Co-ingestion may disrupt the extended-release formulation resulting in increased lorazepam exposure and increasing the risk for lorazepam overdose. 0 Lorazepam is an UGT substrate and indinavir is an UGT inhibitor. Educate patients about the risks and symptoms of respiratory depression and sedation. 0000000016 00000 n The Vd is smaller in neonates and slightly larger in non-neonatal pediatric patients. DISCONTINUATION: To discontinue, gradually taper the dose. Aspirin, ASA; Butalbital; Caffeine; Codeine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. 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. 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. Guaifenesin; Hydrocodone; Pseudoephedrine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Educate patients about the risks and symptoms of respiratory depression and sedation. Monitor breastfed infants exposed to benzodiazepines through breast milk for sedation, poor feeding, and poor weight gain. 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. 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. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. WebView topics in the Pharmacological Index benzodiazepines section of Daviss Drug Guide. Chlorpheniramine; Ibuprofen; Pseudoephedrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. If methadone is initiated for pain in an opioid-naive patient taking a benzodiazepine, use an initial methadone dose of 2.5 mg PO every 12 hours. 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. Skeletal Muscle Relaxants: (Moderate) Concomitant use of skeletal muscle relaxants with benzodiazepines can result in additive CNS depression. Lorazepam is an UGT substrate and gemfibrozil is an UGT inhibitor. (Moderate) Monitor for an increase in lorazepam-related adverse reactions and consider reducing the dose of lorazepam if concomitant use of lorazepam and ombitasvir is necessary. Consider the developmental and health benefits of breast-feeding along with the clinical need for lorazepam and any potential adverse effects on the breastfed infant from lorazepam or the underlying condition. Educate patients about the risks and symptoms of respiratory depression and sedation. (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. Azelastine: (Moderate) Monitor for excessive sedation and somnolence during coadministration of azelastine and benzodiazepines. 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. Based on non-neonatal pediatric pharmacokinetic models, lorazepam 0.1 mg/kg (up to 4 mg) is expected to achieve a Cmax of 100 ng/mL; concentrations greater than 30 ng/mL are expected to be maintained for 6 to 12 hours for most pediatric patients. Aspirin, ASA; Caffeine; Orphenadrine: (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. Use caution with this combination. Risk factors for the development of prolonged QT syndrome may include the use of benzodiazepines. Meprobamate: (Moderate) Concomitant administration of benzodiazepines with meprobamate can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Desflurane: (Moderate) Concurrent use with benzodiazepines can decrease the minimum alveolar concentration (MAC) of desflurane needed to produce anesthesia. Skilled care residents: The federal Omnibus Budget Reconciliation Act (OBRA) regulates the use of anxiolytics in long-term care facility (LTCF) residents. 0.05 to 0.1 mg/kg IV or IM as a single dose (Max: 2 to 4 mg). 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. Select Try/Buy and follow instructions to begin your free 30-day trial. 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. Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. 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. 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 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. 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. Mirtazapine: (Moderate) Monitor for unusual drowsiness and sedation during coadministration of benzodiazepines and mirtazapine due to the risk for additive CNS depression. (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. Coadminstration of lorazepam with valproic acid causes increased plasma concentrations and reduced clearance of lorazepam. n3kGz=[==B0FX'+tG,}/Hh8mW2p[AiAN#8$X?AKHI{!7. (Moderate) Drowsiness has been reported during administration of carbetapentane. 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. Patients should be warned of the possibility of drowsiness that may impair performance of potentially hazardous tasks such as driving an automobile or operating machinery. (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. Initially, 2 to 3 mg/day PO given in 2 to 3 divided doses. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. 0000001412 00000 n Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. No standard benzodiazepine tapering schedule is suitable for all patients; therefore, create a patient-specific plan to gradually reduce the dosage. Mefloquine: (Moderate) Coadministration of mefloquine and anticonvulsants may result in lower than expected anticonvulsant concentrations and loss of seizure control. Lofexidine: (Moderate) Monitor for excessive hypotension and sedation during coadministration of lofexidine and benzodiazepines. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. T1 - LORazepam Barbiturates: (Moderate) Additive CNS and/or respiratory depression may occur with concurrent use. 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. COMT inhibitors: (Major) Concomitant administration of benzodiazepines with other drugs have CNS depressant properties, including COMT inhibitors, can potentiate the CNS effects of either agent. If such therapy is initiated or discontinued, monitor the clinical response to the benzodiazepine. 