Use caution when combining melatonin with benzodiazepines for other uses. Dexchlorpheniramine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Avoid use of benzodiazepines in older adults with the following due to the potential for symptom exacerbation or adverse effects: delirium (new-onset or worsening delirium), dementia (adverse CNS effects), and history of falls/fractures (ataxia, impaired psychomotor function, syncope, and additional falls). Symptoms reported following discontinuation of benzodiazepines include headache, anxiety, tension, depression, insomnia, restlessness, confusion, irritability, sweating, rebound phenomena, dysphoria, dizziness, derealization, depersonalization, hyperacusis, numbness/tingling of extremities, hypersensitivity to light, noise, and physical contact/perceptual changes, involuntary movements, nausea, vomiting, diarrhea, loss of appetite, hallucinations/delirium, convulsions/seizures, tremor, abdominal cramps, myalgia, agitation, palpitations, tachycardia, panic attacks, vertigo, hyperreflexia, short-term memory loss, and hyperthermia. 2016;35(4):247-50. Homatropine; Hydrocodone: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. lorazepam for more than 4 months or stop taking this medication without talking to your doctor. (Moderate) Additive CNS and/or respiratory depression may occur with concurrent use. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. In general, dose selection for an elderly patient should be cautious, and lower doses may be sufficient in these patients (see DOSAGE AND ADMINISTRATION). Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. A loading dose (i.e., 2 to 4 mg IV) is generally required. 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. Educate patients about the risks and symptoms of respiratory depression and sedation. Educate patients about the risks and symptoms of respiratory depression and sedation. Ethinyl Estradiol; Norgestrel: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. If lorazepam is used in patients with depression, ensure adequate antidepressant therapy and monitor closely for worsening symptoms. disease. Participants in Cohort 1 received lorazepam 0.1 mg/kg up to a maximum dose of 4 mg/kg. Because the use of these drugs is rarely a matter of urgency, the use of lorazepam during this period should be avoided. 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. 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. Lorazepam is an UGT substrate and ombitasvir is an UGT inhibitor. Coadministration may increase the risk of CNS depressant-related side effects. 0.05 mg/kg/dose IV every 2 to 8 hours as needed. If administered to patients who have received a benzodiazepine chronically, abrupt interruption of benzodiazepine agonism by flumazenil can induce benzodiazepine withdrawal including seizures. Maprotiline: (Moderate) Benzodiazepines or other CNS depressants should be combined cautiously with maprotiline because they could cause additive depressant effects and possible respiratory depression or hypotension. Mefloquine: (Moderate) Coadministration of mefloquine and anticonvulsants may result in lower than expected anticonvulsant concentrations and loss of seizure control. Perampanel: (Moderate) Patients taking benzodiazepines with perampanel may experience increased CNS depression. Dextromethorphan; Guaifenesin; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. Benzhydrocodone; Acetaminophen: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Use caution with this combination. In postmarketing experience, overdose with lorazepam has occurred predominantly in combination with alcohol and/or other drugs. Optical densities (ODs) were measured with a spectrophotometer to search for subvisible particles and assess turbidity; pH was also measured. Microaggregates were not detected by microscope. Meperidine; Promethazine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. The results suggest that lorazepam can be stored on ambulances. Triprolidine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Feb 22, 2015. skyler20 said: Ativan is only good for 14 days out of the refrigerator. Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. Hydrocodone; Pseudoephedrine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. The 60-day temperature-dependent degradation of midazolam and Lorazepam in the prehospital environment. Use caution with this combination. Abrupt discontinuation of product should be avoided and a gradual dosage-tapering schedule followed after extended therapy. Lorazepam Oral Sol: 1mL, 2mg Loreev XR Oral Cap ER: 1mg, 1.5mg, 2mg, 3mg DOSAGE & INDICATIONS For the short-term management of anxiety or generalized anxiety disorder (GAD). Educate patients about the risks and symptoms of respiratory depression and sedation. Avoid prescribing opiate cough medications in patients taking benzodiazepines. Amobarbital: (Moderate) Additive CNS and/or respiratory depression may occur with concurrent use. Even at the recommended concentrations, precipitation has occurred in some situations. 2022 Nov 7;79(22):2053-2057. doi: 10.1093/ajhp/zxac106. 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. Skilled care residents: The federal Omnibus Budget Reconciliation Act (OBRA) regulates the use of anxiolytics in long-term care facility (LTCF) residents. Educate patients about the risks and symptoms of respiratory depression and sedation. (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. 