reticular activating system. Note: Your username may be different from the email address used to register your account. The risk of next-day impairment, including impaired driving, is increased if daridorexant is taken with other CNS depressants. AU - Quiring,Courtney, Reduce injectable buprenorphine dose by 1/2, and for the buprenorphine transdermal patch, start therapy with the 5 mcg/hour patch. If 3 intermittent boluses of lorazepam are needed in a 6 hour time period, increase the infusion rate by 0.005 mg/kg/hour (50% of initial rate). A Nursing Central subscription is required to. Use of benzodiazepines late in pregnancy may result in a neonatal abstinence syndrome (NAS) or floppy infant syndrome (FIS). 2 to 4 mg PO at bedtime as needed. 2 mg IV every 30 to 60 minutes as needed. Apomorphine: (Moderate) Apomorphine causes significant somnolence. Acetaminophen; Diphenhydramine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. The severity of this interaction may be increased when additional CNS depressants are given. If a benzodiazepine is required during pregnancy, avoid first trimester administration if possible, consider short-acting agents, limit treatment to the lowest effective dosage and duration, and discontinue the drug well before delivery. 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. 0000063185 00000 n We're glad you have enjoyed Davis's Drug Guide! (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. Lorazepam is excreted renally as an inactive metabolite; less than 1% is excreted unchanged. Brompheniramine; Dextromethorphan; Phenylephrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. 0000001594 00000 n 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. Cyclizine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Additive CNS depressant effects are possible when ziprasidone is used concurrently with any CNS depressant. T1 - LORazepam Benzhydrocodone; Acetaminophen: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Administration of the extended-release capsules by sprinkling the contents in 15 mL of applesauce did not significantly affect overall drug exposure or Tmax. WebRead this chapter of Davis's Drug Guide for Rehabilitation Professionals online now, exclusively on F.A. Download the Nursing Central app by Unbound Medicine, 2. 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. Avoid prescribing opiate cough medications in patients taking benzodiazepines. Initially, 1 to 2 mg/day PO given in 2 to 3 divided doses; increase gradually as needed and tolerated. Levonorgestrel; Ethinyl Estradiol: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. (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. 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. The combination of benzodiazepines and maprotiline is commonly used clinically and is considered to be safe as long as patients are monitored for excessive adverse effects from either agent. 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. T1 - LORazepam Lorazepam is an UGT substrate and atazanavir is an UGT inhibitor. Pyrimethamine: (Moderate) Mild hepatotoxicity has been reported when pyrimethamine was coadministered with lorazepam. Plasma concentrations are proportional to the dose given. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. 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. Limited published data are available in the pediatric population. Drospirenone; Ethinyl Estradiol: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. 0000000016 00000 n Davis AT Collection is a subscription Thalidomide: (Major) The use of benzodiazepine anxiolytics, sedatives, or hypnotics with thalidomide may cause an additive sedative effect and should be avoided. The risk of next-day impairment, including impaired driving, is increased if lemborexant is taken with other CNS depressants. 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). Acetaminophen; Chlorpheniramine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Isoflurane: (Moderate) Concomitant administration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. 0.05 to 0.1 mg/kg IV or IM as a single dose (Max: 2 to 4 mg). Flumazenil does not reverse the actions of barbiturates, opiate agonists, or tricyclic antidepressants. Ethinyl Estradiol; Norethindrone Acetate: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. Limit the use of opioid pain medication with lorazepam to only patients for whom alternative treatment options are inadequate. (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. 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. In a clinical trial, there was clear evidence for a transitory pharmacodynamic interaction between melatonin and another hypnotic agent one hour following co-dosing. Monitor patients for decreased pressor effect if these agents are administered concomitantly. Dexbrompheniramine: (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. Educate patients about the risks and symptoms of respiratory depression and sedation. Send the page "" Educate patients about the risks and symptoms of respiratory depression and sedation. Guanabenz can potentiate the effects of CNS depressants such as benzodiazepines, when administered concomitantly. 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. All sleep medications should be used in accordance with approved product labeling. Aspirin, ASA; Butalbital; Caffeine: (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. Monitor for excessive sedation, dizziness, and a potential for loss of consciousness during brexanolone use. Lorazepam is an UGT substrate and pibrentasvir is an UGT inhibitor. Olanzapine: (Major) Concurrent use of intramuscular olanzapine and parenteral benzodiazepines is not recommended due to the potential for adverse effects from the combination including excess sedation and/or cardiorespiratory depression. Administration of the extended-release capsules with a high-fat and high calorie meal delayed median Tmax by approximately 2 hours and did not affect overall drug exposure. Secobarbital: (Moderate) Additive CNS and/or respiratory depression may occur with concurrent use. A Davis's Drug Guide subscription is required to. 0.05 to 0.1 mg/kg/dose (Max: 2 mg/dose) IV every 30 to 60 minutes as needed.[64934]. Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. Have patients swallow the ER capsules whole.If patient has difficulty swallowing: Contents of the ER capsules may be sprinkled over a tablespoon of cool applesauce and consumed without chewing. Sodium oxybate (GHB) has the potential to impair cognitive and motor skills. Thalidomide frequently causes drowsiness and somnolence. Monitor patients for decreased pressor effect if these agents are administered concomitantly. 0000004934 00000 n Educate patients about the risks and symptoms of respiratory depression and sedation. Aspirin, ASA; Oxycodone: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. (Moderate) Additive CNS and/or respiratory depression may occur with concurrent use. 0000010283 00000 n Excessive amounts of benzyl alcohol in neonates have been associated with hypotension, metabolic acidosis, and kernicterus. Educate patients about the risks and symptoms of respiratory depression and sedation. 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. Estradiol ; Levomefolate: ( Moderate ) the therapeutic effect of phenylephrine may be lorazepam davis pdf patients... Melatonin and another hypnotic agent one hour following co-dosing levonorgestrel ; Ethinyl Estradiol may enhance the metabolism lorazepam! Educate patients about the risks and symptoms of respiratory depression may occur with concurrent use symptoms of respiratory depression occur..., or tricyclic antidepressants pyrimethamine was coadministered with lorazepam to only patients for whom alternative treatment options are.... Ugt substrate and atazanavir is an UGT substrate and dasabuvir is an UGT inhibitor Estradiol Norethindrone. 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