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Lorazepam Disease Interactions

There are 12 disease interactions with lorazepam.

Major

Benzodiazepines (applies to lorazepam) acute alcohol intoxication

Major Potential Hazard, High plausibility.

The use of benzodiazepines with alcohol is not recommended. Patients with acute alcohol intoxication exhibit depressed vital signs. The central nervous system depressant effects of benzodiazepines may be additive with those of alcohol, and severe respiratory depression and death may occur. Therapy with benzodiazepines should be administered cautiously in patients who might be prone to acute alcohol intake.

References

  1. "Product Information. Xanax (alprazolam)." Pharmacia and Upjohn (2002):
  2. "Product Information. Valium (diazepam)." Roche Laboratories (2002):
  3. "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories (2002):
  4. "Product Information. Serax (oxazepam)." Wyeth-Ayerst Laboratories (2001):
  5. "Product Information. Restoril (temazepam)." Sandoz Pharmaceuticals Corporation (2001):
  6. "Product Information. Halcion (triazolam)." Pharmacia and Upjohn (2001):
  7. "Product Information. Dalmane (flurazepam)." Roche Laboratories (2001):
  8. "Product Information. Tranxene (clorazepate)." Abbott Pharmaceutical (2001):
  9. "Product Information. Klonopin (clonazepam)." Roche Laboratories (2001):
  10. "Product Information. ProSom (estazolam)." Abbott Pharmaceutical, Abbott Park, IL.
  11. "Product Information. Librium (chlordiazepoxide)." Roche Laboratories (2001):
  12. "Product Information. Doral (quazepam)." Wallace Laboratories (2001):
  13. "Product Information. Versed (midazolam)." Roche Laboratories (2001):
  14. "Product Information. Onfi (clobazam)." Lundbeck Inc (2011):
View all 14 references
Major

Benzodiazepines (applies to lorazepam) closed-angle glaucoma

Major Potential Hazard, Low plausibility. Applicable conditions: Glaucoma/Intraocular Hypertension

The manufacturers consider the use of benzodiazepines to be contraindicated in patients with acute angle-closure glaucoma or untreated open-angle glaucoma. These agents do not possess anticholinergic activity but have very rarely been associated with increased intraocular pressure.

References

  1. "Product Information. Xanax (alprazolam)." Pharmacia and Upjohn (2002):
  2. "Product Information. Valium (diazepam)." Roche Laboratories (2002):
  3. "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories (2002):
  4. "Product Information. Serax (oxazepam)." Wyeth-Ayerst Laboratories (2001):
  5. "Product Information. Restoril (temazepam)." Sandoz Pharmaceuticals Corporation (2001):
  6. "Product Information. Halcion (triazolam)." Pharmacia and Upjohn (2001):
  7. "Product Information. Dalmane (flurazepam)." Roche Laboratories (2001):
  8. "Product Information. Tranxene (clorazepate)." Abbott Pharmaceutical (2001):
  9. "Product Information. Klonopin (clonazepam)." Roche Laboratories (2001):
  10. "Product Information. ProSom (estazolam)." Abbott Pharmaceutical, Abbott Park, IL.
  11. "Product Information. Librium (chlordiazepoxide)." Roche Laboratories (2001):
  12. "Product Information. Doral (quazepam)." Wallace Laboratories (2001):
  13. "Product Information. Versed (midazolam)." Roche Laboratories (2001):
  14. Fraunfelder FT, Fraunfelder FW; Randall JA "Drug-Induced Ocular Side Effects" Boston, MA: Butterworth-Heinemann (2001):
View all 14 references
Major

Benzodiazepines (applies to lorazepam) drug dependence

Major Potential Hazard, High plausibility. Applicable conditions: Drug Abuse/Dependence

Benzodiazepines have the potential to cause dependence and abuse. Tolerance as well as physical and psychological dependence can develop, particularly after prolonged use and/or excessive dosages. However, abrupt cessation following continual use of as few as 6 weeks at therapeutic levels has occasionally precipitated withdrawal symptoms. Addiction- prone individuals, such as those with a history of alcohol or substance abuse, should be under careful surveillance when treated with benzodiazepines. It may be prudent to refrain from dispensing large quantities of medication to these patients. After prolonged use or if dependency is suspected, withdrawal of benzodiazepine therapy should be undertaken gradually using a dosage- tapering schedule. If withdrawal symptoms occur, temporary reinstitution of benzodiazepines may be necessary.

