how to give lorazepam im injection

Lorazepam: a medicine to treat anxiety and sleeping problems It may be necessary to increase the dose of lorazepam in female patients who are concomitantly taking oral contraceptives. Inform patients that the use of Lorazepam Injection more frequently than recommended, even at recommended dosages, exposes users to risks of abuse, misuse, and addiction, which can lead to overdose and death, especially when used in combination with other medications (e.g., opioid analgesics), alcohol, and/or illicit substances. More than half the patients in each study had tonic-clonic status epilepticus; patients with simple partial and complex partial status epilepticus comprised the rest of the population studied, along with a smaller number of patients who had absence status. Death is more often associated with polysubstance use (especially benzodiazepines with other CNS depressants such as opioids and alcohol). Misuse is the intentional use, for therapeutic purposes, of a drug by an individual in a way other than prescribed by a health care provider or for whom it was not prescribed. Pharmaceutical form 4. As a result, there may be difficulty in differentiating withdrawal symptoms from potential re-emergence or continuation of symptoms for which the benzodiazepine was being used. Although Lorazepam Injection is indicated only for intermittent use (see. Position the index and. Attachment to the specific binding site enhances the affinity of GABA for its receptor site on the same receptor complex. Coadministration of lorazepam (2 mg intravenously) with oral contraceptive steroids (norethindrone acetate, 1 mg, and ethinyl estradiol, 50 g, for at least 6 months) to healthy females (n=7) was associated with a 55% decrease in half-life, a 50% increase in the volume of distribution, thereby resulting in an almost 3.7-fold increase in total clearance of lorazepam as compared with control healthy females (n=8). Studies in healthy adult volunteers reveal that intravenous lorazepam in doses up to 3.5 mg/70 kg does not alter sensitivity to the respiratory stimulating effect of carbon dioxide and does not enhance the respiratory-depressant effects of doses of meperidine up to 100 mg/70 kg (also determined by carbon dioxide challenge) as long as patients remain sufficiently awake to undergo testing. Moving is a huge life event that is inherently stressful. Patients at an increased risk of withdrawal adverse reactions after benzodiazepine discontinuation or rapid dosage reduction include those who take higher dosages (i.e., higher and/or more frequent doses) and those who have had longer durations of use (see WARNINGS, Dependence and Withdrawal Reactions). The table represents the pooling of results from the two controlled trials. Nevertheless, the development of seizures after treatment with benzodiazepines is probably rare, based on the incidence in the uncontrolled treatment series reported (i.e., seizures were not observed for 112 pediatric patients and 18 adults or during approximately 400 doses). Accordingly, lorazepam plasma concentrations were about two-fold higher for at least 12 hours post-dose administration during valproate treatment. The benzodiazepine antagonist flumazenil may be used in hospitalized patients as an adjunct to, not as a substitute for, proper management of benzodiazepine overdose. Following single intravenous doses of 1.5 to 3 mg of Lorazepam Injection, mean total body clearance of lorazepam decreased by 20% in 15 elderly subjects of 60 to 84 years of age compared to that in 15 younger subjects of 19 to 38 years of age. 4 Ways to Give an Injection - wikiHow Lorazepam (Injection Route) Proper Use - Mayo Clinic There are insufficient data to support a statement regarding the distribution of adverse events by race. The Best Intramuscular Injection Sites - Verywell Health Consequently, no dosage adjustment appears to be necessary in elderly subjects based solely on their age. For the designated indications as a premedicant, the usual recommended dose of lorazepam for intramuscular injection is 0.05 mg/kg up to a maximum of 4 mg. As with all premedicant drugs, the dose should be individualized (see CLINICAL PHARMACOLOGY, WARNINGS, PRECAUTIONS, and ADVERSE REACTIONS). For optimum effect, measured