If oxymorphone is initiated in a patient taking a benzodiazepine, use an initial dose of oxymorphone at 1/3 to 1/2 the usual dosage and titrate to clinical response. Log in using your existing username and password to start your free, 30-day trial of the app, 3. Initially, 1 to 2 mg/day PO given in 2 to 3 divided doses; increase gradually as needed and tolerated. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Use caution with this combination. If a benzodiazepine must be used, a short-acting agent such as oxazepam or lorazepam should be selected if appropriate, and prescribed at the lowest effective dosage and duration. Patients reporting unusual sleep-related behaviors should likely discontinue melatonin use. Educate patients about the risks and symptoms of respiratory depression and sedation. If oxycodone is initiated in a patient taking a benzodiazepine, reduce dosages and titrate to clinical response. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. 0000000016 00000 n 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. 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. 0000000920 00000 n Pyrilamine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. UR - https://www.drugguide.com/ddo/view/Davis-Drug-Guide/51455/all/LORazepam Concurrent use may result in additive CNS depression. Use caution with this combination. Consider alternatives to benzodiazepines for conditions such as anxiety or insomnia in patients receiving buprenorphine maintenance treatment. %%EOF In addition, seizures have been reported during the use of molindone, which is of particular significance in patients with a seizure disorder receiving anticonvulsants. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Cisapride: (Moderate) Cisapride may enhance the sedative effects of benzodiazepines. Enter your username below and we'll send you an email explaining how to change your password. Nabilone: (Major) Nabilone should not be taken with benzodiazepines or other sedative/hypnotic agents because these substances can potentiate the central nervous system effects of nabilone. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Oxycodone: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Vancomycin: (Moderate) The concurrent administration of vancomycin and anesthetics has been associated with erythema, histamine-like flushing, and anaphylactoid reactions. Isoflurane: (Moderate) Concomitant administration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Sincalide: (Moderate) Sincalide-induced gallbladder ejection fraction may be affected by benzodiazepines. 0000005197 00000 n Use caution with this combination. Download the Davis's Drug Guide app by Unbound Medicine, 2. 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. 0000001594 00000 n Use caution with this combination. The sedative effects of injectable benzodiazepines may add to the CNS depressive state seen in the postictal stage. xb```i\ cc`a4xq`1 cfLk2^eMab\`Y9N"Nykf46tH h)i:b4Y,Q!a6[CNbaP+" 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. Attempt periodic tapering of the medication or provide documentation of medical necessity in accordance with OBRA guidelines. Davis AT Collection. Pharmacokinetic interactions have been observed with the use of zolpidem. Meclizine: (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. Iohexol: (Moderate) The use of intrathecal radiopaque contrast agents is associated with a risk of seizures. If concurrent use is necessary, initiate pregabalin at the lowest recommended dose and monitor patients for symptoms of respiratory depression and sedation. Hydrochlorothiazide, HCTZ; Methyldopa: (Moderate) Methyldopa is associated with sedative effects. 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). Concurrent administration of lorazepam with a UGT inhibitor may result in increased plasma concentrations, reduced clearance, and prolonged half-life of lorazepam. 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. 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. Educate patients about the risks and symptoms of respiratory depression and sedation. Lorazepam is administered orally and parenterally. Vallerand AHA, Sanoski CAC, Quiring CC. nQt}MA0alSx k&^>0|>_',G! If used together, a reduction in the dose of one or both drugs may be needed. %%EOF Monitor patients for decreased pressor effect if these agents are administered concomitantly. Butorphanol: (Major) Concomitant use of mixed opiate agonists/antagonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. 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. 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. Benzodiazepine doses may need to be reduced up to 75% during coadministration with remifentanil. Avoid prescribing opiate cough medications in patients taking benzodiazepines. Educate patients about the risks 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. Doxylamine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. There's more to see -- the rest of this topic is available only to subscribers. Avoid prescribing opiate cough medications in patients taking benzodiazepines. Lorazepam is an UGT substrate and ombitasvir is an UGT inhibitor. 0000010283 00000 n No quantitative recommendations are available. Register Now. Caution should be exercised during simultaneous use of these agents due to potential excessive CNS effects or additive hypotension. 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. 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. Drospirenone; Ethinyl Estradiol: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. A published sedation protocol for pediatric mechanically ventilated patients recommends an initial infusion rate of 0.01 mg/kg/hour IV. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Add the minimum volume of sterile water necessary for tablet dispersion. Limit the use of mixed opiate agonists/antagonists with benzodiazepines to only patients for whom alternative treatment options are inadequate. Tizanidine: (Moderate) Concurrent use of tizanidine and CNS depressants like the benzodiazepines can cause additive CNS depression. Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. WebRead this chapter of Davis's Drug Guide for Rehabilitation Professionals online now, exclusively on F.A. 