References

  1. "Product Information. Xanax (alprazolam)." Pharmacia and Upjohn (2002):
  2. "Product Information. Valium (diazepam)." Roche Laboratories (2002):
  3. "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories (2002):
  4. "Product Information. Serax (oxazepam)." Wyeth-Ayerst Laboratories (2001):
  5. "Product Information. Restoril (temazepam)." Sandoz Pharmaceuticals Corporation (2001):
  6. "Product Information. Halcion (triazolam)." Pharmacia and Upjohn (2001):
  7. "Product Information. Dalmane (flurazepam)." Roche Laboratories (2001):
  8. "Product Information. Tranxene (clorazepate)." Abbott Pharmaceutical (2001):
  9. "Product Information. Klonopin (clonazepam)." Roche Laboratories (2001):
  10. "Product Information. ProSom (estazolam)." Abbott Pharmaceutical, Abbott Park, IL.
  11. "Product Information. Librium (chlordiazepoxide)." Roche Laboratories (2001):
  12. "Product Information. Doral (quazepam)." Wallace Laboratories (2001):
  13. "Product Information. Onfi (clobazam)." Lundbeck Inc (2011):
  14. "Product Information. Byfavo (remimazolam)." Acacia Pharma, Inc (2020):
View all 14 references
Major

Benzodiazepines (applies to lorazepam) renal/liver disease

Major Potential Hazard, Moderate plausibility. Applicable conditions: Renal Dysfunction

Benzodiazepines are metabolized by the liver, and the metabolites are excreted in the urine. Chlordiazepoxide, clorazepate, diazepam, flurazepam and quazepam undergo oxidative N-dealkylation to active metabolites that are substantially longer-acting than the parent compound. These metabolites then undergo further biotransformation to pharmacologically inactive products before excretion by the kidney. Therapy with benzodiazepines should be administered cautiously at lower initial dosages in patients with impaired renal and/or hepatic function. Agents that are converted to weakly active, short-acting, or inactive metabolites may be preferable in hepatic impairment. Lorazepam, oxazepam and temazepam are conjugated to inactive metabolites, while alprazolam, estazolam and triazolam undergo hydroxylation to weakly active or inactive metabolites.

