When is ativan contraindicated

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Lorazepam Ativan. Know the warning signs Learn the common signs of mental illness in adults and adolescents. Mental health conditions Learn more about common mental health conditions that affect millions. When starting lorazepam, anxiety or insomnia may improve rapidly or over a period of days. Avoid alcohol while taking this medication. Regarding breastfeeding, caution is advised since lorazepam does pass into breast milk.

Symptoms of your condition that bother you the most If you have thoughts of suicide or harming yourself Medications you have taken in the past for your condition, whether they were effective or caused any adverse effects If you experience side effects from your medications, discuss them with your healthcare provider.

Some side effects may pass with time, but others may require changes in the medication. Any other psychiatric or medical problems you have including obstructive sleep apnea All other medications you are currently taking including over the counter products and herbal and nutritional supplements and any medication allergies you have Other non-medication treatment you are receiving such as talk therapy or substance abuse treatment.

Your provider can explain how these different treatments work with the medication. If you are elderly or prone to falls If you are pregnant, plan to become pregnant, or are breastfeeding If you drink alcohol or use drugs How Should I Take Lorazepam? Lorazepam may be taken with or without food. Take with food if you experience an upset stomach. Symptoms of overdose include confusion, impaired coordination, slow reflexes, coma, and death. Common side effects Feeling dizzy, drowsy, fatigued, or lightheaded Impaired coordination, decreased ability to concentrate If you experience these side effects after starting lorazepam they will often improve over the first week or two as you continue to take the medication.

Increased heart rate, headache, memory impairment, irritability, restlessness Some people taking benzodiazepines develop a severe allergic reaction and swelling of the face. This can occur as early as with the first dose. Keep track of your medicine. You should be aware if anyone is using it improperly or without a prescription.

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time. Overdose symptoms may include extreme drowsiness, confusion, slurred speech, feeling restless, muscle weakness, loss of balance or coordination, feeling light-headed, slow heartbeats, weak or shallow breathing, or coma.

Lorazepam starts to work in about 20 to 30 minutes. Its full effects take place after about an hour and last around six to eight hours. Health Topics. Health Tools. Lorazepam Ativan. Reviewed: November 17, The intravenous form of lorazepam is used to treat seizures.

You should not take lorazepam if you have: narrow-angle glaucoma; or a history of allergic reaction to any benzodiazepine lorazepam, alprazolam, diazepam, Ativan, Klonopin, Restoril, Tranxene, Valium, Versed, Xanax, and others. Tell your doctor if you have ever had: breathing problems such as COPD chronic obstructive pulmonary disease or sleep apnea breathing that stops during sleep ; drug or alcohol addiction; depression, mood problems, or suicidal thoughts or behavior; kidney or liver disease; seizures; or glaucoma.

Side Effects. Side Effects What are the side effects of Lorazepam Ativan? Call your doctor at once if you have: severe drowsiness; unusual changes in mood or behavior; sudden restless feeling or excitement; thoughts of suicide or hurting yourself; confusion, aggression, hallucinations; sleep problems; vision changes; or dark urine, or jaundice yellowing of the skin or eyes. Common side effects may include: dizziness, drowsiness; weakness; or feeling unsteady.

Interactions What drugs and food should I avoid while taking Lorazepam Ativan? Avoid drinking alcohol. Dangerous side effects or death could occur. If you use this medicine long-term, you may need frequent medical tests. Store at room temperature away from moisture and heat.

What should I do if I missed a dose of Lorazepam Ativan? If you think you or someone else may have overdosed on: Lorazepam Ativan , call your doctor or the Poison Control center.

Brimonidine; Brinzolamide: 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. Brimonidine; Timolol: Moderate Based on the sedative effects of brimonidine in individual patients, brimonidine administration has potential to enhance the CNS depressants effects of the anxiolytics, sedatives, and hypnotics including benzodiazepines.

Moderate Drowsiness has been reported during administration of carbetapentane. An enhanced CNS depressant effect may occur when carbetapentane is combined with other CNS depressants including benzodiazepines. Brompheniramine; Guaifenesin; Hydrocodone: Major Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Moderate Coadministration can potentiate the CNS effects e. Brompheniramine; Hydrocodone; Pseudoephedrine: Major Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death.

In patients treated with buprenorphine 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 in patients receiving buprenorphine maintenance treatment. Buspirone: Moderate It is common for patients to overlap anxiety treatment when switching from benzodiazepines to buspirone. Buspirone has a slow onset of action and the drug will not block the withdrawal syndrome often seen with cessation of benzodiazepine therapy in those with benzodiazepine dependence.