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. 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. Monitor patients for decreased pressor effect if these agents are administered concomitantly. Separate multiple email address with a comma. Max: 4 mg/dose. We're glad you have enjoyed Davis's Drug Guide! Dextromethorphan; Diphenhydramine; Phenylephrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Davis AT Collection. ET - 18 Ombitasvir; Paritaprevir; Ritonavir: (Moderate) Monitor for an increase in lorazepam-related adverse reactions and consider reducing the dose of lorazepam if concomitant use of lorazepam and ombitasvir is necessary. If tapentadol is initiated in a patient taking a benzodiazepine, a reduced initial dosage of tapentadol is recommended. Prasterone, Dehydroepiandrosterone, DHEA (FDA-approved): (Major) Prasterone, dehydroepiandrosterone, DHEA may inhibit the metabolism of benzodiazepines (e.g., alprazolam, estazolam, midazolam) which undergo CYP3A4-mediated metabolism. Glecaprevir; Pibrentasvir: (Moderate) Monitor for an increase in lorazepam-related adverse reactions and consider reducing the dose of lorazepam if concomitant use of lorazepam and glecaprevir is necessary. 10 mg/day PO; maximum IM and IV dose highly variable dependent upon indication. If a benzodiazepine must be used in a patient with a history of falls or fractures, consider reducing use of other CNS-active medications that increase the risk of falls and fractures and implement other strategies to reduce fall risk. If a higher dosage is needed, increase the evening dose before the daytime doses. Carbinoxamine; Pseudoephedrine: (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. Limited data available; 0.025 to 0.05 mg/kg/dose PO every 6 hours as needed for management of anticipatory nausea/vomiting. Educate patients about the risks and symptoms of respiratory depression and sedation. Use caution with this combination. The clinical significance of this interaction is not certain. If the extended-release oxymorphone tablets are used concurrently with a CNS depressant, use an initial dosage of 5 mg PO every 12 hours. Avoid opiate cough medications in patients taking benzodiazepines. @`qhGH[ 4XI3`` ) `uo$!%XvJ8K*21``HbdztiFO#11fe8i'":R u Compounded Oral Suspension (1 mg/mL)Place 180 lorazepam 2 mg tablets in a 12-ounce amber glass bottle. Daridorexant: (Major) Monitor for excessive sedation and somnolence during use of daridorexant with benzodiazepines. Concurrent administration of lorazepam with a UGT inhibitor may result in increased plasma concentrations, reduced clearance, and prolonged half-life of lorazepam. Educate patients about the risks and 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. Max: 2 mg/day PO, unless documentation of need for higher doses is provided. At steady state, AUCTau, Cmax, and Cmin were 694 ng x hour/mL, 35 ng/mL and 25 ng/mL, respectively, following once daily administration of the 3 mg ER capsules. 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 hydromorphone is initiated in a patient taking a benzodiazepine, reduce the initial dosage of hydromorphone and titrate to clinical response; for hydromorphone extended-release tablets, use 1/3 to 1/2 of the estimated hydromorphone starting dose. Ergotamine; 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. Use of PVC containers results in significant drug loss; PVC administration sets can also be expected to contribute to sorption losses.Dilute lorazepam injection with a compatible diluent such as 5% Dextrose Injection (preferred) or 0.9% Sodium Chloride Injection to a final concentration of 0.2 mg/mL. Usual adult dose range is 2 to 4 mg PO at bedtime as needed; use for more than 4 months has not been evaluated. Morphine; Naltrexone: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. 0000004769 00000 n 2. Use an initial morphine; naltrexone dose of 20 mg/0.8 mg PO every 24 hours. The use of benzodiazepines exposes users to risks of abuse, misuse, and addiction, which can lead to overdose or death. 1 to 2 mg IV as a single dose plus diphenhydramine for additional sedation. Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir: (Moderate) Monitor for an increase in lorazepam-related adverse reactions and consider reducing the dose of lorazepam if concomitant use of lorazepam and dasabuvir is necessary. Rotigotine: (Major) Concomitant use of rotigotine with other CNS depressants, such as benzodiazepines, can potentiate the sedative effects of rotigotine. Studies in healthy volunteers show that in single high doses, lorazepam has a tranquilizing action on the central nervous system with usually no appreciable effect on the respiratory or cardiovascular systems. Erlotinib: (Moderate) Monitor for an increase in lorazepam-related adverse reactions and consider reducing the dose of lorazepam if concomitant use of lorazepam and erlotinib is necessary. (Moderate) Additive CNS and/or respiratory depression may occur with concurrent use. If concurrent use is necessary, initiate gabapentin at the lowest recommended dose and monitor patients for symptoms of respiratory depression and sedation. Clemastine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. If 3 intermittent boluses of lorazepam are needed in a 6 hour time period, increase the infusion rate by 0.005 mg/kg/hour (50% of initial rate). Educate patients about the risks and symptoms of respiratory depression and sedation. 