References

  1. Sellers EM, Giles HG, Greenblatt DJ, et al. "Chlordiazepoxide and oxazepam disposition in cirrhosis." Clin Pharmacol Ther 26 (1979): 240-6
  2. Hicks R, Davis JM, Dysken MW, et al. "The pharmacokinetics of psychotropic medication in the elderly: a review." J Clin Psychiatry 42 (1981): 374-85
  3. Koepke HH, Walker BR, Chiang ST, Murray TG "Renal disease, age, and oxazepam kinetics." Clin Pharmacol Ther 30 (1981): 805-9
  4. Hoyumpa AM "Disposition and elimination of minor tranquilizers in the aged and in patients with liver disease." South Med J 71 (1978): 23-8
  5. Desmond PV, Kraus JW, Marshall JP, Wilkinson GR, Johnson RF, Schenker S "Effects of age and liver disease on disposition of lorazepam." Clin Pharmacol Ther 24 (1978): 411-9
  6. de Schepper PJ, Tjandramaga TB, Verberckmoes R, Verbeeck RK "Impaired elimination of lorazepam following subchronic administration in two patients with renal failure." Br J Clin Pharmacol 12 (1981): 749-50
  7. Greenblatt DJ "Clinical pharmacokinetics of oxazepam and lorazepam." Clin Pharmacokinet 6 (1981): 89-105
  8. Koepke HH, Walker BR, Morrison G, Chiang ST "Effect of renal impairment and hemodialysis on lorazepam kinetics." Clin Pharmacol Ther 35 (1984): 646-52
  9. Avant GR, Klotz U, Hoyumpa A, Schenker S, Wikinson GR "The effects of age and liver disease on the disposition and elimination of diazepam in adult man." J Clin Invest 55 (1975): 347-59
  10. Blair AD, Cutler RE "Pharmacokinetics of diazepam in normal and uremic humans." Clin Pharmacol Ther 25 (1979): 219-20
  11. Abernathy DR, Divoll M, Greenblatt DJ, Kaschell HJ, Klehr U, Ochs HR "Diazepam kinetics in patients with renal insufficiency or hyperthyroidism." Br J Clin Pharmacol 12 (1981): 829-32
  12. Piraino B, Smith RB, Kroboth PD, Schmith VD "Alprazolam in end-stage renal disease: I. Pharmacokinetics." J Clin Pharmacol 31 (1991): 571-9
  13. Agrell B, Liden A, Moser G, Olsen I, Dehlin O, Kullingsjo H "Pharmacokinetics of alprazolam in geriatric patients with neurotic depression." Pharmacol Toxicol 68 (1991): 121-4
  14. Sellers EM, Giles HG, Greenblatt DJ, et al. "Chlordiazepoxide and oxazepam disposition in cirrhosis." Clin Pharmacol Ther 26 (1979): 240-6
  15. Robinson JD, Morgan DD, Mendenhall CL "Clinical pharmacokinetics of chlordiazepoxide in patients with alcoholic hepatitis." Eur J Clin Pharmacol 19 (1981): 279-85
  16. Tedesco FJ, Mills LR "Diazepam (valium) hepatitis." Dig Dis Sci 27 (1982): 470-2
  17. de Silva JAF, Strojny N "Determination of flurazepam and its major biotransformation products in blood and urine by spectrophotofluorometry and spectrophotometry." J Pharm Sci 60 (1971): 1303-14
  18. de Silva JAF, Kaplan SA, Jack ML, et al. "Blood level profile in man following chronic oral administration of flurazepam hydrochloride." J Pharm Sci 62 (1973): 1932-5
  19. Harmatz JJ, Divoll M, Greenblatt DJ "Kinetics and clinical effects of flurazepam in young and elderly noninsomniacs." Clin Pharmacol Ther 30 (1981): 475-86
  20. Desmond PV, Watson KJ, Ghabrial H, et al. "The effects of age and chronic liver disease on the elimination of temazepam." Eur J Clin Pharmacol 30 (1986): 93-7
  21. Koss FW, Molzahn M, Bozler G, Busch U "Pharmacokinetics of oxazepam following multiple administration in volunteers and patients with chronic renal disease." Arzneimittelforschung 31 (1981): 1507-11
  22. Smith RB, Dittert LW, Juhl RP, Van Thiel DH "Alprazolam pharmacokinetics in alcoholic liver disease." J Clin Pharmacol 24 (1984): 113-9
  23. Carter J, Holt JH, Ozawa T, Johnson J, Padilla BG "Adverse effects of flurazepam in a hemodialysis patient." J Am Assoc Nephrol Nurses Tech 4 (1977): 93-5
  24. Smith RB, Kroboth PD, Rault R, Juhl RP, Puschett JB, Silver MR, Sorkin MI "Effects of end-stage renal disease and aluminum hydroxide on temazepam kinetics." Clin Pharmacol Ther 37 (1985): 453-9
  25. Moretti-Ojemann L, Troupin AS, Levy RH, Wilensky AJ "Clorazepate kinetics in treated epileptics." Clin Pharmacol Ther 24 (1978): 22-30
  26. Divoll MK, Soong MH, Shader RI, Boxenbaum HG, Greenblatt DJ, Harmatz JS "Desmethyldiazepam pharmacokinetics: studies following intravenous and oral desmethyldiazepam, oral clorazepate, and intravenous diazepam." J Clin Pharmacol 28 (1988): 853-9
  27. Rauh HW, Greenblatt DJ, Kaschell HJ, Ochs HR "Clorazepate dipotassium and diazepam in renal insufficiency: serum concentrations and protein binding of diazepam and desmethyldiazepam." Nephron 37 (1984): 100-4
  28. Branch RA, Roberts RK, Wilkinson GR, Schenker S "Effect of age and parenchymal liver disease on the disposition and elimination of chlordiazepoxide (librium)." Gastroenterology 75 (1978): 479-85
  29. Smith RB, Kroboth PD, Rault R, Juhl RP, Puschett JB, Silver MR, Sorkin MI "Effects of end stage renal disease and aluminium hydroxide on triazolam pharmacokinetics." Br J Clin Pharmacol 19 (1985): 839-42
  30. Smith RB, Kroboth PD, Juhl RP, Van Thiel DH "Nighttime dosing of triazolam in patients with liver disease and normal subjects: kinetics and daytime effects." J Clin Pharmacol 27 (1987): 555-60
  31. Chung M, Gural R, Hilbert JM, Radwanski E, Symchowicz S, Zampaglione N "Quazepam kinetics in the elderly." Clin Pharmacol Ther 36 (1984): 566-9
  32. Gural RP, Chung M, Hilbert JM, Radwanski E, Symchowicz S, Zampaglione N "Multiple-dose quazepam kinetics." Clin Pharmacol Ther 35 (1984): 520-4
  33. Gustavson LE, Carrigan PJ "The clinical pharmacokinetics of single doses of estazolam." Am J Med 88 (1990): s2-5
  34. Arnold JD, Allen MD, Greenblatt DJ "Single- and multiple-dose kinetics of estazolam, a triazolo benzodiazepine." Psychopharmacology (Berl) 66 (1979): 267-74
  35. "Product Information. Xanax (alprazolam)." Pharmacia and Upjohn (2002):
  36. "Product Information. Valium (diazepam)." Roche Laboratories (2002):
  37. "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories (2002):
  38. "Product Information. Serax (oxazepam)." Wyeth-Ayerst Laboratories (2001):
  39. "Product Information. Restoril (temazepam)." Sandoz Pharmaceuticals Corporation (2001):
  40. "Product Information. Halcion (triazolam)." Pharmacia and Upjohn (2001):
  41. "Product Information. Dalmane (flurazepam)." Roche Laboratories (2001):
  42. "Product Information. Tranxene (clorazepate)." Abbott Pharmaceutical (2001):
  43. "Product Information. Klonopin (clonazepam)." Roche Laboratories (2001):
  44. "Product Information. ProSom (estazolam)." Abbott Pharmaceutical, Abbott Park, IL.
  45. "Product Information. Librium (chlordiazepoxide)." Roche Laboratories (2001):
  46. "Product Information. Doral (quazepam)." Wallace Laboratories (2001):
  47. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
View all 47 references
Major

