Chlorthalidone; Clonidine: (Moderate) Clonidine has CNS depressive effects and can potentiate the actions of other CNS depressants including benzodiazepines. Brand Name Generic Name Stability, InUse, Room Temp Adlyxin Lixisenatide 14 days . Metyrapone: (Moderate) Metyrapone may cause dizziness and/or drowsiness. Max: 4 mg/dose. Educate patients about the risks and symptoms of respiratory depression and sedation. However, in one study involving single intravenous doses of 1.5 mg to 3 mg of lorazepam injection, mean total body clearance of lorazepam decreased by 20% in 15 elderly subjects of 60 to 84 years of age compared to that in 15 younger subjects of 19 to 38 years of age. Lorazepam Injection, USP CIV. Educate patients about the risks and symptoms of respiratory depression and sedation. A search of the published medical literature revealed Immediate-release tablets and solution: Lorazepam is readily absorbed following an oral dose, with an absolute bioavailability of 90% reported following administration of immediate-release tablets. If oxycodone is initiated in a patient taking a benzodiazepine, reduce dosages and titrate to clinical response. (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. Lorazepam is an UGT substrate and probenecid is an UGT inhibitor. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. 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. Olanzapine; Fluoxetine: (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. Based on these results, lorazepam 0.16 mg/mL appears physically stable in 0.9% sodium chloride polypropylene syringes when stored at room temperature for 48 hours. Caution should be used when vigabatrin is given in combination with benzodiazepines. Aldesleukin, IL-2: (Moderate) Aldesleukin, IL-2 may affect CNS function significantly. Lurasidone: (Moderate) Due to the CNS effects of lurasidone, caution should be used when lurasidone is given in combination with other centrally acting medications such as anxiolytics, sedatives, and hypnotics, including benzodiazepines. or t.i.d. When temperature excursion data was unavailable in published form, product manufacturers were surveyed via telephone and/or email. The effectiveness of lorazepam in long-term use, that is, more than 4 months, has not been assessed by systematic clinical studies. If oxycodone is initiated in a patient taking a benzodiazepine, reduce dosages and titrate to clinical response. Xanax Oral Concentrate ALPRAZolam Oral Concentrate . 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. Extended-release (ER) capsules: Pharmacokinetics of the extended-release capsules are dose proportional over the dose range of 1 to 3 mg. Steady-state is usually achieved following 5 days of administration. The manufacturer has no labeling that says excursions are permitted. The severity and timeline of the withdrawal symptoms will depend largely on who long one has used Lorazepam, the size of the doses taken, the frequency of the doses, concurrent substance use, and the presence . It is also used for short-term relief of the symptoms of anxiety or anxiety caused by depression. 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. An in vitro study demonstrated significant increases in lorazepam release from the extended-release capsule 2 hours post-dose with approximately 91%-95% and 37 -42% of drug release in the presence of 40% and 20% alcohol, respectively. These agents include the benzodiazepines. Eight polypropylene Becton Dickinson (BD) syringes and 6 glass bottles were prepared under aseptic conditions by diluting 1 mL of lorazepam solution 4 mg/mL in 23 mL of sodium chloride solution to a final concentration of 167 mcg/mL. 24 hours (reconstituted solution at concentration of 5 mg/mL, diluted with Sterile Water for Injection). Use caution with this combination. Concurrent use may result in additive CNS depression. Cohen V, Jellinek SP, Teperikidis L, Berkovits E, Goldman WM. 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. Jahns BE, et al. Lorazepam injection also contains benzyl alcohol as a preservative. 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 concurrent use is necessary, monitor for excessive sedation and somnolence. Coadminstration of lorazepam with valproic acid causes increased plasma concentrations and reduced clearance of lorazepam. In a clinical trial, there was clear evidence for a transitory pharmacodynamic interaction between melatonin and another hypnotic agent one hour following co-dosing. 2022 Jul 8;79(14):1123-1124. doi: 10.1093/ajhp/zxac127. 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. Lidocaine and Prilocaine Cream. Lorazepam is an UGT substrate and probenecid is an UGT inhibitor. PDF USP Compounding Standards and Beyond-Use Dates (BUDs) Use with caution. Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. Coadministration may increase the risk of CNS depressant-related side effects. The 60-day temperature dependent degradation of midazolam and lorazepam in the prehospital environment. The CNS depressant effects of topiramate can be potentiated pharmacodynamically by concurrent use of CNS depressant agents such as the benzodiazepines. Zolpidem: (Major) Concomitant administration of benzodiazepines with zolpidem can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. The federal Omnibus Budget Reconciliation Act (OBRA) regulates medication use in residents of long-term care facilities (LTCFs). Although oral formulations of olanzapine and benzodiazepines may be used together, additive effects on respiratory depression and/or CNS depression are possible. Do not store in a bathroom. Meprobamate: (Moderate) Concomitant administration of benzodiazepines with meprobamate can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. 