1 mg IV as a single dose, initially; may repeat dose after 5 minutes if chest pain persists. Segesterone Acetate; Ethinyl Estradiol: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. If you need further assistance, please contact Support. 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. Avoid prescribing opiate cough medications in patients taking benzodiazepines. Flumazenil does not affect the pharmacokinetics of the benzodiazepines. Davis AT Collection is a subscription There is a possibility of interaction with valerian at normal prescription dosages of anxiolytics, sedatives, and hypnotics (including barbiturates and benzodiazepines). 0000009584 00000 n During the treatment of status epilepticus, the use of injectable benzodiazepines, like lorazepam, is often implemented as an adjunct to other supportive therapies. 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 a mixed opiate agonist/antagonist, 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. Avoid prescribing opiate cough medications in patients taking benzodiazepines. Levonorgestrel; Ethinyl Estradiol: (Minor) Ethinyl estradiol may enhance the metabolism of lorazepam. If a benzodiazepine is required during pregnancy, avoid first trimester administration if possible, consider short-acting agents, limit treatment to the lowest effective dosage and duration, and discontinue the drug well before delivery. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. 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. Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. 1. startxref Patient counseling is important, as cisapride alone does not cause drowsiness or affect psychomotor function. 10 mg/day PO; maximum IM and IV dose highly variable depending upon indication. No specific anesthetic or sedation drug has been shown to be safer than another. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Specific maximum dosage information not available; the dose required is dependent on route of administration, indication, and clinical response.1 to 11 years: Safety and efficacy have not been established. Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. startxref Use caution with this combination. Usual Dose Range: 2 to 6 mg/day; Max: 10 mg/day PO. Safety and efficacy of extended-release capsules and parenteral lorazepam have not been established. Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. Diphenhydramine; Phenylephrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. If used together, a reduction in the dose of one or both drugs may be needed. 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. 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. Specifically, sodium oxybate use is contraindicated in patients being treated with sedative hypnotic drugs. 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.". Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. CNS depressants can potentiate the effects of stiripentol. Codeine; Guaifenesin; Pseudoephedrine: (Major) Concomitant use of opiate agonists 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. Dose range: 0.025 to 0.1 mg/kg/dose. In another case report, the ingestion of excessive melatonin along with normal doses of chlordiazepoxide and an antidepressant resulted in lethargy and short-term amnestic responses. Carefully evaluate each syringe/bag before administration.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 or glass containers. xref 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). 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. Difelikefalin: (Moderate) Monitor for dizziness, somnolence, mental status changes, and gait disturbances if concomitant use of difelikefalin with CNS depressants is necessary. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, use the lowest effective dose and minimum duration possible. 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. Butorphanol: (Major) Concomitant use of mixed opiate agonists/antagonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. coma / Early / 0.1-1.2seizures / Delayed / 0-1.0apnea / Delayed / 1.0muscle paralysis / Delayed / Incidence not knownsuicidal ideation / Delayed / Incidence not knownneuroleptic malignant syndrome-like symptoms / Delayed / Incidence not knownpulmonary edema / Early / Incidence not knownrespiratory arrest / Rapid / Incidence not knownpulmonary hypertension / Delayed / Incidence not knownpneumothorax / Early / Incidence not knownGI bleeding / Delayed / Incidence not knowntissue necrosis / Early / Incidence not knownrenal tubular necrosis / Delayed / Incidence not knownSIADH / Delayed / Incidence not knownlactic acidosis / Delayed / Incidence not knownanaphylactoid reactions / Rapid / Incidence not knownpericardial effusion / Delayed / Incidence not knownheart failure / Delayed / Incidence not knowncardiac arrest / Early / Incidence not knownbradycardia / Rapid / Incidence not knownAV block / Early / Incidence not knownhearing loss / Delayed / Incidence not knownpancytopenia / Delayed / Incidence not knownagranulocytosis / Delayed / Incidence not knowncoagulopathy / Delayed / Incidence not knownneonatal respiratory depression / Rapid / Incidence not knownneonatal abstinence syndrome / Early / Incidence not known, erythema / Early / 2.0-2.4hypotension / Rapid / 0.1-2.4confusion / Early / 0.1-1.3depression / Delayed / 1.3-1.3delirium / Early / 1.3-1.3hypoventilation / Rapid / 0.1-1.2ataxia / Delayed / 0.1-1.0hallucinations / Early / 0.1-1.0elevated hepatic enzymes / Delayed / 0-1.0cystitis / Delayed / 0-1.0metabolic acidosis / Delayed / 0-1.0dysarthria / Delayed / Incidence