Benzodiazepines (applies to lorazepam) respiratory depression

Major Potential Hazard, High plausibility. Applicable conditions: Pulmonary Impairment, Asphyxia, Respiratory Arrest

Benzodiazepines may cause respiratory depression and apnea, usually when given in high dosages and/or by intravenous administration. However, some patients may be susceptible at commonly used dosages, including the elderly, debilitated or severely ill patients, those receiving other CNS depressants, and those with limited ventilatory reserve, chronic pulmonary insufficiency or other respiratory disorders. Therapy with benzodiazepines should be administered cautiously in these patients. Appropriate monitoring and individualization of dosage are particularly important, and equipment for resuscitation should be immediately available if the parenteral route is used. Benzodiazepines, especially injectable formulations, should generally be avoided in patients with sleep apnea, severe respiratory insufficiency, or hypoxia.

References

  1. Iber FL, Kruss DM, Livak A "Apnea and cardiopulmonary arrest during and after endoscopy." J Clin Gastroenterol 14 (1992): 109-13
  2. Cohen S, Khan A "Respiratory distress with use of lorazepam in mania." J Clin Psychopharmacol 7 (1987): 199-200
  3. Donaldson D, Gibson G "System complications with intravenous diazepam." Oral Surg Oral Med Oral Patho 49 (1980): 126-30
  4. Eldridge PR, Punt JA "Risks associated with giving benzodiazepines to patients with acute neurological injuries." Br Med J 300 (1990): 1189-90
  5. Hsu K, Man GC, Sproule BJ "Effect of alprazolam on exercise and dyspnea in patients with chronic obstructive pulmonary disease." Chest 90 (1986): 832-6
  6. Garnett D, Gillin JC, Weingartner H, Greenblatt DJ, Mendelson WB "A clinical study of flurazepam." Sleep 5 (1982): 350-60
  7. "Product Information. Xanax (alprazolam)." Pharmacia and Upjohn (2002):
  8. "Product Information. Valium (diazepam)." Roche Laboratories (2002):
  9. "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories (2002):
  10. "Product Information. Serax (oxazepam)." Wyeth-Ayerst Laboratories (2001):
  11. "Product Information. Restoril (temazepam)." Sandoz Pharmaceuticals Corporation (2001):
  12. Groves LJ, Pierce MW, Shu VS "Safety of estazolam. The United States clinical experience." Am J Med 88 (1990): s12-7
  13. Badr S, Juan D, Skatrud JB, Begle RL "Ventilatory response to single, high dose estazolam in healthy humans." J Clin Pharmacol 30 (1990): 543-8
  14. Jr, Sullivan RJ "Respiratory depression requiring ventilatory support following 0.5 mg of triazolam." J Am Geriatr Soc 37 (1989): 450-2
  15. "Product Information. Halcion (triazolam)." Pharmacia and Upjohn (2001):
  16. "Product Information. Dalmane (flurazepam)." Roche Laboratories (2001):
  17. Berry DJ, Model DG "Effects of chlordiazepoxide in respiratory failure due to chronic bronchitis." Lancet 2 (1974): 869-70
  18. Dixon D "Respiratory depression following midazolam." Anaesthesia 40 (1985): 922
  19. Elstad MR, Jr Whittaker SE, Yakel DL "Midazolam-induced angioedema and bronchoconstriction." Crit Care Med 20 (1992): 307-8
  20. Eriksson I, Sunzel M, Berggren L, Mollenholt P "Changes in respiratory pattern after repeated doses of diazepam and midazolam in healthy subjects." Acta Anaesthesiol Scand 31 (1987): 667-72
  21. Taylor JW, Simon KB "Possible intramuscular midazolam-associated cardiorespiratory arrest and death." DICP 24 (1990): 695-7
  22. Bugedo GJ, Munoz HR, Dagnino JA, Rufs JA "Benzodiazepine premedication causes hypoxemia during spinal anesthesia in geriatric patients." Reg Anesth 17 (1992): 139-42
  23. "Product Information. Tranxene (clorazepate)." Abbott Pharmaceutical (2001):
  24. "Product Information. Klonopin (clonazepam)." Roche Laboratories (2001):
  25. "Product Information. ProSom (estazolam)." Abbott Pharmaceutical, Abbott Park, IL.
  26. "Product Information. Librium (chlordiazepoxide)." Roche Laboratories (2001):
  27. Erskine R, Murphy PJ, Langton JA "The effect of intravenously administered diazepam, midazolam and flumazenil on the sensitivity of upper airway reflexes." Anaesthesia 49 (1994): 105-10
  28. "Product Information. Doral (quazepam)." Wallace Laboratories (2001):
  29. "Product Information. Versed (midazolam)." Roche Laboratories (2001):
  30. Berry RB, Bower J, Light RW, Prosise G, Kouchi K "Triazolam in patients with obstructive sleep apnea." Am J Respir Crit Care Med 151 (1995): 450-4
  31. "Product Information. Byfavo (remimazolam)." Acacia Pharma, Inc (2020):
View all 31 references
Major

