If you have any of these conditions, you may need a dose adjustment or special tests to safely take this medication. FDA pregnancy category D. Lorazepam can cause birth defects in an unborn baby. Do not use lorazepam without your doctor's consent if you are pregnant. Tell your doctor if you become pregnant during treatment.
Use an effective form of birth control while you are using this medication. It is not known whether lorazepam passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.
The sedative effects of lorazepam may last longer in older adults. Accidental falls are common in elderly patients who take benzodiazepines. Use caution to avoid falling or accidental injury while you are taking lorazepam. Do not give this medication to a child younger than 12 years old. How should I take lorazepam Ativan? Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor.
Follow the directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results from this medication. Measure the liquid form of lorazepam with a special dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one. Lorazepam should be used for only a short time.
Do not take this medication for longer than 4 months without your doctor's advice. Lorazepam may be habit-forming and should be used only by the person it was prescribed for. Lorazepam should never be shared with another person, especially someone who has a history of drug abuse or addiction.
If concurrent use is necessary, use the lowest effective dose and minimum duration possible. If methadone is initiated for pain in an opioid-naive patient taking a benzodiazepine, use an initial methadone dose of 2. If a benzodiazepine is prescribed for an indication other than epilepsy in a patient taking an opiate agonist, use a lower initial benzodiazepine dose and titrate to response. In patients treated with methadone for opioid use disorder, cessation of benzodiazepines or other CNS depressants is preferred in most cases.
Consider alternatives to benzodiazepines for conditions such as anxiety or insomnia during methadone maintenance treatment. Moderate Concurrent use of benzodiazepines and other CNS active medications including skeletal muscle relaxants, can potentiate the CNS effects of either agent. Moderate CNS depression can be increased when methscopolamine is combined with other CNS depressants such as any anxiolytics, sedatives, and hypnotics.
Minor Combined use of metoclopramide and other CNS depressants, such as anxiolytics, sedatives, and hypnotics, can increase possible sedation. Other drugs that may also cause drowsiness, such as benzodiazepines, should be used with caution. Moderate The concomitant administration of metyrosine with benzodiazepines can result in additive sedative effects.
Moderate Concurrent use of many CNS-active drugs with milnacipran or levomilnacipran has not been evaluated by the manufacturer. Therefore, caution is advisable when combining anxiolytics, sedatives, and hypnotics or other psychoactive medications with these medications.
Minor Injectable minocycline contains magnesium sulfate heptahydrate. Because of the CNS-depressant effects of magnesium sulfate, additive central-depressant effects can occur following concurrent administration with CNS depressants such as benzodiazepines.
Moderate Consistent with the pharmacology of mirtazapine and the drug's side effect profile, additive effects may occur with other CNS-active agents, including benzodiazepines. Moderate Consistent with the pharmacology of molindone, additive effects may occur with other CNS active drugs such as anticonvulsants. In addition, seizures have been reported during the use of molindone, which is of particular significance in patients with a seizure disorder receiving anticonvulsants.
Adequate dosages of anticonvulsants should be continued when molindone is added; patients should be monitored for clinical evidence of loss of seizure control or the need for dosage adjustments of either molindone or the anticonvulsant. MAOIs can cause a variable change in seizure patterns, so careful monitoring of the patient with epilepsy is required when benzodiazepines are used in the treatment of epilepsy. If morphine is initiated in a patient taking a benzodiazepine, reduce initial dosages and titrate to clinical response.
For extended-release tablets, start with morphine 15 mg PO every 12 hours, and for extended-release capsules, start with 30 mg PO every 24 hours or less. Moderate Concomitant use of nabilone with other CNS depressants can potentiate the effects of nabilone on respiratory depression. Minor Nitroglycerin can cause hypotension. This action may be additive with other agents that can cause hypotension such as benzodiazepines. Patients should be monitored more closely for hypotension if nitroglycerin is used concurrently with benzodiazepines.
Moderate Additive CNS depression may occur when oxybutynin is used concomitantly with other CNS-depressant drugs, including anxiolytics, sedatives, and hypnotics.
If the extended-release oxymorphone tablets are used concurrently with a CNS depressant, use an initial dosage of 5 mg PO every 12 hours. Moderate Drugs that can cause CNS depression, if used concomitantly with paliperidone, can increase both the frequency and the intensity of adverse effects such as drowsiness, sedation, and dizziness.