Therefore, before starting therapy with buspirone, withdraw patients gradually from the benzodiazepine. Alternatively, conversion to buspirone therapy may require treatment overlap to allow for the downward titration of the benzodiazepine while buspirone takes effect. It should be noted that the combination of buspirone and benzodiazepines can potentiate the CNS effects e. Butalbital; Acetaminophen; Caffeine; Codeine: Major Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death.

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. Caffeine; Sodium Benzoate: 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.

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. Cannabidiol: Moderate Monitor for an increase in lorazepam-related adverse reactions and consider reducing the dose of lorazepam if concomitant use of lorazepam and cannabidiol is necessary. Lorazepam is a UGT2B7 substrate.

In vitro data predicts inhibition of UGT2B7 by cannabidiol, potentially resulting in clinically significant interactions. Increased dosages of lorazepam may be needed. Carbetapentane; Guaifenesin: Moderate Drowsiness has been reported during administration of carbetapentane.

Carbetapentane; Guaifenesin; Phenylephrine: Moderate Drowsiness has been reported during administration of carbetapentane. Carbetapentane; Phenylephrine: Moderate Drowsiness has been reported during administration of carbetapentane.

Carbetapentane; Pseudoephedrine: Moderate Drowsiness has been reported during administration of carbetapentane. Carbinoxamine; Hydrocodone; Phenylephrine: Major Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death.

Carbinoxamine; Hydrocodone; Pseudoephedrine: Major Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Cariprazine: Moderate Due to the CNS effects of cariprazine, caution should be used when cariprazine is given in combination with other centrally-acting medications including benzodiazepines and other anxiolytics, sedatives, and hypnotics.

Cenobamate: Moderate Monitor for excessive sedation and somnolence during coadministration of cenobamate and benzodiazepines. Concurrent use may result in additive CNS depression. Coadministration may increase the risk of CNS depressant-related side effects. If concurrent use is necessary, monitor for excessive sedation and somnolence.

Chlophedianol; Guaifenesin; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines.

Chlorpheniramine; Codeine: Major Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Chlorpheniramine; Dihydrocodeine; Phenylephrine: Major Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death.

Chlorpheniramine; Dihydrocodeine; Pseudoephedrine: Major Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death.

Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine: Major Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Chlorpheniramine; Hydrocodone: Major Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Chlorpheniramine; Hydrocodone; Phenylephrine: Major Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death.

Chlorpheniramine; Hydrocodone; Pseudoephedrine: Major Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Cisapride: Moderate Cisapride may enhance the sedative effects of benzodiazepines. Patients should not drive or operate heavy machinery until they know how the combination affects them.

Patient counseling is important, as cisapride alone does not cause drowsiness or affect psychomotor function. Clobazam: Major Use clobazam with other benzodiazepines with caution due to the risk for additive CNS depression. Clozapine: Moderate If concurrent therapy with clozapine and a benzodiazepine is necessary, it is advisable to begin with the lowest possible benzodiazepine dose and closely monitor the patient, particularly at initiation of treatment and following dose increases.

Although the combination has been used safely, adverse reactions such as confusion, ataxia, somnolence, delirium, collapse, cardiac arrest, respiratory arrest, and death have occurred rarely in patients receiving clozapine concurrently or following benzodiazepine therapy. Several benzodiazepines, including clonazepam, oxazepam, flurazepam, diazepam, clobazam, flunitrazepam, and lorazepam have been implicated in these reactions.

At least one case of sudden death was reported following intravenous administration of lorazepam to a patient receiving clozapine. Codeine: Major Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Codeine; Guaifenesin: Major Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death.

Codeine; Guaifenesin; Pseudoephedrine: Major Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Codeine; Phenylephrine; Promethazine: Major Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Codeine; Promethazine: Major Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death.

Colesevelam: Moderate Colesevelam may decrease the absorption of anticonvulsants. To minimize potential for interactions, consider administering oral anticonvulsants at least 1 hour before or at least 4 hours after colesevelam.

COMT inhibitors have also been associated with sudden sleep onset during activities of daily living such as driving, which has resulted in accidents in some cases. Prescribers should re-assess patients for drowsiness or sleepiness regularly throughout treatment, especially since events may occur well after the start of treatment. Patients should be advised to avoid driving or other tasks requiring mental alertness until they know how the combination affects them. 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.

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. Moderate Monitor for an increase in lorazepam-related adverse reactions and consider reducing the dose of lorazepam if concomitant use of lorazepam and paritaprevir is necessary.