Benzodiazepines (applies to lorazepam) seizures

Major Potential Hazard, Moderate plausibility.

The use of benzodiazepines in patients with seizure disorders may increase the incidence or precipitate the onset of generalized tonic-clonic seizures (grand mal). Appropriate anticonvulsant medication might need to be initiated or the dosage increased. Abrupt cessation of benzodiazepine therapy may precipitate seizures and other withdrawal symptoms, particularly after prolonged use and/or excessive dosages. Status epilepticus may occur in patients with a history of seizures withdrawn rapidly from benzodiazepine therapy. Following chronic administration, cessation of benzodiazepine therapy should occur gradually with incrementally reduced dosages. Patients should be advised not to discontinue medication without first consulting with the physician.

References

  1. Ananth J "Abstinence syndrome from therapeutic doses of oxazepam." Can J Psychiatry 28 (1983): 592
  2. Wilbur R, Kulik AV "Abstinence syndrome from therapeutic doses of oxazepam." Can J Psychiatry 28 (1983): 298-300
  3. Busto U, Sellers EM, Naranjo CA, et al. "Withdrawal reaction after long-term therapeutic use of benzodiazepines." N Engl J Med 315 (1986): 854-9
  4. Billings RF, Hersch EL "Acute confusional state with status petit mal as a withdrawal syndrome: and five year follow-up." Can J Psychiatry 33 (1988): 157-9
  5. Howe JG "Lorazepam withdrawal seizures." Br Med J 280 (1980): 1163-4
  6. Jacoby JA, Bixler EO, Kales JD, Soldatos CR, Kales A "Lorazepam: effects on sleep and withdrawal phenomena." Pharmacology 32 (1986): 121-30
  7. Sellers EM, Robinson GM "Diazepam withdrawal seizures." Can Med Assoc J 126 (1982): 944-5
  8. Browne JL, Hauge KJ "A review of alprazolam withdrawal." Drug Intell Clin Pharm 20 (1986): 837-41
  9. Gauthier S, Ghadirian AM, Wong T "Convulsions in patients abruptly withdrawn from clonazepam while receiving neuroleptic medication ." Am J Psychiatry 144 (1987): 686
  10. De Bellis M, Post RM, Theodore WH, Devinsky O, Hauser P "Benzodiazepine withdrawal delirium with catatonic features. Occurrence in patients with partial seizure disorders." Arch Neurol 46 (1989): 696-9
  11. Boenigk HE, Specht U, Wolf P "Discontinuation of clonazepam after long-term treatment." Epilepsia 30 (1989): 458-63
  12. Alvarez N, Doubt C, Hartford E "Epileptic seizures induced by clonazepam." Clin Electroencephalogr 12 (1981): 57-65
  13. Conell LJ, Berlin RM "Withdrawal symptoms after long-term treatment with therapeutic doses of flurazepam: a case report." Am J Psychiatry 140 (1983): 488-90
  14. Bond WS, Schwartz M "Withdrawal reactions after long-term treatment with flurazepam." Clin Pharm 3 (1984): 316-8
  15. "Product Information. Xanax (alprazolam)." Pharmacia and Upjohn (2002):
  16. "Product Information. Valium (diazepam)." Roche Laboratories (2002):
  17. "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories (2002):
  18. "Product Information. Serax (oxazepam)." Wyeth-Ayerst Laboratories (2001):
  19. "Product Information. Restoril (temazepam)." Sandoz Pharmaceuticals Corporation (2001):
  20. Gujavarty KS, Tien AY "Seizure following withdrawal from triazolam." Am J Psychiatry 142 (1985): 1516-7
  21. Patterson WM "Triazolam withdrawal." J Clin Psychiatry 49 (1988): 369
  22. Pawluczyk S, Syapin PJ, Schneider LS "Seizures following triazolam withdrawal despite benzodiazepine treatment." J Clin Psychiatry 48 (1987): 418-9
  23. "Product Information. Halcion (triazolam)." Pharmacia and Upjohn (2001):
  24. "Product Information. Dalmane (flurazepam)." Roche Laboratories (2001):
  25. Boisse NR, Ryan GP "Experimental induction of benzodiazepine tolerance and physical dependence." J Pharmacol Exp Ther 226 (1983): 100-7
  26. Petursson H, Lader MH "Benzodiazepine dependence." Br J Addict 76 (1981): 133-45
  27. Jr, Finley PR, Nolan PE "Precipitation of benzodiazepine withdrawal following sudden discontinuation of midazolam." DICP 23 (1989): 151-2
  28. "Product Information. Tranxene (clorazepate)." Abbott Pharmaceutical (2001):
  29. "Product Information. Klonopin (clonazepam)." Roche Laboratories (2001):
  30. "Product Information. ProSom (estazolam)." Abbott Pharmaceutical, Abbott Park, IL.
  31. "Product Information. Librium (chlordiazepoxide)." Roche Laboratories (2001):
  32. Cowley DS, Ries RK, Roy-Byrne PP, Sullivan MD "Adjunctive treatment of benzodiazepine discontinuation syndromes - a review." J Psychiatr Res 27 Suppl (1993): 143-53
  33. "Product Information. Doral (quazepam)." Wallace Laboratories (2001):
  34. "Product Information. Versed (midazolam)." Roche Laboratories (2001):
  35. Albizzati MG, Bassi S, Borghi C, Frattola L, Garreau M, Morselli PL, Piolti R "Comparison of the efficacy, safety and withdrawal of alpidem and alprazolam in anxious patients." Br J Psychiatry 165 (1994): 94-100
View all 35 references
Major