Caution should be used when paliperidone is given in combination with other centrally-acting medications including anxiolytics, sedatives, and hypnotics, buprenorphine, butorphanol, dronabinol, THC, ethanol, nabilone, nalbuphine, opiate agonists, and pentazocine.
Moderate Concurrent use of papaverine with potent CNS depressants such as benzodiazepines could lead to enhanced sedation. Major A reduction in seizure threshold has been reported following concomitant administration of pemoline with anticonvulsant agents. Dosage adjustments of anticonvulsants may be necessary during simultaneous use of these drugs.
Moderate Patients taking benzodiazepines with perampanel may experience increased CNS depression. Monitor patients for adverse effects; dose adjustment of either drug may be necessary. Moderate Phenothiazines are CNS depressant drugs that may have cumulative effects when administered concurrently and they should be used cautiously with anxiolytic, sedative, and hypnotic type drugs, such as the benzodiazepines. Caution should be exercised during simultaneous use of these agents due to potential excessive CNS effects or additive hypotension.
Additionally, sleep-related behaviors, such as sleep-driving, are more likely to occur during concurrent use of other CNS depressants than with sedatives alone. Monitor for additive effects, unusual moods or behaviors, and warn about the potential effects to driving and other activities. The CNS depressant effects of topiramate can be potentiated pharmacodynamically by concurrent use of CNS depressant agents such as the benzodiazepines. Concurrent use of topiramate and benzodiazepines associated with thrombocytopenia e.
Moderate Due to the effects of pimozide on cognition, it should be used cautiously with other CNS depressants including benzodiazepines. While more study is needed, benzodiazepine-induced CNS sedation and other adverse effects might be increased in some individuals if DHEA is co-administered. Moderate Pregabalin can potentiate the CNS-depressant action of other drugs such as benzodiazepines.
Moderate Probenecid may inhibit the metabolism of the benzodiazepines, including those which are metabolized by conjugation e. In addition, pretreatment with probenecid shortened the induction time 85 vs. Patients receiving alprazolam therapy should be monitored for signs of altered benzodiazepine response when probenecid is initiated or discontinued. Minor CNS depressants benzodiazepines can potentiate the CNS depression caused by procarbazine therapy, so these drugs should be used together cautiously.
Moderate Mild hepatotoxicity has been reported when pyrimethamine was coadministered with lorazepam. Patients should be monitored for a potential increase in the pharmacologic effect of lorazepam when coadministered with quetiapine.
Somnolence is a commonly reported adverse effect of quetiapine; coadministration of quetiapine with lorazepam may result in additive sedative effects. 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.
Pharmacokinetic interactions have been observed with the use of zolpidem. Ramelteon use with hypnotics of any kind is considered duplicative therapy and these drugs are generally not co-administered.
Moderate The CNS-depressant effects of MAOIs can be potentiated with concomitant administration of other drugs known to cause CNS depression including buprenorphine, butorphanol, dronabinol, THC, nabilone, nalbuphine, and anxiolytics, sedatives, and hypnotics.
Use these drugs cautiously with MAOIs; warn patients to not drive or perform other hazardous activities until they know how a particular drug combination affects them. In some cases, the dosages of the CNS depressants may need to be reduced. 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.
Moderate Concomitant use of ropinirole with other CNS depressants can potentiate the sedation effects of ropinirole.
Major Concomitant use of rotigotine with other CNS depressants, such as benzodiazepines, can potentiate the sedative effects of rotigotine. Moderate Dopaminergic medications, including safinamide, may cause a sudden onset of somnolence which sometimes has resulted in motor vehicle accidents.
Patients may not perceive warning signs, such as excessive drowsiness, or they may report feeling alert immediately prior to the event. Because of possible additive effects, advise patients about the potential for increased somnolence during concurrent use of safinamide with other sedating medications, such as benzodiazepines.
Moderate Sincalide-induced gallbladder ejection fraction may be affected by benzodiazepines. 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. Moderate Concomitant use of skeletal muscle relaxants with benzodiazepines can result in additive CNS depression. Severe Sodium oxybate should not be used in combination with CNS depressant anxiolytics, sedatives, and hypnotics or other sedative CNS depressant drugs.
Specifically, sodium oxybate use is contraindicated in patients being treated with sedative hypnotic drugs. Sodium oxybate GHB has the potential to impair cognitive and motor skills. For example, the concomitant use of barbiturates and benzodiazepines increases sleep duration and may contribute to rapid onset, pronounced CNS depression, respiratory depression, or coma when combined with sodium oxybate.