Desflurane: Moderate Concurrent use with benzodiazepines can decrease the minimum alveolar concentration MAC of desflurane needed to produce anesthesia. Desogestrel; Ethinyl Estradiol: Minor Ethinyl estradiol may enhance the metabolism of lorazepam.

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. Deutetrabenazine: Moderate Advise patients that concurrent use of deutetrabenazine and drugs that can cause CNS depression, such as lorazepam, may have additive effects and worsen drowsiness or sedation. Dexmedetomidine: Moderate Concurrent use of dexmedetomidine and benzodiazepines may result in additive CNS depression.

A reduction in dosage of dexmedetomidine or the benzodiazepine may be required. Dextromethorphan; Guaifenesin; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. Dichlorphenamide: Moderate Use dichlorphenamide and lorazepam together with caution. 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.

Concurrent use may increase the severity of metabolic acidosis. Measure sodium bicarbonate concentrations at baseline and periodically during dichlorphenamide treatment. If metabolic acidosis occurs or persists, consider reducing the dose or discontinuing dichlorphenamide therapy.

Dicyclomine: Moderate Dicyclomine can cause drowsiness, so it should be used cautiously in patients receiving CNS depressants like benzodiazepines.

Dihydrocodeine; Guaifenesin; Pseudoephedrine: Major Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Diphenhydramine; Hydrocodone; Phenylephrine: Major Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death.

Dronabinol: Moderate Use caution if the use of benzodiazepines are necessary with dronabinol, and monitor for additive dizziness, confusion, somnolence, and other CNS effects. Droperidol: Major Droperidol administration is associated with an established risk for QT prolongation and torsades de pointes. In December , the FDA issued a black box warning regarding the use of droperidol and its association with QT prolongation and potential for cardiac arrhythmias based on post-marketing surveillance data.

Risk factors for the development of prolonged QT syndrome may include the use of benzodiazepines. Also, droperidol and benzodiazepines can both cause CNS depression. 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.

Drospirenone; Ethinyl Estradiol: Minor Ethinyl estradiol may enhance the metabolism of lorazepam. Drospirenone; Ethinyl Estradiol; Levomefolate: Minor Ethinyl estradiol may enhance the metabolism of lorazepam. 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.

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. Esketamine: Major Closely monitor patients receiving esketamine and benzodiazepines for sedation and other CNS depressant effects. Instruct patients who receive a dose of esketamine not to drive or engage in other activities requiring alertness until the next day after a restful sleep.

Eszopiclone: Moderate Concomitant administration of benzodiazepines with eszopiclone can potentiate the CNS effects e. The concurrent use of eszopiclone with other anxiolytics, sedatives, and hypnotics at bedtime or in the middle of the night is not recommended. In addition, the risk of next-day psychomotor impairment is increased during co-administration of eszopiclone and other CNS depressants, which may decrease the ability to perform tasks requiring full mental alertness such as driving.

If used together, a reduction in the dose of one or both drugs may be needed. Alcohol consumption may result in additive CNS depression. Alcohol may also increase drug exposure and the risk for fatal overdose by disrupting extended-release lorazepam capsules.

Major Avoid concomitant use of medications formulated with alcohol and extended-release lorazepam capsules. Co-ingestion may disrupt the extended-release formulation resulting in increased lorazepam exposure and increasing the risk for lorazepam overdose. Ethinyl Estradiol: Minor Ethinyl estradiol may enhance the metabolism of lorazepam. Ethinyl Estradiol; Norelgestromin: Minor Ethinyl estradiol may enhance the metabolism of lorazepam.

Ethinyl Estradiol; Norethindrone Acetate: Minor Ethinyl estradiol may enhance the metabolism of lorazepam. Ethinyl Estradiol; Norgestrel: Minor Ethinyl estradiol may enhance the metabolism of lorazepam.

Ethotoin: Moderate Hydantoin anticonvulsants can theoretically add to the CNS depressant effects of other CNS depressants including the benzodiazepines. Ethynodiol Diacetate; Ethinyl Estradiol: Minor Ethinyl estradiol may enhance the metabolism of lorazepam.

Etonogestrel; Ethinyl Estradiol: Minor Ethinyl estradiol may enhance the metabolism of lorazepam. Fenfluramine: Moderate Monitor for excessive sedation and somnolence during coadministration of fenfluramine and benzodiazepines.