Benzodiazepines (iv/im) (applies to lorazepam) prolonged hypotension

Major Potential Hazard, High plausibility. Applicable conditions: Shock, Altered Consciousness

Benzodiazepines should not be administered by injection to patients in shock or coma. The hypnotic and hypotensive effects of these agents may be prolonged and intensified in such patients.

References

  1. "Product Information. Valium (diazepam)." Roche Laboratories (2002):
  2. "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories (2002):
  3. "Product Information. Librium (chlordiazepoxide)." Roche Laboratories (2001):
  4. "Product Information. Versed (midazolam)." Roche Laboratories (2001):
  5. "Product Information. Byfavo (remimazolam)." Acacia Pharma, Inc (2020):
View all 5 references
Major

MDVs (applies to lorazepam) prematurity

Major Potential Hazard, Moderate plausibility. Applicable conditions: Prematurity/Underweight in Infancy

Parenteral medications formulated in multidose vials often contain benzyl alcohol as a preservative. Their use is considered by drug manufacturers to be contraindicated in neonates, particularly premature infants and infants of low birth weight. When used in bacteriostatic saline intravascular flush and endotracheal tube lavage solutions, benzyl alcohol has been associated with fatalities and severe respiratory and metabolic complications in low-birth-weight premature infants. Thus, single-dose formulations should always be used in infants whenever possible. However, many experts feel that, in the absence of benzyl alcohol-free equivalents, the amount of the preservative present in these formulations should not necessarily preclude their use if they are clearly indicated. The American Academy of Pediatrics considers benzyl alcohol in low doses (such as when used as a preservative in some medications) to be safe for newborns. However, the administration of high dosages of these medications must take into account the total amount of benzyl alcohol administered. The level at which toxicity may occur is unknown.

References

  1. "Product Information. Fragmin (dalteparin)." Pharmacia and Upjohn (2001):
  2. "Product Information. Mesnex (mesna)." Bristol-Myers Squibb (2001):
  3. "Product Information. Mivacron (mivacurium)." Glaxo Wellcome (2001):
  4. "Product Information. Nuromax (doxacurium)." Glaxo Wellcome (2001):
  5. "Product Information. Tracrium (atracurium)." Glaxo Wellcome (2001):
  6. ""Inactive" ingredients in pharmaceutical products: update (subject review). American Academy of Pediatrics Committee on Drugs. Available from: URL: http://www.aap.org/policy/re9706.html." Pediatrics 99 (1997): 268-78
View all 6 references
Moderate

Benzodiazepines (applies to lorazepam) depression

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Psychosis

Benzodiazepines depress the central nervous system and may cause or exacerbate mental depression and cause suicidal behavior and ideation. Episodes of mania and hypomania have also been reported in depressed patients treated with some of these agents. Therapy with benzodiazepines should be administered cautiously in patients with a history of depression or other psychiatric disorders. Patients should be monitored for any changes in mood or behavior. It may be prudent to refrain from dispensing large quantities of medication to these patients.

