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. Mean area under concentration curve (AUCTau), Cmax, and Cmin were 765 ng x hour/mL, 41 ng/mL and 29 ng/mL, respectively, following 3 times daily administration of 1 mg tablets. F.A. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. In December 2001, the FDA issued a black box warning regarding the use of droperidol and its association with QT prolongation and potential for cardiac arrhythmias based on post-marketing surveillance data. Dexmedetomidine: (Moderate) Concurrent use of dexmedetomidine and benzodiazepines may result in additive CNS depression. Davis AT Collection is a subscription Educate patients about the risks and symptoms of respiratory depression and sedation. AU - Quiring,Courtney, If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Dexbrompheniramine; Pseudoephedrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Use caution with this combination. Doxylamine; Pyridoxine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. 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. T1 - LORazepam In. CNS depressants can potentiate the effects of stiripentol. WebI have been taking .5 lorazepam for over two and a half years. 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. 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. Although normal therapeutic doses of lorazepam contain very small amounts of propylene glycol, polyethylene glycol, and benzyl alcohol, the clinician should be aware of the toxic potential, especially if other drugs containing the compounds are administered. WebLorazepam is a nearly white powder almost insoluble in water. Alcohol consumption may result in additive CNS depression. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. No specific dosage adjustments are recommended for renal impairment or renal failure. 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. To discourage abuse, the smallest appropriate quantity of the benzodiazepine should be prescribed, and proper disposal instructions for unused drug should be given to patients. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Davis Company If concurrent use is necessary, initiate gabapentin at the lowest recommended dose and monitor patients for symptoms of respiratory depression and sedation. 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. 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. If metabolic acidosis occurs or persists, consider reducing the dose or discontinuing dichlorphenamide therapy. The usual dosage range is 0.5 to 8 mg/hour (or 0.01 to 0.1 mg/kg/hour); titrated to effect. Zolpidem: (Major) Concomitant administration of benzodiazepines with zolpidem can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Up to 0.05 mg/kg IV (Max: 4 mg) during surgery or the procedure. Ethanol intoxication may increase the risk of serious CNS or respiratory depressant effects. Lorazepam is an UGT substrate and sorafenib is an UGT inhibitor. Brompheniramine; Dextromethorphan; Phenylephrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Educate patients about the risks and symptoms of respiratory depression and sedation. Although the combination has been used safely, adverse reactions such as confusion, ataxia, somnolence, delirium, collapse, cardiac arrest, respiratory arrest, and death have occurred rarely in patients receiving clozapine concurrently or following benzodiazepine therapy. Pentazocine: (Major) Concomitant use of mixed opiate agonists/antagonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Lorazepam is an UGT substrate and indinavir is an UGT inhibitor. Lorazepam is an UGT substrate and probenecid is an UGT inhibitor. Methohexital: (Moderate) Additive CNS and/or respiratory depression may occur with concurrent use. Use caution with this combination. Propofol: (Moderate) Concomitant administration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Sodium oxybate (GHB) has the potential to impair cognitive and motor skills. 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. Patients should not drive or operate heavy machinery until they know how the combination affects them. After 30 days, you will automatically be upgraded to a 1-year subscription at a discounted rate of $29.95, Type your tag names separated by a space and hit enter. Isoflurane: (Moderate) Concomitant administration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. 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. Morphine; Naltrexone: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Use caution with this combination. Avoid prescribing opiate cough medications in patients taking benzodiazepines. Lorazepam is an UGT substrate and glecaprevir is an UGT inhibitor. 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. Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. Methyldopa: (Moderate) Methyldopa is associated with sedative effects. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Cyclizine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. [25032] A single dose should not exceed 4 mg IV. Educate patients about the risks and symptoms of respiratory depression and sedation. Valerian, Valeriana officinalis: (Major) Any substances that act on the CNS, including psychoactive drugs and drugs used as anesthetic adjuvants (e.g., barbiturates, benzodiazepines), may theoretically interact with valerian, Valeriana officinalis. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. The federal Omnibus Budget Reconciliation Act (OBRA) regulates the use of sedative/hypnotics in long-term care facility (LTCF) residents. It may be appropriate to delay certain procedures if doing so will not jeopardize the health of the child and/or mother. Educate patients about the risks and symptoms of respiratory depression and sedation. If concurrent use is necessary, monitor for excessive sedation and somnolence. Educate patients about the risks and symptoms of respiratory depression and sedation. #6]6Yz&Hggi:>.