as lack of recall, intravenous lorazepam should be administered 15 to 20 minutes before the anticipated operative procedure. IM lorazepam is not preferred in the treatment of status epilepticus because therapeutic lorazepam levels may not be reached as quickly as with IV administration. For optimum effect, measured as lack of recall, intravenous lorazepam should be administered 15 to 20 minutes before the anticipated operative procedure. Manufactured for: Central nervous system toxicity, including seizures and intraventricular hemorrhage, as well as unresponsiveness, tachypnea, tachycardia, and diaphoresis have been associated with propylene glycol toxicity. A 4-mg dose provides a C. max of approximately 48 ng/mL. Resuscitative equipment for ventilatory support should be readily available (see WARNINGS and DOSAGE AND ADMINISTRATION). The usual precautions in treating status epilepticus should be employed. Before prescribing Lorazepam Injection and throughout treatment, assess each patients risk for abuse, misuse, and addiction. Lorazepam Injection, USP is available in the following dosage strength as a single-dose vial: 2 mg per mL, NDC 72572-380-25, 25 x 1 mL vial. lower back or side pain. Lorazepam - Brand name: Ativan. The additive central-nervous-system effects of other drugs, such as phenothiazines, narcotic analgesics, barbiturates, antidepressants, scopolamine, and monoamine-oxidase inhibitors, should be borne in mind when these other drugs are used concomitantly with or during the period of recovery from Lorazepam Injection (see CLINICAL PHARMACOLOGY and WARNINGS). With normally functioning kidneys, forced diuresis with intravenous fluids and electrolytes may accelerate elimination of benzodiazepines from the body. An IM injection is a shot of medicine given into a muscle (intramuscular). It undergoes rigorous internal medical review and is updated regularly to reflect new information. lorazepam injection, USP VIAL Dosage and Administration 2 mg/mL For IM use Dilute for IV use Protect from light Refrigerate 1 mL vial, NDC 72572-380-25 Rx Only The prescriber should be aware of a risk of seizure in association with flumazenil treatment, particularly in long-term benzodiazepine users and in cyclic antidepressant overdose. Sedatives, tranquilizers and narcotic analgesics may produce a more prolonged and profound effect when administered along with injectable lorazepam. Five patients (5/446) who underwent regional anesthesia were observed to have airway obstruction. Use carton to protect contents from light. These sites have large, easy-to-locate muscles with little fatty tissue. Furthermore, patients who are susceptible to further seizure episodes should receive adequate maintenance antiepileptic therapy. At clinically relevant concentrations, lorazepam is 912% bound to plasma proteins; its volume of distribution is approximately 1.3 L/kg. Using this medicine during the later pregnancy may cause problems in your newborn baby (eg . All rights reserved. Do not use if solution is discolored or contains a precipitate. Ativan, Loreev XR (lorazepam) dosing, indications, interactions Clean the skin on and around the site with an alcohol wipe. Abuse and misuse of benzodiazepines commonly involve concomitant use of other medications, alcohol, and/or illicit substances, which is associated with an increased frequency of serious adverse outcomes. The results of a preimplantation study in rats, in which the oral lorazepam dose was 20 mg/kg, showed no impairment of fertility. Age does not appear to have a clinically significant effect on lorazepam kinetics (see CLINICAL PHARMACOLOGY). These tests included: CBC, urinalysis, SGOT, SGPT, bilirubin, alkaline phosphatase, LDH, cholesterol, uric acid, BUN, glucose, calcium, phosphorus, and total proteins. Abuse and misuse of benzodiazepines may lead to addiction. Lorazepam Injection Prescribing Information Package insert / product label Dosage form: injection Drug classes: Benzodiazepine anticonvulsants, Benzodiazepines, Miscellaneous antiemetics J Code (medical billing code): J2060 (2 mg, injection) Medically reviewed by Drugs.com. Dosage form: injection Drug classes: Benzodiazepine anticonvulsants, Benzodiazepines, Miscellaneous antiemetics Medically reviewed by Drugs.com. The