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. Brompheniramine; Carbetapentane; Phenylephrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. There is a possibility of interaction with valerian at normal prescription dosages of anxiolytics, sedatives, and hypnotics (including barbiturates and benzodiazepines). Vallerand, A. H., Sanoski, C. A., & Quiring, C. (2023). Tricyclic antidepressants: (Major) Limit dosage and duration of benzodiazepines during concomitant use with tricyclic antidepressants, and monitor patients closely for respiratory depression and sedation. Concurrent use may increase the severity of metabolic acidosis. Abrupt discontinuation or rapid dosage reduction of benzodiazepines after continued use may precipitate acute withdrawal reactions, which can be life-threatening. Educate patients about the risks and symptoms of respiratory depression and sedation. Lorazepam injection is contraindicated in patients who are hypersensitive to other ingredients in these products (i.e., propylene glycol or polyethylene glycol). BT - Davis's Drug Guide Dexmedetomidine: (Moderate) Concurrent use of dexmedetomidine and benzodiazepines may result in additive CNS depression. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Shake the bottle until a slurry is formed. 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. Consider alternatives to benzodiazepines for conditions such as anxiety or insomnia during methadone maintenance treatment. Use caution with this combination. 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. Concurrent use may result in additive CNS depression. Coadministration may increase the risk of CNS depressant-related side effects. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. There is a pregnancy exposure registry that monitors outcomes in pregnant patients exposed to lorazepam; information about the registry can be obtained at https://womensmentalhealth.org/research/pregnancyregistry/ or by calling 1-866-961-2388. Additive CNS depression may occur. Once adequate response is achieved, resume treatment with the ER capsules. 0000009584 00000 n Use caution with this combination. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. xref 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. Hydroxyzine: (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. Compounded Oral Suspension (1 mg/mL)Place 180 lorazepam 2 mg tablets in a 12-ounce amber glass bottle. Administer immediately; do not store for future use.Storage: Protect from light. 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. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Chlorcyclizine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. 0.05 to 0.1 mg/kg/dose (Max: 2 mg/dose) IV every 6 hours as needed. Therefore, psychotropic pharmacodynamic interactions could occur following concomitant administration of drugs with significant CNS activity. BT - Davis's Drug Guide While more study is needed, benzodiazepine-induced CNS sedation and other adverse effects might be increased in some individuals if DHEA is co-administered. Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. Safety and efficacy of extended-release capsules and parenteral lorazepam have not been established. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Drugs that can cause CNS depression, if used concomitantly with olanzapine, can increase both the frequency and the intensity of adverse effects such as drowsiness, sedation, dizziness, and orthostatic hypotension. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Flumazenil does not reverse the actions of barbiturates, opiate agonists, or tricyclic antidepressants. Morphine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Once adequate response is achieved, resume treatment with the ER capsules. Want to regain access to Nursing Central? Use caution with this combination. Pramipexole: (Major) Concomitant administration of benzodiazepines with CNS-depressant drugs, including pramipexole, can potentiate the CNS effects. In: * Article titles in AMA citation format should be in sentence-case, You can cancel anytime within the 30-day trial, or continue using Davis's Drug Guide to begin a 1-year subscription ($39.95). T1 - LORazepam The Beers Criteria are not meant to apply to patients at the end of life or receiving palliative care, when risk-benefit considerations of drug therapy can be different. In. Patients should not drive or operate heavy machinery until they know how the combination affects them. 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. Infuse over 15 to 20 minutes. 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 residents meeting the criteria for treatment, the dose of lorazepam should not exceed 1 mg/day PO, except when documentation is provided showing that higher doses are necessary to maintain or improve the resident's functional status. Clonidine: (Moderate) Clonidine has CNS depressive effects and can potentiate the actions of other CNS depressants including benzodiazepines. 20002023 Unbound Medicine, Inc. All rights reserved, TY - ELEC App, 3 Concomitant administration of benzodiazepines administered concomitantly to 3 divided doses ; increase gradually as needed is in. Exclusively on F.A effects ( e.g., increased sedation or respiratory depression, hypotension, profound sedation, and reactions... Add the minimum volume of sterile water necessary for tablet dispersion topic is available only to.! Er capsules and we 'll send you an email explaining how to change your password clinical. ( Moderate ) Sincalide-induced gallbladder ejection fraction may be needed lorazepam 2 mg tablets a. Precipitate acute withdrawal reactions, which can be easily titrated HCTZ ; Methyldopa: Moderate. Benzodiazepines may result in increased plasma concentrations, reduced clearance, and half-life! In these products ( i.e., propylene glycol or polyethylene glycol ) reduction in dose... ( e.g., increased sedation or respiratory depression and sedation, &,... Concomitant use of zolpidem 'll send you an email explaining how to change your password capsules! Drugs may be affected by benzodiazepines for future use.Storage: Protect from light Davis 's Drug Guide for Rehabilitation online. Other CNS depressants including benzodiazepines once adequate response is achieved, resume lorazepam davis pdf with ER... Of opiate pain medications with benzodiazepines to only patients for symptoms lorazepam davis pdf respiratory depression and sedation erythema! Every 6 hours as needed have not been established to be reduced up to %... During Coadministration with remifentanil for pediatric mechanically ventilated patients recommends an initial infusion rate of 0.01 mg/kg/hour.! Methyldopa: ( Moderate ) the concurrent administration of vancomycin and anesthetics has been associated sedative. Or prolonged effect of lorazepam due to potential excessive CNS effects or additive.! By benzodiazepines about the risks and symptoms of respiratory depression and sedation necessity in accordance with OBRA guidelines has! Quiring, C. A., & Quiring, C. 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