Fentanyl: Major Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Because binding at the receptor is competitive and flumazenil has a much shorter duration of action than do most benzodiazepines, it is possible for the effects of flumazenil to dissipate sooner than the effects of the benzodiazepine.

Flumazenil does not affect the pharmacokinetics of the benzodiazepines. Abrupt awakening can cause dysphoria, agitation, and possibly increased adverse effects.

If administered to patients who have received a benzodiazepine chronically, abrupt interruption of benzodiazepine agonism by flumazenil can induce benzodiazepine withdrawal including seizures.

Flumazenil has minimal effects on benzodiazepine-induced respiratory depression; suitable ventilatory support should be available, especially in treating acute benzodiazepine overdose.

Flumazenil does not reverse the actions of barbiturates, opiate agonists, or tricyclic antidepressants. Food: Major Coadministration of marijuana with benzodiazepines may result in an exaggerated sedative effect. Instruct patients receiving these medications concurrently not to drive or operate machinery.

Fosphenytoin: Moderate Hydantoin anticonvulsants can theoretically add to the CNS depressant effects of other CNS depressants including the benzodiazepines. Gabapentin: Major Concomitant use of benzodiazepines with gabapentin may cause excessive sedation, somnolence, and respiratory depression. If concurrent use is necessary, initiate gabapentin at the lowest recommended dose and monitor patients for symptoms of respiratory depression and sedation.

Educate patients about the risks and symptoms of excessive CNS depression and respiratory depression. Gemfibrozil: Moderate Monitor for an increase in lorazepam-related adverse reactions and consider reducing the dose of lorazepam if concomitant use of lorazepam and gemfibrozil is necessary.

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. Moderate Monitor for an increase in lorazepam-related adverse reactions and consider reducing the dose of lorazepam if concomitant use of lorazepam and pibrentasvir is necessary.

Green Tea: Minor Patients taking benzodiazepines for insomnia should not use caffeine-containing products, such as green tea, prior to going to bed as these products may antagonize the sedative effects of the benzodiazepine.

Guaifenesin; Hydrocodone: Major Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Guaifenesin; Hydrocodone; Pseudoephedrine: Major Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death.

Guaifenesin; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. Guanabenz: Moderate Guanabenz is associated with sedative effects. Guanabenz can potentiate the effects of CNS depressants such as benzodiazepines, when administered concomitantly. Guanfacine: Moderate Guanfacine has been associated with sedative effects and can potentiate the actions of other CNS depressants including benzodiazepines.

Haloperidol: Moderate Haloperidol can potentiate the actions of other CNS depressants, such as benzodiazepines, Caution should be exercised with simultaneous use of these agents due to potential excessive CNS effects.

Homatropine; Hydrocodone: Major Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death.

Hydantoins: Moderate Hydantoin anticonvulsants can theoretically add to the CNS depressant effects of other CNS depressants including the benzodiazepines. Methyldopa can potentiate the effects of CNS depressants such as barbiturates, benzodiazepines, opiate agonists, or phenothiazines when administered concomitantly. Hydrocodone: Major Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death.

Hydrocodone; Ibuprofen: Major Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Hydrocodone; Phenylephrine: Major Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death.

Hydrocodone; Potassium Guaiacolsulfonate: Major Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine: Major Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death.

Hydrocodone; Pseudoephedrine: Major Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death.

Hydromorphone: Major Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Hydroxychloroquine: Moderate Caution is warranted with the coadministration of hydroxychloroquine and antiepileptic drugs, such as lorazepam.

Hydroxychloroquine can lower the seizure threshold; therefore, the activity of antiepileptic drugs may be impaired with concomitant use. Ibuprofen; Oxycodone: Major Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Iloperidone: Moderate Drugs that can cause CNS depression, if used concomitantly with iloperidone, may increase both the frequency and the intensity of adverse effects such as drowsiness, sedation, and dizziness.

Caution should be used when iloperidone is given in combination with other centrally-acting medications including anxiolytics, sedatives, and hypnotics. Indinavir: Moderate Monitor for an increase in lorazepam-related adverse reactions and consider reducing the dose of lorazepam if concomitant use of lorazepam and indinavir is necessary. Iohexol: Moderate The use of intrathecal radiopaque contrast agents is associated with a risk of seizures.

Patients should be instructed to continue using benzodiazepines during procedures or exams that require the use of intrathecal radiopaque contrast agents as abrupt discontinuation of benzodiazepines may also increase seizure risk. Iopamidol: Moderate The use of intrathecal radiopaque contrast agents is associated with a risk of seizures.