use of benzodiazepines, like Lorazepam Injection, is ordinarily only an initial step of a complex and sustained intervention which may require additional interventions, (e.g., concomitant intravenous administration of phenytoin). Keep the big picture in mind. Use carton to protect contents from light. When properly diluted, the drug may be injected directly into a vein or into the tubing of an existing intravenous infusion. There have been rare reports of significant respiratory depression, stupor and/or hypotension with the concomitant use of loxapine and lorazepam. EQUIPMENT NECESSARY TO MAINTAIN A PATENT AIRWAY SHOULD BE IMMEDIATELY AVAILABLE PRIOR TO INTRAVENOUS ADMINISTRATION OF LORAZEPAM (see WARNINGS). The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Clinical pharmacokinetics of lorazepam. II. Intramuscular injection Occasional anomalies (reduction of tarsals, tibia, metatarsals, malrotated limbs, gastroschisis, malformed skull, and microphthalmia) were seen in drug-treated rabbits without relationship to dosage. Links to sites outside of Pfizer Medical Information are provided as a resource to the viewer. Experience with further doses of lorazepam is very limited. The safety of lorazepam in pediatric patients has not been established. The intramuscular (IM) and rectal routes are alternative routes of delivery for antiepileptic drugs (AEDs) when the intravenous route is not practical or possible. Do not exceed the recommended dosing frequency; avoid or minimize concomitant use of CNS depressants and other substances associated with abuse, misuse, and addiction (e.g., opioid analgesics, stimulants); and advise patients on the proper disposal of unused drug. Although normal therapeutic doses of this product deliver amounts of benzyl alcohol that are substantially lower than those reported in association with the gasping syndrome, the minimum amount of benzyl alcohol at which toxicity may occur is not known. Drug information provided by: Merative, Micromedex. Allow the alcohol to dry before administering the injection. In those patients in whom a greater likelihood of lack of recall for perioperative events would be beneficial, larger doses as high as 0.05 mg/kg up to a total of 4 mg may be administered (see CLINICAL PHARMACOLOGY, WARNINGS, PRECAUTIONS, and ADVERSE REACTIONS). In a published study in primates, administration of an anesthetic dose of ketamine for 24 hours on Gestation Day 122 increased neuronal apoptosis in the developing brain of the fetus. CARE SHOULD BE TAKEN TO DETERMINE THAT ANY INJECTION WILL NOT BE INTRA-ARTERIAL AND THAT PERIVASCULAR EXTRAVASATION WILL NOT TAKE PLACE. A 4-mg dose provides a C. max . Warnings Impairment of performance may persist for greater intervals because of extremes of age, concomitant use of other drugs, stress of surgery, or the general condition of the patient. A second study (n=119) was a double-blind dose-comparison trial with 3 doses of Lorazepam Injection: 1 mg, 2 mg, and 4 mg. The gasping syndrome, characterized by central nervous system depression, metabolic acidosis, gasping respirations, and high levels of benzyl alcohol and its metabolites found in the blood and urine, has been associated with the administration of intravenous solutions containing the preservative benzyl alcohol in neonates. Lorazepam is a benzodiazepine (ben-zoe-dye-AZE-eh-peen) that is used to treat a seizure emergency called status epilepticus. This article stems from the widespread use of this cocktail. Pediatric patients (as well as adults) with atypical petit mal status epilepticus have developed brief tonic-clonic seizures shortly after lorazepam was given. The lack of recall and recognition was optimum within 2 hours following intramuscular administration and 15 to 20 minutes after intravenous injection. The use of Lorazepam Injection intra-arterially is contraindicated because, as with other injectable benzodiazepines, inadvertent intra-arterial injection may produce arteriospasm resulting in gangrene which may require amputation (see WARNINGS). COMMON BRAND NAMES When scopolamine is used concomitantly with injectable lorazepam, an increased incidence of sedation, hallucinations and irrational behavior has been observed.
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