References

  1. "Product Information. Xanax (alprazolam)." Pharmacia and Upjohn (2002):
  2. "Product Information. Valium (diazepam)." Roche Laboratories (2002):
  3. "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories (2002):
  4. "Product Information. Serax (oxazepam)." Wyeth-Ayerst Laboratories (2001):
  5. "Product Information. Restoril (temazepam)." Sandoz Pharmaceuticals Corporation (2001):
  6. "Product Information. Halcion (triazolam)." Pharmacia and Upjohn (2001):
  7. "Product Information. Dalmane (flurazepam)." Roche Laboratories (2001):
  8. "Product Information. Tranxene (clorazepate)." Abbott Pharmaceutical (2001):
  9. "Product Information. Klonopin (clonazepam)." Roche Laboratories (2001):
  10. "Product Information. ProSom (estazolam)." Abbott Pharmaceutical, Abbott Park, IL.
  11. "Product Information. Librium (chlordiazepoxide)." Roche Laboratories (2001):
  12. "Product Information. Doral (quazepam)." Wallace Laboratories (2001):
  13. "Product Information. Onfi (clobazam)." Lundbeck Inc (2011):
View all 13 references
Moderate

Benzodiazepines (applies to lorazepam) obesity

Moderate Potential Hazard, Moderate plausibility.

The plasma half-lives of benzodiazepines may be prolonged in obese patients, presumably due to increased distribution into fat. Marked increases in distribution (> 100%) have been reported for diazepam and midazolam, and moderate increases (25% to 100%) for alprazolam, lorazepam, and oxazepam. Therapy with benzodiazepines should be administered cautiously in obese patients, with careful monitoring of CNS status. Longer dosing intervals may be appropriate. When dosing by weight, loading doses should be based on actual body weight, while maintenance dose should be based on ideal body weight to avoid toxicity.

References

  1. "Product Information. Xanax (alprazolam)." Pharmacia and Upjohn (2002):
  2. "Product Information. Valium (diazepam)." Roche Laboratories (2002):
  3. "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories (2002):
  4. "Product Information. Serax (oxazepam)." Wyeth-Ayerst Laboratories (2001):
  5. "Product Information. Restoril (temazepam)." Sandoz Pharmaceuticals Corporation (2001):
  6. "Product Information. Halcion (triazolam)." Pharmacia and Upjohn (2001):
  7. "Product Information. Dalmane (flurazepam)." Roche Laboratories (2001):
  8. "Product Information. Tranxene (clorazepate)." Abbott Pharmaceutical (2001):
  9. "Product Information. Klonopin (clonazepam)." Roche Laboratories (2001):
  10. "Product Information. ProSom (estazolam)." Abbott Pharmaceutical, Abbott Park, IL.
  11. "Product Information. Librium (chlordiazepoxide)." Roche Laboratories (2001):
  12. "Product Information. Doral (quazepam)." Wallace Laboratories (2001):
  13. "Product Information. Versed (midazolam)." Roche Laboratories (2001):
  14. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
View all 14 references
Moderate

Benzodiazepines (applies to lorazepam) paradoxical reactions

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Psychosis, Hyperkinetic Syndrome of Childhood

Paradoxical reactions, including excitability, irritability, aggressive behavior, agitation, nervousness, hostility, anxiety, sleep disturbances, nightmares and vivid dreams, have been reported with the use of benzodiazepines in psychiatric patients and pediatric patients with hyperactive aggressive disorders. Such patients should be monitored for signs of paradoxical stimulation during therapy with benzodiazepines. The manufacturers do not recommend the use of benzodiazepines for the treatment of psychosis.