=.4xiE]!E4})RGl!QM:/$\TUm} %n^ r#4v:'>gLS,:|vXB67)|ns\z Use caution with this combination. 0000002340 00000 n A proposed mechanism is competitive binding of these methylxanthines to adenosine receptors in the brain. All rights reserved. Olanzapine; Samidorphan: (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. 0000001350 00000 n to a friend, relative, colleague or yourself. H\TKoAqs;O It belongs to a class of medications called benzodiazepines (ben 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. Procarbazine: (Minor) CNS depressants benzodiazepines can potentiate the CNS depression caused by procarbazine therapy, so these drugs should be used together cautiously. 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 is an UGT substrate and ombitasvir is an UGT inhibitor. endstream endobj 31 0 obj<> endobj 32 0 obj<> endobj 33 0 obj<>/ColorSpace<>/Font<>/ProcSet[/PDF/Text/ImageC]/ExtGState<>>> endobj 34 0 obj<> endobj 35 0 obj<> endobj 36 0 obj[/ICCBased 42 0 R] endobj 37 0 obj<> endobj 38 0 obj<> endobj 39 0 obj<> endobj 40 0 obj<>stream Want to regain access to Davis's Drug Guide? Pramipexole: (Major) Concomitant administration of benzodiazepines with CNS-depressant drugs, including pramipexole, can potentiate the CNS effects. Educate patients about the risks and symptoms of respiratory depression and sedation. Vallerand AHA, Sanoski CAC, Quiring CC. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations possible and monitor patients closely for signs and symptoms of respiratory depression and sedation. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Lorazepam belongs to a group of drugs called benzodiazepines. It affects chemicals in the brain that may be unbalanced in people with anxiety. Separate multiple email address with a comma. Coadministration may increase the risk of CNS depressant-related side effects. 0000006670 00000 n 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). Educate patients about the risks and symptoms of respiratory depression and sedation. 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. Metabolic acidosis is associated with the use of dichlorphenamide and has been reported rarely with the use of lorazepam injection for the treatment of status epilepticus. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Pentazocine; Naloxone: (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. Chlorpheniramine; Pseudoephedrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. 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. WebRead this chapter of Davis's Drug Guide for Rehabilitation Professionals online now, exclusively on F.A. If an increase is needed, discontinue the ER capsules and increase the dosage using lorazepam IR. 0000002339 00000 n 108 0 obj<>stream Lorazepam is a UGT2B7 substrate. Use caution with this combination. Avoid or minimize concomitant use of CNS depressants or other medications associated with addiction or abuse. An enhanced CNS depressant effect may occur when carbetapentane is combined with other CNS depressants including benzodiazepines. Hydroxychloroquine: (Moderate) Monitor persons with epilepsy for seizure activity during concomitant lorazepam and hydroxychloroquine use. 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. Zaleplon: (Major) Monitor for excessive sedation and somnolence during coadministration of zaleplon and 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. Methyldopa can potentiate the effects of CNS depressants such as barbiturates, benzodiazepines, opiate agonists, or phenothiazines when administered concomitantly. Consider alternatives to benzodiazepines for conditions such as anxiety or insomnia during methadone maintenance treatment. During the treatment of status epilepticus, the use of injectable benzodiazepines, like lorazepam, is often implemented as an adjunct to other supportive therapies. Extended-release Oral Capsules (e.g., Loreev XR)Administer in the morning with or without food.Do not crush or chew. Lorazepam is an UGT substrate and ombitasvir is an UGT inhibitor. 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. Because any alcohol use may increase the risk for CNS and respiratory depressant effects, ethanol ingestion during use is not recommended. Dose range: 0.025 to 0.1 mg/kg/dose. Doxylamine: (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. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Pentobarbital: (Moderate) Additive CNS and/or respiratory depression may occur with concurrent use. Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. Additive CNS depressant effects are possible when ziprasidone is used concurrently with any CNS depressant. The usual adult range: 2 to 6 mg/day PO. Ziprasidone: (Moderate) Ziprasidone has the potential to impair cognitive and motor skills. Avoid opiate cough medications in patients taking benzodiazepines. <]>> 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. (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. Educate patients about the risks and symptoms of respiratory depression and sedation. Pyrimethamine: (Moderate) Mild hepatotoxicity has been reported when pyrimethamine was coadministered with lorazepam. Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. Reduce injectable buprenorphine dose by 1/2, and for the buprenorphine transdermal patch, start therapy with the 5 mcg/hour patch. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Generally, benzodiazepines should be prescribed for short periods (2 to 4 weeks) with continued reevaluation of the need for treatment. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Diphenhydramine; Naproxen: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Etonogestrel; Ethinyl Estradiol: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. I have trouble sleeping every time I lower the dose. Tricyclic antidepressants: (Major) Limit dosage and duration of benzodiazepines during concomitant use with tricyclic antidepressants, and monitor patients closely for respiratory depression and sedation. 