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. Avoid opiate cough medications in patients taking benzodiazepines. Educate patients about the risks and symptoms of respiratory depression and sedation. 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 an opiate agonist, 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. Download the Davis's Drug Guide app by Unbound Medicine, 2. If no additional boluses are needed, consider reducing the infusion rate. confusion, aggression, hallucinations; sleep problems; vision changes; or. Codeine; Promethazine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Avoid opiate cough medications in patients taking benzodiazepines. Flumazenil does not affect the pharmacokinetics of the benzodiazepines. PB - F.A. Vallerand AHA, Sanoski CAC, Quiring CC. If metabolic acidosis occurs or persists, consider reducing the dose or discontinuing dichlorphenamide therapy. Aldesleukin, IL-2: (Moderate) Aldesleukin, IL-2 may affect CNS function significantly. Optimum anxiolytic and sedative effects occur approximately 1 to 2 hours after administration, with the degree of sedation dependent on the dose administered and the presence or absence of other medications. Educate patients about the risks and symptoms of respiratory depression and sedation. Procarbazine: (Minor) CNS depressants benzodiazepines can potentiate the CNS depression caused by procarbazine therapy, so these drugs should be used together cautiously. Use an initial morphine; naltrexone dose of 20 mg/0.8 mg PO every 24 hours. Aripiprazole: (Moderate) Monitor blood pressure and for unusual drowsiness and sedation during coadministration of aripiprazole and benzodiazepines. Includes App for iPhone, iPad, and Android smartphone + tablet. Particular caution is required in determining the amount of time needed after outpatient procedures or surgery before it is safe for any patient to ambulate. 0.04 to 0.05 mg/kg IV as a single dose administered 30 minutes prior to chemotherapy. xb```f``Z @1X T0fk?oZC@jKKU]r3(!( 6A-+dXc Usual dose range: 2 to 6 mg/day PO. Specific maximum dosage information not available; the dose required is dependent on route of administration, indication, and clinical response. Some patients may experience excessive sedation and impaired ability to perform tasks. 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. Mirtazapine: (Moderate) Monitor for unusual drowsiness and sedation during coadministration of benzodiazepines and mirtazapine due to the risk for additive CNS depression. Segesterone Acetate; Ethinyl Estradiol: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. Davis AT Collection. 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. Use caution with this combination. Cannabidiol: (Moderate) Monitor for an increase in lorazepam-related adverse reactions and consider reducing the dose of lorazepam if concomitant use of lorazepam and cannabidiol is necessary. Iopamidol: (Moderate) The use of intrathecal radiopaque contrast agents is associated with a risk of seizures. Ventilatory support should also be available for the preanesthetic use of injectable benzodiazepines. Alcohol consumption may result in additive CNS depression. Sorafenib: (Moderate) Monitor for an increase in lorazepam-related adverse reactions and consider reducing the dose of lorazepam if concomitant use of lorazepam and sorafenib is necessary. If oxycodone is initiated in a patient taking a benzodiazepine, reduce dosages 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. There are exceptions that may warrant the use of an anxiolytic such as a long-acting benzodiazepine for withdrawal from a short-acting benzodiazepine, use for neuromuscular syndromes (e.g., tardive dyskinesia, restless legs syndrome, seizure disorder, cerebral palsy), or end of life care. Suvorexant: (Moderate) CNS depressant drugs may have cumulative effects when administered concurrently and they should be used cautiously with suvorexant. 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. All sleep medications should be used in accordance with approved product labeling. 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. 0000001722 00000 n Meperidine; Promethazine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Use caution with this combination. Davis AT Collection. 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. 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). 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. Patients should be monitored more closely for hypotension if nitroglycerin is used concurrently with benzodiazepines. The federal Omnibus Budget Reconciliation Act (OBRA) regulates the use of sedative/hypnotics in long-term care facility (LTCF) residents. For fluid restricted patients, data suggest that a concentration of 0.5 mg/mL or 1 mg/mL is stable for up to 24 hours and may be used. Separate multiple email address with a comma. Dexmedetomidine: (Moderate) Concurrent use of dexmedetomidine and benzodiazepines may result in additive CNS depression. Safety and efficacy have not been established. Ethinyl Estradiol; Norethindrone Acetate: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. Diphenoxylate; Atropine: (Moderate) Concomitant administration of benzodiazepines with CNS-depressant drugs, such as diphenoxylate/difenoxin, can potentiate the CNS effects of either agent. A loading dose (i.e., 2 to 4 mg IV) is generally required. For acetaminophen; oxycodone extended-release tablets, start with 1 tablet PO every 12 hours, and for other oxycodone products, use an initial dose of oxycodone at 1/3 to 1/2 the usual dosage. 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). In addition, the risk of next-day psychomotor impairment is increased during co-administration of eszopiclone and other CNS depressants, which may decrease the ability to perform tasks requiring full mental alertness such as driving. There is no evidence of accumulation of lorazepam with administration up to 6 months. Educate patients about the risks and symptoms of respiratory depression and sedation. If the extended-release tapentadol tablets are used concurrently with a benzodiazepine, use an initial tapentadol dose of 50 mg PO every 12 hours. Ramelteon: (Moderate) Ramelteon is a sleep-promoting agent; therefore, additive pharmacodynamic effects are possible when combining ramelteon with benzodiazepines or other miscellaneous anxiolytics, sedatives, and hypnotics. %%EOF Use caution with this combination. 0000001412 00000 n 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 davis pDF Lorazepam is used for the short-term relief of symptoms of anxiety, such as anxiety attacks. 81 28 1. Lorazepam is an UGT substrate and atazanavir is an UGT inhibitor. Lorazepam belongs to a group of drugs called benzodiazepines. It affects chemicals in the brain that may be unbalanced in people with anxiety. Use caution with this combination. Dosage adjustments may be necessary when administered together because of potentially additive CNS effects. Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. Use caution with this combination. 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. 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. Log in using your existing username and password to start your free, 30-day trial of the app, 3. BT - Davis's Drug Guide A reduction in dose of the CNS depressant may be needed in some cases. 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. 12 years: Up to 10 mg/day PO for anxiety disorders; 4 mg/day PO for insomnia. Benzodiazepines act at the level of the limbic, thalamic, and hypothalamic regions of the CNS, and can produce any level of CNS depression required including sedation, hypnosis, skeletal muscle relaxation, anticonvulsant activity, and coma. Effects of 5% and 10% alcohol on drug release were not significant 2 hours post-dose. 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