References

  1. French AP "Dangerously aggressive behavior as a side effect of alprazolam." Am J Psychiatry 146 (1989): 276
  2. Charney DS, Goodman WK "A case of alprazolam, but not lorazepam, inducing manic symptoms." J Clin Psychiatry 48 (1987): 117-8
  3. Pearce GL, Rawson NS, Edwards JG, Inman WH "Prescription-event monitoring of 10,895 patients treated with alprazolam." Br J Psychiatry 158 (1991): 387-92
  4. Barash D, Wysowski DK "Adverse behavioral reactions attributed to triazolam in the Food and Drug Administration's Spontaneous Reporting System." Arch Intern Med 151 (1991): 2003-8
  5. Brubaker BH, Bixler EO, Kales JD, Kales A "Adverse reactions to benzodiazepine hypnotics: spontaneous reporting system." Pharmacology 35 (1987): 286-300
  6. Rosenbaum JF, Cohen LS "Clonazepam: new uses and potential problems." J Clin Psychiatry 48 (1987): 50-6
  7. Harbison JW, White MC, Silverman JJ "Psychosis associated with clonazepam therapy for blepharospasm." J Nerv Ment Dis 170 (1982): 117-9
  8. Dorevitch A "Mania associated with clonazepam." DICP 25 (1991): 938-9
  9. Isaacs G, Nitzan I, Marchevsky S "Behavioral disinhibition with clonazepam." Gen Hosp Psychiatry 10 (1988): 447
  10. Binder RL "Three case reports of behavioral disinhibition with clonazepam." Gen Hosp Psychiatry 9 (1987): 151-3
  11. Swinson RP, Koczerginski D, Kennedy SH "Clonazepam and lithium--a toxic combination in the treatment of mania?" Int Clin Psychopharmacol 4 (1989): 195-9
  12. Borofsky GF, Fava M "Sexual disinhibition during treatment with a benzodiazepine: a case report." Int J Psychiatry Med 21 (1991): 99-104
  13. Cunningham TA "Letter: Adverse reaction to flurazepam." Can Med Assoc J 112 (1975): 805
  14. Pollack MH "Clonazepam: a review of open clinical trials." J Clin Psychiatry 48 (1987): 12-5
  15. "Product Information. Xanax (alprazolam)." Pharmacia and Upjohn (2002):
  16. "Product Information. Valium (diazepam)." Roche Laboratories (2002):
  17. "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories (2002):
  18. "Product Information. Serax (oxazepam)." Wyeth-Ayerst Laboratories (2001):
  19. "Product Information. Restoril (temazepam)." Sandoz Pharmaceuticals Corporation (2001):
  20. Karch FE "Rage reaction associated with clorazepate dipotassium." Ann Intern Med 91 (1979): 61-2
  21. Sachs G, Falk WE, Weilburg JB "Triazolam-induced brief episodes of secondary mania in a depressed patient." J Clin Psychiatry 48 (1987): 492-3
  22. Rothschild AJ "Disinhibition, amnestic reactions, and other adverse reactions secondary to triazolam: a review of the literature." J Clin Psychiatry 53 (1992): 69-79
  23. Conn D, Schogt B "Paranoid symptoms associated with triazolam." Can J Psychiatry 30 (1985): 462-3
  24. "Product Information. Halcion (triazolam)." Pharmacia and Upjohn (2001):
  25. "Product Information. Dalmane (flurazepam)." Roche Laboratories (2001):
  26. Viscott DS "Chlordiazepoxide and hallucinations. Report of cases." Arch Gen Psychiatry 19 (1968): 370-6
  27. Beirne OR, Fiset L, Roy-Byrne P, Milgrom P "Disinhibition of behaviors with midazolam: report of a case." J Oral Maxillofac Surg 50 (1992): 645-9
  28. Miwa LJ, Lobo BL "Midazolam disinhibition reaction." Drug Intell Clin Pharm 22 (1988): 725
  29. "Product Information. Tranxene (clorazepate)." Abbott Pharmaceutical (2001):
  30. "Product Information. Klonopin (clonazepam)." Roche Laboratories (2001):
  31. "Product Information. ProSom (estazolam)." Abbott Pharmaceutical, Abbott Park, IL.
  32. "Product Information. Librium (chlordiazepoxide)." Roche Laboratories (2001):
  33. Hughes JR, Bickel WK, Higgins ST, Rush CR "A comparison of the acute behavioral effects of triazolam and temazepam in normal volunteers." Psychopharmacology (Berl) 112 (1993): 407-14
  34. "Product Information. Doral (quazepam)." Wallace Laboratories (2001):
  35. "Product Information. Versed (midazolam)." Roche Laboratories (2001):
View all 35 references
Moderate

Lorazepam (applies to lorazepam) upper GI disease

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Gastroesophageal Reflux Disease

The manufacturer recommends the use of caution when prescribing lorazepam for prolonged periods in patients with upper gastrointestinal disease, especially in the elderly. The appearance or worsening of upper gastrointestinal symptoms should be monitored.

References

  1. "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories (2002):

Lorazepam drug interactions

There are 389 drug interactions with lorazepam.

Lorazepam alcohol/food interactions

There are 2 alcohol/food interactions with lorazepam.


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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.