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. Consider alternatives to benzodiazepines for conditions such as anxiety or insomnia in patients receiving buprenorphine maintenance treatment. Acceptable storage information for all products for which storage is recommended at temperatures below room temperature (20-25 C [68-77 F]) was compiled and arranged in tabular format. Share MJ, Harrison RD, Folstad J, Fleming RA. Concomitant use of clozapine and lorazepam may produce marked sedation, excessive salivation, hypotension, ataxia, delirium, and respiratory arrest. Limited data available; 0.025 to 0.05 mg/kg/dose PO every 6 hours as needed for management of anticipatory nausea/vomiting. store at room temperature 68F to 77F ; discard if not used after 3 months. Basics Name LORazepam Pronunciation (lor A ze pam) Brand Names: US Ativan LORazepam Intensol Loreev XR Therapeutic Category Antianxiety Agent Antiemetic Antiseizure Agent, Benzodiazepine Benzodiazepine Hy. The benzodiazepine antagonist flumazenil may be used in hospitalized patients as an adjunct to, not as a substitute for, proper management of benzodiazepine overdose. Additive CNS depression may occur. Ombitasvir; Paritaprevir; Ritonavir: (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. The peak plasma level of lorazepam from a 2 mg dose is approximately 20 ng/mL. Brimonidine; Timolol: (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. The usual dosage range is 0.5 to 8 mg/hour (or 0.01 to 0.1 mg/kg/hour); titrated to effect. If used together, a reduction in the dose of one or both drugs may be needed. In debilitated adults give 1 to 2 mg/day PO in 2 to 3 divided doses initially. If used together, a reduction in the dose of one or both drugs may be needed. Some patients may experience excessive sedation and impaired ability to perform tasks. Brompheniramine; Dextromethorphan; Phenylephrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. When a higher dosage is needed, the evening dose should be increased before the daytime doses. Lorazepam is an UGT substrate and erlotinib is an UGT inhibitor. Limit the use of mixed opiate agonists/antagonists with benzodiazepines to only patients for whom alternative treatment options are inadequate. How long is lorazepam stable out of the refrigerator? Prehosp Emerg Care. (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. Chlorpheniramine; Dihydrocodeine; Phenylephrine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Lower doses of one or both agents may be required. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Keywords: If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Use caution with this combination. Peak concentrations in plasma occur approximately two hours following administration. Aspirin, ASA; Caffeine; Orphenadrine: (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. 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. In patients with depression, a possibility for suicide should be borne in mind; benzodiazepines should not be used in such patients without adequate antidepressant therapy. Studies in healthy volunteers show that in single high doses lorazepam has a tranquilizing action on the central nervous system with no appreciable effect on the respiratory or cardiovascular systems. 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. Three samples of each drug and one sample of the albumin products were used for each storage condition. 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. When higher dosage is indicated, the evening dose should be increased before the daytime doses. Dronabinol: (Moderate) Use caution if the use of benzodiazepines are necessary with dronabinol, and monitor for additive dizziness, confusion, somnolence, and other CNS effects. Remimazolam: (Major) The sedative effect of remimazolam can be accentuated by 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. Acetaminophen; Chlorpheniramine; Dextromethorphan: (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. Use caution with this combination. Doses of other central-nervous-system-depressant drugs ordinarily should be reduced. Methyldopa can potentiate the effects of CNS depressants such as barbiturates, benzodiazepines, opiate agonists, or phenothiazines when administered concomitantly. 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. Methadone: (Major) Concurrent use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. 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. When used as an anticonvulsant, cessation of seizure activity may occur within 5 minutes. Oxazepam: 5-11 hours. Lorazepam is a generic medication also available under the trade name Ativan. Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. After reconstitution, refrigerated solution (5 mg/mL concentration, diluted with Sterile Water for Injection) stable for one week. 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. 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. Stability of the drugs stored in different temperature settings. Hydrochlorothiazide, HCTZ; Methyldopa: (Moderate) Methyldopa is associated with sedative effects. Monitor patients for decreased pressor effect if these agents are administered concomitantly. For anxiety, most patients require an initial dose of 2 mg/day to 3 mg/day given b.i.d. If such therapy is initiated or discontinued, monitor the clinical response to the benzodiazepine. However, an increased risk of congenital malformations associated with the use of minor tranquilizers (chlordiazepoxide, diazepam, and meprobamate) during the first trimester of pregnancy has been suggested in several studies. 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. Lorazepam is excreted renally as an inactive metabolite; less than 1% is excreted unchanged.

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