Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. 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. In animal studies, melatonin has been shown to increase benzodiazepine binding to receptor sites. According to the Beers Criteria, benzodiazepines are considered potentially inappropriate medications (PIMs) in geriatric adults and avoidance is generally recommended, although some agents may be appropriate for seizures, rapid eye movement sleep disorders, benzodiazepine or ethanol withdrawal, severe generalized anxiety disorder, or peri-procedural anesthesia. 10 mg/day PO; maximum IM and IV dose highly variable dependent upon indication. If benzhydrocodone is initiated in a patient taking a benzodiazepine, reduce initial dosage and titrate to clinical response. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. 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. 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. Norethindrone; Ethinyl Estradiol; Ferrous fumarate: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. 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. Effects of 5% and 10% alcohol on drug release were not significant 2 hours post-dose. 25 to 50 mg 4 to 6 hours before sexual activity. Adults over 50 years of age may experience a greater incidence of central nervous system (CNS) depression and more respiratory depression with use of lorazepam, particularly with preanesthetic use. These can include: Ativan may lead to physical and psychological dependence and addiction.*. Vilazodone: (Moderate) Due to the CNS effects of vilazodone, caution should be used when vilazodone is given in combination with other centrally acting medications such as the benzodiazepines. Report any behavioral or personality changes such as confusion, forgetfulness, slurred speech, decreased mental acuity, or excessive excitation. Neonatal metabolism of benzodiazepines occurs more slowly than in adults, and when used chronically, accumulation may occur producing sedation, nausea, poor feeding, or other adverse effects, particularly with long-acting benzodiazepines (e.g., diazepam, chlordiazepoxide). F.A. In . Educate patients about the risks and symptoms of respiratory depression and sedation. Specific maximum dosage information not available; the dose required is dependent on route of administration, indication, and clinical response. Use caution with this combination. Lorazepam injection also contains benzyl alcohol as a preservative. 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. Symptoms typically occur within 414 days after initiation of drug therapy, but can occur at any time during drug use. EENT: blurred vision. If hydromorphone is initiated in a patient taking a benzodiazepine, reduce the initial dosage of hydromorphone and titrate to clinical response; for hydromorphone extended-release tablets, use 1/3 to 1/2 of the estimated hydromorphone starting dose. Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. 1. A boxed warning is the strongest warning required by the Food and Drug Administration (FDA). During the treatment of status epilepticus, the use of injectable benzodiazepines, like lorazepam, is often implemented as an adjunct to other supportive therapies. With misuse, a drug is taken in a way other than how its prescribed. Below are examples of these side effects. Aldesleukin, IL-2: (Moderate) Aldesleukin, IL-2 may affect CNS function significantly. Call your doctor right away if you have any serious side effects. 1 to 20 mg/hour continuous IV infusion. Patients should not drive or operate heavy machinery until they know how the combination affects them. It is approximately 85% protein-bound. Therefore, caution is advisable when combining anxiolytics, sedatives, and hypnotics or other psychoactive medications with these medications. fluphenazine (floo-fen-a-zeen) Apo-Fluphenazine, Modecate Concentrate, PMS-Fluphenazine, Prolixin, Prolixin Decanoate, Apo-Fluphenazine, Modecate Concentrate, PMS-Fluphenazine, Prolixin, Prolixin Decanoate. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Long-term use of Ativan should be avoided when possible because it can cause serious side effects. If headaches dont get better or are bothersome, talk with your doctor. Register Now. Lorazepam is an UGT substrate and sorafenib is an UGT inhibitor. GI: anorexia, constipation, drug-induced hepatitis, dry mouth, ileus, nausea, weight gain. Increase gradually as needed and tolerated. Other people who take it have a reduced appetite. Therefore, caution is advisable when combining anxiolytics, sedatives, and hypnotics or other psychoactive medications with levomilnacipran. Glecaprevir; Pibrentasvir: (Moderate) Monitor for an increase in lorazepam-related adverse reactions and consider reducing the dose of lorazepam if concomitant use of lorazepam and glecaprevir is necessary. Ziprasidone: (Moderate) Ziprasidone has the potential to impair cognitive and motor skills. 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. Prescribers should re-assess patients for drowsiness or sleepiness regularly throughout treatment, especially since events may occur well after the start of treatment. Clinicians should be aware that the use of flumazenil may increase the risk of seizures, particularly in long-term users of benzodiazepines. 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. short-term changes in mood or behavior, such as restlessness, anger, crying, or confusion. OBRA provides dosing guidance for lorazepam as an anxiolytic and a sedative. If you know someone at immediate risk of self-harm, suicide, or hurting another person: If you or someone you know is having thoughts of suicide, a prevention hotline can help. Lorazepam is an UGT substrate and valproic acid is an UGT inhibitor. Educate patients about the risks and symptoms of respiratory depression and sedation. Carefully evaluate each syringe/bag before administration.Storage: Lorazepam diluted with 5% Dextrose Injection or 0.9% Sodium Chloride Injection at a concentration of 0.2 mg/mL, 0.5 mg/mL, or 1 mg/mL is stable for 24 hours when stored in polypropylene syringes or glass containers. Molindone: (Moderate) Consistent with the pharmacology of molindone, additive effects may occur with other CNS active drugs such as anticonvulsants. Older adults and people with certain physical conditions may need to start with a lower dosage. Daridorexant: (Major) Monitor for excessive sedation and somnolence during use of daridorexant with benzodiazepines. For Intermezzo brand of sublingual zolpidem tablets, reduce the dose to 1.75 mg/night. Theophylline, Aminophylline: (Minor) Aminophylline or Theophylline have been reported to counteract the pharmacodynamic effects of diazepam and possibly other benzodiazepines. Aspirin, ASA; Butalbital; Caffeine; Codeine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Use caution with this combination. Lorazepam dosage should be modified depending on clinical response and degree of renal impairment. 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; Diphenhydramine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Max: 2 mg/day PO, unless documentation of need for higher doses is provided. Some formulations of lorazepam injection also contain benzyl alcohol and are contraindicated in patients with known benzyl alcohol hypersensitivity. A person caring for you should seek emergency medical attention if you have slow breathing with long pauses, blue colored lips, or if you are hard to wake up. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. 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. Acrivastine; Pseudoephedrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Monitor patients for decreased pressor effect if these agents are administered concomitantly. Tell your doctor if you feel an increased urge to use more of this medicine. LORazepam General **BEERS Drug** Pronunciation: lor- az -e-pam To hear audio pronunciation of this topic, purchase a subscription or log in. Alternatively, 0.025 to 0.05 mg/kg/dose IV every 6 hours as needed for management of anticipatory or breakthrough nausea/vomiting. -Initial dose: 2 to 3 mg orally per day, given 2 to 3 times per day 1 INDICATIONS ATIVAN is indicated for: the short-term relief of manifestations of excessive anxiety in patients with anxiety neurosis. Using this service may help lower the drugs cost and allow you to get your medication without leaving home. This div only appears when the trigger link is hovered over. Taking Ativan with valproic acid or divalproex (Depakote), a drug used to treat seizures and other conditions, can increase the levels of Ativan in your body. If concurrent use is necessary, use the lowest effective dose and minimum duration possible. If you think your pet has eaten your Ativan, call your veterinarian immediately. 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. 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. 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