Phenobarbital: (Moderate) Additive CNS and/or respiratory depression may occur with concurrent use. High doses and prolonged infusions may increase the risk of propylene glycol toxicity; monitor patients carefully. Concomitant administration of apomorphine and benzodiazepines could result in additive depressant effects. Loxapine: (Moderate) The combination of loxapine and lorazepam has been associated with acute respiratory depression, stupor, and/or hypotension in several patients. Educate patients about the risks and symptoms of respiratory depression and sedation. A Nursing Central subscription is required to. If oxycodone is initiated in a patient taking a benzodiazepine, reduce dosages and titrate to clinical response. Monitor patients for decreased pressor effect if these agents are administered concomitantly. Azelastine: (Moderate) Monitor for excessive sedation and somnolence during coadministration of azelastine and benzodiazepines. 0000001211 00000 n 2 to 4 mg PO at bedtime as needed. Use of ramelteon 8 mg/day for 11 days and a single dose of zolpidem 10 mg resulted in an increase in the median Tmax of zolpidem of about 20 minutes; exposure to zolpidem was unchanged. To hear audio pronunciation of this topic, purchase a subscription or log in. 2y.-;!KZ ^i"L0- @8(r;q7Ly&Qq4j|9 Use caution with this combination. There is a possibility of interaction with valerian at normal prescription dosages of anxiolytics, sedatives, and hypnotics (including barbiturates and benzodiazepines). 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 concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. 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. Use caution with this combination. To view the entire topic, please log in or purchase a subscription. False study results are possible in patients with drug-induced hyper- or hypo-responsiveness; thorough patient history is important in the interpretation of procedure results. Monitor patients for decreased pressor effect if these agents are administered concomitantly. Use caution with this combination. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Patients with renal impairment receiving high doses of intravenous lorazepam may be more likely to develop propylene glycol toxicity. In animal studies, melatonin has been shown to increase benzodiazepine binding to receptor sites. Pseudoephedrine; Triprolidine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Want to regain access to Davis's Drug Guide? Avoid prescribing opiate cough medications in patients taking benzodiazepines. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Monitor neonates exposed to benzodiazepines during pregnancy, labor, or obstetric delivery for signs of sedation, respiratory depression, or lethargy, and manage accordingly. Zaleplon: (Major) Monitor for excessive sedation and somnolence during coadministration of zaleplon and benzodiazepines. Use of midazolam in healthy subjects who received perampanel 6 mg once daily for 20 days decreased the AUC and Cmax of midazolam by 13% and 15%, respectively, possibly due to weak induction of CYP3A4 by perampanel; the specific clinical significance of this interaction is unknown. Vallerand, A. H., Sanoski, C. A., & Quiring, C. (2023). Dosage for patients with severe hepatic disease should be adjusted carefully according to patient response; lower doses may be sufficient in such patients. The drug has also been given sublingually; although, specific sublingual dosage forms are not available in the United States. Lumateperone: (Moderate) Monitor for excessive sedation and somnolence during coadministration of lumateperone and benzodiazepines. 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. In debilitated adults give 1 to 2 mg/day PO in 2 to 3 divided doses initially. Educate patients about the risks and symptoms of respiratory depression and sedation. Use lowest effective dose. Too much propylene glycol can cause central nervous system toxicity such as seizures and intraventricular hemorrhage, unresponsiveness, tachypnea, tachycardia, and diaphoresis. Even that low dose is difficult to get off of. Concurrent use may result in additive CNS depression. The infant should be monitored regularly, and if sedation, nausea, reduced suckling, or other signs of toxicity are observed, either breast-feeding or the benzodiazepine should be discontinued. Aspirin, ASA; Butalbital; Caffeine; Codeine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Chlorpheniramine; Dihydrocodeine; Phenylephrine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. The safety and efficacy of lorazepam extended-release capsules have not been established in pediatric patients. Add the minimum volume of sterile water necessary for tablet dispersion. Drowsiness or dizziness may last Hydroxychloroquine: (Moderate) Monitor persons with epilepsy for seizure activity during concomitant lorazepam and hydroxychloroquine use. A reduction in dosage of dexmedetomidine or the benzodiazepine may be required. 10 mg/day PO; maximum IM and IV dose highly variable depending upon indication. 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. Meclizine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Do not administer lorazepam injection by intra-arterial injection since arteriospasm can occur which may cause tissue damage and/or gangrene.Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit. 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. 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 a mixed opiate agonist/antagonist, use a lower initial dose of the benzodiazepine and titrate to clinical response. Benzodiazepine activity shows the highest affinity for GABA subtype A receptor modulation compared to subtype B receptors. 0000005452 00000 n 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. Dose range: 0.025 to 0.1 mg/kg/dose. Tiagabine: (Moderate) Because of the possible additive effects of drugs that depress the central nervous system, benzodiazepines should be used with caution in patients receiving tiagabine. Initiate extended-release (ER) dosing with the total daily dose of lorazepam given PO once daily in the morning. Davis AT Collection. Injectable and oral lorazepam formulations are contraindicated in patients with acute closed-angle glaucoma. There's more to see -- the rest of this topic is available only to subscribers. 0000003779 00000 n Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. Monitor patients for decreased pressor effect if these agents are administered concomitantly. These agents include the benzodiazepines. AU - Vallerand,April Hazard, 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. 108 0 obj<>stream Acrivastine; Pseudoephedrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Lorazepam injection is contraindicated in patients with sleep apnea syndrome or severe respiratory insufficiency who are not receiving mechanical ventilation. 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 Belladonna; Opium: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. 0.05 mg/kg PO as a single dose (Max: 4 mg) 45 to 90 minutes prior to procedure. If morphine is initiated in a patient taking a benzodiazepine, reduce initial dosages and titrate to clinical response. HyTSwoc [5laQIBHADED2mtFOE.c}088GNg9w '0 Jb Acetaminophen; Chlorpheniramine; Phenylephrine : (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. HWr|WS;XYI2 (| JZ@OLO8/'N,=e%^"Zvyrz\8/A4EhYH 4y8!xY0FqCKEK:]!`>s_J821Ip >_JRs~!x25H"W/rySjXuX$Q4(cI45%G KRd*9AOO4g(j2C: The risks of physiological dependence and withdrawal increase with longer treatment duration and higher daily dose. Buprenorphine: (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. Measure sodium bicarbonate concentrations at baseline and periodically during dichlorphenamide treatment. DISCONTINUATION: To discontinue, gradually taper the dose. 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. Doxylamine; Pyridoxine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. trailer Lorazepam dosage should be modified depending on clinical response and degree of renal impairment. Acetaminophen; Caffeine; Dihydrocodeine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Patients who present for treatment may have an underlying psychological and/or physiological disturbance such as depression and should be thoroughly evaluated prior to initiation of the drug. Use caution with this combination. 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. Benztropine: (Moderate) CNS depressants, such as anxiolytics, sedatives, and hypnotics, can increase the sedative effects of benztropine. In. Use an initial morphine; naltrexone dose of 20 mg/0.8 mg PO every 24 hours. A1 - Sanoski,Cynthia A, Concurrent use may result in additive CNS depression. Clemastine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. 2. Even that low dose is difficult to get off of. Range: 1 to 10 mg/day PO. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Low dose is difficult to get off of total daily dose of lorazepam extended-release capsules and utilize immediate-release! 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