Moderate CNS depressant drugs may have cumulative effects when administered concurrently and they should be used cautiously with suvorexant. A reduction in dose of the CNS depressant may be needed in some cases. These agents include the benzodiazepines. If tapentadol is initiated in a patient taking a benzodiazepine, a reduced initial dosage of tapentadol is recommended. If the extended-release tapentadol tablets are used concurrently with a benzodiazepine, use an initial tapentadol dose of 50 mg PO every 12 hours.
Moderate Teduglutide may increase absorption of benzodiazepines or other psychotropic agents because of it's pharmacodynamic effect of improving intestinal absorption. In studies with teduglutide, one of the subjects was receiving concomitant treatment with prazepam and experienced dramatic deterioration in mental status progressing to coma during her first week of teduglutide therapy.
Both drugs were discontinued, and the coma resolved 5 days later. Careful monitoring and possible dose adjustment of the psychotropic agent is recommended. Moderate Concurrent use of tetrabenazine and drugs that can cause CNS depression, such as benzodiazepines, can increase both the frequency and the intensity of adverse effects such as drowsiness, sedation, dizziness, and orthostatic hypotension.
Major The use of benzodiazepine anxiolytics, sedatives, or hypnotics with thalidomide may cause an additive sedative effect and should be avoided. Thalidomide frequently causes drowsiness and somnolence.
Dose reductions may be required. Patients should be instructed to avoid situations where drowsiness may be a problem and not to take other medications that may cause drowsiness without adequate medical advice. Moderate Aminophylline has been reported to counteract the pharmacodynamic effects of diazepam. A proposed mechanism is competitive binding of aminophylline to adenosine receptors in the brain.
Whether a similar interaction occurs with other benzodiazepines is not known. If aminophylline therapy is initiated or discontinued, monitor the clinical response to benzodiazepines. Moderate Theophylline has been reported to counteract the pharmacodynamic effects of diazepam. A proposed mechanism is competitive binding of theophylline to adenosine receptors in the brain. If theophylline therapy is initiated or discontinued, monitor the clinical response to benzodiazepines. Moderate Thiothixene can potentiate the CNS-depressant action of other drugs such as benzodiazepines.
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. Moderate Trazodone can lower the seizure threshold of anticonvulsants, although the overall risk is low at therapeutic doses.
Patients may require increased concentrations of anticonvulsants to achieve equivalent effects if trazodone is added. CNS depressants should be used cautiously in patients receiving trazodone because of additive CNS-depressant effects, including possible respiratory depression or hypotension. Moderate Concomitant administration of benzodiazepines with CNS-depressant drugs, such as tricyclic antidepressants, can potentiate the CNS effects of either agent.
Tricyclic antidepressants may also lower the seizure threshold leading to pharmacodynamic interactions with anticonvulsant benzodiazepines i.
The significance of this interaction has not been described; therefore, patients should be monitored closely for symptoms of tricyclic toxicity during coadministration of these agents with alprazolam. Moderate CNS depressants, such as anxiolytics, sedatives, and hypnotics, can increase the sedative effects of trihexyphenidyl. Moderate The concurrent use of trimethobenzamide with other medications that cause CNS depression, like the benzodiazepines, may potentiate the effects of either trimethobenzamide or the benzodiazepine.
Major Any substances that act on the CNS, including psychoactive drugs and drugs used as anesthetic adjuvants e. The valerian derivative, dihydrovaltrate, binds at barbiturate binding sites; valerenic acid has been shown to inhibit enzyme-induced breakdown of GABA in the brain; the non-volatile monoterpenes valepotriates have sedative activity. Safety and effectiveness of Ativan lorazepam in children of less than 12 years have not been established.
As with other benzodiazepines, periodic blood counts and liver function tests are recommended for patients on long-term therapy. Carcinogenesis And Mutagenesis No evidence of carcinogenic potential emerged in rats during an month study with Ativan lorazepam.
No studies regarding mutagenesis have been performed. Pregnancy Reproductive studies in animals were performed in mice, rats, and two strains of rabbits. Occasional anomalies reduction of tarsals, tibia , metatarsals , malrotated limbs, gastroschisis , malformed skull, and microphthalmia were seen in drug-treated rabbits without relationship to dosage.
Although all of these anomalies were not present in the concurrent control group, they have been reported to occur randomly in historical controls. The clinical significance of the above findings is not known. However, an increased risk of congenital malformations associated with the use of minor tranquilizers chlordiazepoxide, diazepam, and meprobamate during the first trimester of pregnancy has been suggested in several studies.