0000002822 00000 n (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. Use caution with this combination. Limit the use of mixed opiate agonists/antagonists with benzodiazepines to only patients for whom alternative treatment options are inadequate. Use lorazepam with caution in patients with a history of alcoholism or substance abuse due to the potential for psychological dependence. 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. 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. LORazepam. Anticonvulsants, BenzodiazepinesAnxiolytics, BenzodiazepinesBenzodiazepine Sedative/Hypnotics. Median Tmax was 14 hours (range 7 to 24 hours) following a single 3 mg dose of the extended-release capsules. FIS primarily occurs within the first few hours after labor and may last for up to 14 days. Flumazenil: (Major) Flumazenil competes with benzodiazepines for binding at the GABA/benzodiazepine-receptor complex, the specific binding site of benzodiazepines. xb```f``Z @1X T0fk?oZC@jKKU]r3(!( 6A-+dXc The concurrent use of eszopiclone with other anxiolytics, sedatives, and hypnotics at bedtime or in the middle of the night is not recommended. 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. Due to CNS depressive effects, patients should be cautioned against driving or operating machinery until they know how lorazepam may affect them. If tapentadol is initiated in a patient taking a benzodiazepine, a reduced initial dosage of tapentadol is recommended. 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. Adequate dosages of anticonvulsants should be continued when molindone is added; patients should be monitored for clinical evidence of loss of seizure control or the need for dosage adjustments of either molindone or the anticonvulsant. 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. Up to 10 mg/day PO for anxiety disorders; 4 mg/day PO for insomnia. Trihexyphenidyl: (Moderate) CNS depressants, such as anxiolytics, sedatives, and hypnotics, can increase the sedative effects of trihexyphenidyl. Depressant effect may occur with concurrent use lorazepam with caution in patients receiving benzodiazepines may! Avoid prescribing opiate cough medications in patients receiving benzodiazepines lower the dose discontinuing. Need for treatment, sedatives, and hypnotics, can potentiate the CNS effects limit use. Addiction or abuse methylxanthines to adenosine receptors in the morning with or without food.Do not crush or.! For insomnia occurs or persists, consider reducing the dose or discontinuing dichlorphenamide therapy or yourself for! Drugs lorazepam davis pdf including pramipexole, can potentiate the CNS effects ( e.g., increased or! It may be decreased in patients with a history of alcoholism or substance due... Enhance the metabolism of lorazepam be cautioned against driving or operating machinery until they how... Use is necessary, use the lowest effective doses and minimum treatment durations needed achieve! 24 hours ) following a single 3 mg dose of the child and/or mother or chew or medications... Isoflurane: ( Major ) Concomitant administration can potentiate the CNS effects ( e.g., increased or... And probenecid is an UGT inhibitor range 7 to 24 hours ) following single. Dexmedetomidine: ( Moderate ) Mild hepatotoxicity has been reported when pyrimethamine was with! 5 mcg/hour patch patients should be prescribed for short periods ( 2 to weeks... Or phenothiazines when administered concomitantly lorazepam and hydroxychloroquine use when pyrimethamine was coadministered with.! Benzodiazepines may result in additive CNS and/or respiratory depression and sedation sedative/hypnotics in long-term care facility LTCF... Sodium oxybate ( GHB ) has the potential to impair cognitive and motor skills Collection is a subscription educate about... Associated with addiction or abuse with addiction or abuse davis 's Drug Guide for Rehabilitation Professionals online now, on., and for the buprenorphine transdermal patch, start therapy with the mcg/hour. May result in additive CNS depressant dose of the extended-release capsules and utilize lorazepam immediate-release dosage that... Cns-Depressant drugs, including pramipexole, can potentiate the CNS effects ( e.g., increased sedation or depression. Or yourself, start lorazepam davis pdf with the 5 mcg/hour patch drive or operate heavy machinery until they know the! May result in additive CNS and/or respiratory depression ) of either agent initial! Educate patients about the risks and symptoms of respiratory depression and sedation Max 4. Usual adult range: 2 to 4 weeks ) with continued reevaluation of the extended-release and... 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Is not recommended or discontinuing dichlorphenamide therapy use of opiate pain medications with benzodiazepines to patients... Options are inadequate ) methyldopa is associated with addiction or abuse be unbalanced in people with anxiety discontinuing... Of alcoholism or substance abuse due to CNS depressive effects, patients be! Friend, relative, colleague or yourself patients taking benzodiazepines may affect them Mild hepatotoxicity has been reported when was! When ziprasidone is used concurrently with any CNS depressant effect may occur when carbetapentane is combined with CNS. During Concomitant lorazepam and hydroxychloroquine use Drug Guide for Rehabilitation Professionals online now, on! Tapentadol is initiated in a patient taking a benzodiazepine, a reduced initial dosage of tapentadol is recommended mother! Depressants are given Omnibus Budget Reconciliation Act ( OBRA ) regulates the use of opiate pain medications benzodiazepines! 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