2022 Nov 7;79(22):2053-2057. doi: 10.1093/ajhp/zxac106. In general, dose selection for an elderly patient should be cautious, and lower doses may be sufficient in these patients (see DOSAGE AND ADMINISTRATION). Benztropine: (Moderate) CNS depressants, such as anxiolytics, sedatives, and hypnotics, can increase the sedative effects of benztropine. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Lorazepam - publications.ashp.org Oxazepam: 5-11 hours. 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. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. The peak plasma level of lorazepam from a 2 mg dose is approximately 20 ng/mL. Therefore, in the management of overdosage, it should be borne in mind that multiple agents may have been taken. Norethindrone; Ethinyl Estradiol: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. At room temperature, the lorazepam solution lost ~22% of its original concentration after 4 months, but the samples under refrigeration and in the helicopter were still stable. In a retrospective cohort study of breast-feeding mothers using a benzodiazepine (n = 124), sedation was not reported in any infant exposed to lorazepam through breast milk (52% of participants). Acetaminophen; Pamabrom; Pyrilamine: (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. 4 mg IV every 15 to 20 minutes for 2 doses, then 8 mg IV every 15 to 20 minutes for 2 doses, then 16 mg IV every 15 to 20 minutes for 3 doses as needed. Of note, normal therapeutic lorazepam injectable doses contain very small amounts of propylene glycol, polyethylene glycol, and benzyl alcohol. Monitor patients for decreased pressor effect if these agents are administered concomitantly. Efficacy of long-term use (more than 4 months) for anxiety disorders has not been evaluated. Pentazocine: (Major) Concomitant use of mixed opiate agonists/antagonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Keep lid tightly closed. Flumazenil does not reverse the actions of barbiturates, opiate agonists, or tricyclic antidepressants. 2 to 4 mg IM every 30 to 60 minutes as needed. The severity of this interaction may be increased when additional CNS depressants are given. Akorn, Inc.; 2022. PDF LORAZEPAM INTENSOL Oral Concentrate USP 2 mg per mL 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. Concentrated Oral Solution (2 mg/mL)Measure dosage using a calibrated oral syringe/dropper.Dilute the oral concentrate in water, juice, soda, or semi-solid food (e.g., applesauce, pudding) prior to administration. Coadministration of lorazepam with probenecid may cause a more rapid onset or prolonged effect of lorazepam due to increased half-life and decreased total clearance. NDC 0054-3532-44: Bottle of 30 mL with calibrated syringe (graduations 0.05 mL on the syringe). The tablets and concentrate (liquid) are usually taken with or without food two or three times a day. As with all patients on CNS-depressant drugs, patients receiving lorazepam should be warned not to operate dangerous machinery or motor vehicles and that their tolerance for alcohol and other CNS depressants will be diminished. "Lorazepam" published on Jan 2021 by ASHP. Atropine; Difenoxin: (Moderate) Concomitant administration of benzodiazepines with CNS-depressant drugs, such as diphenoxylate/difenoxin, can potentiate the CNS effects of either agent. 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. 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. Use of benzodiazepines late in pregnancy may result in a neonatal abstinence syndrome (NAS) or floppy infant syndrome (FIS). Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. In debilitated patients give 1 to 2 mg/day PO in 2 to 3 divided doses initially. Formulation. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. It is approximately 85% protein-bound. Lorazepam, an antianxiety agent, has the chemical formula, 2H-1,4-benzodiazepin-2-one, 7-chloro-5-(2-chlorophenyl)-1,3-dihydro-3-hydroxy-, ()-: Lorazepam is a white or a practically white powder almost insoluble in water. 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. Guanfacine: (Moderate) Guanfacine has been associated with sedative effects and can potentiate the actions of other CNS depressants including benzodiazepines. However, several meds require storage in the refrigerator or freezer to ensure stability. McMullan JT et. Use caution with this combination. Teduglutide has direct effects on the gut that may increase benzodiazepine exposure by improving oral absorption. If oxycodone is initiated in a patient taking a benzodiazepine, reduce dosages and titrate to clinical response. Max: 10 mg/day PO. If no additional boluses are needed, consider reducing the infusion rate. Educate patients about the risks and symptoms of respiratory depression and sedation. Dose range: 0.02 to 0.1 mg/kg/dose. Acetaminophen; Aspirin, ASA; 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. A newsletter from the Institute for Safe Medication Practices (ISMP) suggests lorazepam injection vial is both physically and chemically stable for up to 60 days at room temperature. Melatonin: (Major) Use caution when combining melatonin with the benzodiazepines; when the benzodiazepine is used for sleep, co-use of melatonin should be avoided. [4] Gottwald MD, Akers LC, Liu PK, et al. 8600 Rockville Pike Levonorgestrel; Ethinyl Estradiol; Ferrous Bisglycinate: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. 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. How long is lorazepam stable at room temperature? - InpharmD