Because the use of these drugs is rarely a matter of urgency, the use of lorazepam during this period should be avoided. The possibility that a woman of childbearing potential may be pregnant at the time of institution of therapy should be considered.
Patients should be advised that if they become pregnant, they should communicate with their physician about the desirability of discontinuing the drug. In humans, blood levels obtained from umbilical cord blood indicate placental transfer of lorazepam and lorazepam glucuronide. Infants of mothers who ingested benzodiazepines for several weeks or more preceding delivery have been reported to have withdrawal symptoms during the postnatal period.
Symptoms such as hypoactivity, hypotonia , hypothermia , respiratory depression, apnea , feeding problems, and impaired metabolic response to cold stress have been reported in neonates born of mothers who have received benzodiazepines during the late phase of pregnancy or at delivery. Nursing Mothers Lorazepam has been detected in human breast milk; therefore, it should not be administered to breastfeeding women, unless the expected benefit to the woman outweighs the potential risk to the infant.
Sedation and inability to suckle have occurred in neonates of lactating mothers taking benzodiazepines. Infants of lactating mothers should be observed for pharmacological effects including sedation and irritability. Clinical circumstances, some of which may be more common in the elderly, such as hepatic or renal impairment, should be considered.
Therefore, in the management of overdosage, it should be borne in mind that multiple agents may have been taken. Symptoms Overdosage of benzodiazepines is usually manifested by varying degrees of central nervous system depression ranging from drowsiness to coma.
In mild cases, symptoms include drowsiness, mental confusion, paradoxical reactions, dysarthria and lethargy. In more serious cases, and especially when other drugs or alcohol were ingested, symptoms may include ataxia , hypotonia , hypotension , cardiovascular depression, respiratory depression, hypnotic state, coma, and death.
Management General supportive and symptomatic measures are recommended; vital signs must be monitored and the patient closely observed. When there is a risk of aspiration , induction of emesis is not recommended. Gastric lavage may be indicated if performed soon after ingestion or in symptomatic patients. Administration of activated charcoal may also limit drug absorption. Hypotension, though unlikely, usually may be controlled with norepinephrine bitartrate injection.
Lorazepam is poorly dialyzable.
When higher dosage is indicated, the evening dose should be increased before the daytime doses. Withdrawal symptoms may include: The physician should periodically reassess the usefulness of the drug for the individual patient, lorazepam dosage in mg. Therefore, these patients should be monitored frequently and have their dosage adjusted carefully according to patient response; the initial dosage should not exceed 2 mg. Concomitant use of clozapine and lorazepam may produce marked sedation, excessive salivation, hypotension, ataxia, deliriumand respiratory arrest. Small decreases in blood pressure and hypotension may occur but are usually not clinically significant, probably being related to the relief of anxiety produced by Ativan lorazepam. Sodium oxybate GHB has the potential to impair cognitive and motor skills. Moderate Hydantoin anticonvulsants can theoretically add to the CNS depressant effects of other CNS depressants including the benzodiazepines. Atropine; Hyoscyamine; Phenobarbital; Scopolamine: Should these occur, use of the drug should be discontinued.
Clinical circumstances, some of which may be more common in the elderly, such as hepatic or renal impairment, should be considered. Human studies suggest that a single short exposure to a general anesthetic in young pediatric patients is unlikely to have negative effects on behavior and learning; however, further research is needed to fully characterize how anesthetic exposure affects brain development. Withdrawal symptoms may include tremor, sweating, muscle crampsstomach pain, lorazepam dosage in mg, vomiting, unusual thoughts or behavior, and seizure convulsions. Therefore, before starting therapy with buspirone, withdraw patients gradually from the benzodiazepine. Management General supportive and symptomatic measures are recommended; vital signs must be monitored and the patient closely observed. Small decreases in blood pressure and hypotension may occur but are usually not clinically significant, probably being related to the relief of anxiety produced by Ativan lorazepam. Metabolic acidosis is associated with the use of dichlorphenamide and has been reported rarely with the use of lorazepam injection for the treatment of status epilepticus. People who are more likely to have this reaction include the elderly, children, and people with a history of alcohol abuse or psychological disturbances. Concomitant use of clozapine and lorazepam may produce marked sedation, excessive salivation, hypotension, ataxia, deliriumand respiratory arrest. The lorazepam of sedation and unsteadiness increased with age. Flumazenil does not reverse the actions of barbiturates, opiate agonists, or tricyclic antidepressants. There is evidence that dosage develops to the sedative effects of benzodiazepines.
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