not knowneuphoria / Early / Incidence not knownamnesia / Delayed / Incidence not knownmemory impairment / Delayed / Incidence not knownpsychosis / Early / Incidence not knownhostility / Early / Incidence not knownmania / Early / Incidence not knownhyperreflexia / Delayed / Incidence not knownrespiratory depression / Rapid / Incidence not knownhypoxia / Early / Incidence not knownmyoclonia / Delayed / Incidence not knownjaundice / Delayed / Incidence not knownhyperbilirubinemia / Delayed / Incidence not knownconstipation / Delayed / Incidence not knownhyponatremia / Delayed / Incidence not knownurinary incontinence / Early / Incidence not knownimpotence (erectile dysfunction) / Delayed / Incidence not knownsinus tachycardia / Rapid / Incidence not knownhypertension / Early / Incidence not knownblurred vision / Early / Incidence not knownleukopenia / Delayed / Incidence not knownthrombocytopenia / Delayed / Incidence not knowntolerance / Delayed / Incidence not knownpsychological dependence / Delayed / Incidence not knownwithdrawal / Early / Incidence not knownphysiological dependence / Delayed / Incidence not known, injection site reaction / Rapid / 0.5-17.0drowsiness / Early / 1.5-15.9dizziness / Early / 6.9-6.9weakness / Early / 4.2-4.2restlessness / Early / 1.3-1.3headache / Early / 0.1-1.2asthenia / Delayed / 0.1-1.0agitation / Early / 0.1-1.0tremor / Early / 0.1-1.0hyperventilation / Early / 0.1-1.0nausea / Early / 0-1.0hypersalivation / Early / 0.1-1.0vomiting / Early / 0-1.0infection / Delayed / 0-1.0chills / Rapid / 0-1.0vertigo / Early / Incidence not knownfatigue / Early / Incidence not knowninsomnia / Early / Incidence not knownanxiety / Delayed / Incidence not knownnightmares / Early / Incidence not knownirritability / Delayed / Incidence not knownhyperactivity / Early / Incidence not knowndiarrhea / Early / Incidence not knownhypothermia / Delayed / Incidence not knownlibido decrease / Delayed / Incidence not knownorgasm dysfunction / Delayed / Incidence not knownrash / Early / Incidence not knownalopecia / Delayed / Incidence not knowndiplopia / Early / Incidence not known. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. [41537] [52904] [52949] Repeated or lengthy use of general anesthetic and sedation drugs during surgeries or procedures in neonates, infants, and children younger than 3 years, including in utero exposure during the third trimester, may have negative effects on brain development. Use caution with this combination. Lumateperone: (Moderate) Monitor for excessive sedation and somnolence during coadministration of lumateperone and benzodiazepines. Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. 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. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. dark urine, or jaundice (yellowing of the skin or eyes). Taking 7.5 mirtazapine for sleep while tapering Remimazolam: (Major) The sedative effect of remimazolam can be accentuated by lorazepam. Educate patients about the risks and symptoms of respiratory depression and sedation. Download the Nursing Central app by Unbound Medicine, 2. (Moderate) Scopolamine may cause dizziness and drowsiness. Even that low dose is difficult to get off of. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. 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. Patients who are taking barbiturates or other sedative/hypnotic drugs should avoid concomitant administration of valerian. 0000003779 00000 n F.A. Butalbital; Acetaminophen; Caffeine; Codeine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Safinamide: (Moderate) Dopaminergic medications, including safinamide, may cause a sudden onset of somnolence which sometimes has resulted in motor vehicle accidents. Risperidone: (Moderate) Due to the primary CNS effects of risperidone, caution should be used when risperidone is given in combination with other centrally acting medications including anxiolytics, sedatives, and hypnotics. Guanabenz: (Moderate) Guanabenz is associated with sedative effects. If used with a benzodiazepine, droperidol should be initiated at a low dose and adjusted upward, with caution, as needed to achieve the desired effect. Use caution with this combination. Vallerand AHA, Sanoski CAC, Quiring CC. Buprenorphine: (Major) Concomitant use of mixed opiate agonists/antagonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Administer the morning after the day of discontinuation of a lorazepam immediate-release (IR) product. Avoid opiate cough medications in patients taking benzodiazepines. Look up information on diseases, tests, and procedures; then consult the database with 5,000+ drugs or refer to 65,000+ dictionary terms. 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 activity shows the highest affinity for GABA subtype A receptor modulation compared to subtype B receptors. Atazanavir: (Moderate) Monitor for an increase in lorazepam-related adverse reactions and consider reducing the dose of lorazepam if concomitant use of lorazepam and atazanavir is necessary. Avoid use of benzodiazepines in older adults with the following due to the potential for symptom exacerbation or adverse effects: delirium (new-onset or worsening delirium), dementia (adverse CNS effects), and history of falls/fractures (ataxia, impaired psychomotor function, syncope, and additional falls). 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. Highest affinity for GABA subtype a receptor modulation compared to subtype B receptors minimum duration possible anticonvulsant concentrations and of... 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