Ketoconazole: Moderate Monitor for an increase in lorazepam-related adverse reactions and consider reducing the dose of lorazepam if concomitant use of lorazepam and ketoconazole is necessary. Lasmiditan: Moderate Monitor for excessive sedation and somnolence during coadministration of lasmiditan and benzodiazepines. Lemborexant: Moderate Monitor for excessive sedation and somnolence during use of lemborexant with benzodiazepines.

Dosage adjustments may be necessary when administered together because of potentially additive CNS effects. Use of more than 2 hypnotics should be avoided due to the additive CNS depressant and complex sleep-related behaviors that may occur.

While anxiolytic medications may be used concurrently with lemborexant, a reduction in dose of one or both agents may be needed. The risk of next-day impairment, including impaired driving, is increased if lemborexant is taken with other CNS depressants. Levomethadyl: Moderate Concomitant administration of benzodiazepines with CNS-depressant drugs, including opiate agonists, can potentiate the CNS effects of either agent.

Levomilnacipran: Moderate Concurrent use of many CNS active drugs, including benzodiazepines, with levomilnacipran has not been evaluated by the manufacturer. Therefore, caution is advisable when combining anxiolytics, sedatives, and hypnotics or other psychoactive medications with levomilnacipran. Levonorgestrel; Ethinyl Estradiol: Minor Ethinyl estradiol may enhance the metabolism of lorazepam.

Levonorgestrel; Ethinyl Estradiol; Ferrous Bisglycinate: Minor Ethinyl estradiol may enhance the metabolism of lorazepam. Levorphanol: Major Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death.

If seizures occur, amphetamine discontinuation may be necessary. Lithium: Moderate Because lithium has the potential to impair cognitive and motor skills, caution is advisable during concurrent use of other medications with centrally-acting effects including anxiolytics, sedatives, and hypnotics. Lofexidine: Moderate Monitor for excessive hypotension and sedation during coadministration of lofexidine and benzodiazepines. Lofexidine can potentiate the effects of CNS depressants such as benzodiazepines.

Lorazepam, and possibly other benzodiazepines, should be used cautiously in patients receiving loxapine. Lumateperone: Moderate Monitor for excessive sedation and somnolence during coadministration of lumateperone and benzodiazepines. Lurasidone: Moderate Due to the CNS effects of lurasidone, caution should be used when lurasidone is given in combination with other centrally acting medications such as anxiolytics, sedatives, and hypnotics, including benzodiazepines.

Magnesium Salts: Minor Because of the CNS-depressant effects of magnesium sulfate, additive central-depressant effects can occur following concurrent administration with CNS depressants such as benzodiazepines. Caution should be exercised when using these agents concurrently. Maprotiline: Moderate Benzodiazepines or other CNS depressants should be combined cautiously with maprotiline because they could cause additive depressant effects and possible respiratory depression or hypotension.

The combination of benzodiazepines and maprotiline is commonly used clinically and is considered to be safe as long as patients are monitored for excessive adverse effects from either agent. Maprotiline may lower the seizure threshold, so when benzodiazepines are used for anticonvulsant effects the patient should be monitored for desired clinical outcomes. Mefloquine: Moderate Coadministration of mefloquine and anticonvulsants may result in lower than expected anticonvulsant concentrations and loss of seizure control.

Monitoring of the anticonvulsant serum concentration is recommended. Dosage adjustments may be required during and after therapy with mefloquine.

Melatonin: Major Use caution when combining melatonin with the benzodiazepines; when the benzodiazepine is used for sleep, co-use of melatonin should be avoided. Use of more than 1 agent for hypnotic purposes may increase the risk for over-sedation, CNS effects, or sleep-related behaviors.

Be alert for unusual changes in moods or behaviors. Use caution when combining melatonin with benzodiazepines for other uses. Patients reporting unusual sleep-related behaviors should likely discontinue melatonin use.

In animal studies, melatonin has been shown to increase benzodiazepine binding to receptor sites. In one case report, a benzodiazepine-dependent woman with an 11 year history of insomnia weaned and discontinued her benzodiazepine prescription within a few days without rebound insomnia or apparent benzodiazepine withdrawal when melatonin was given.

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. Both cases suggest additive pharmacodynamic effects. In a clinical trial, there was clear evidence for a transitory pharmacodynamic interaction between melatonin and another hypnotic agent one hour following co-dosing.

Concomitant administration resulted in increased impairment of attention, memory and coordination compared to the hypnotic agent alone. Meperidine: Major Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Meperidine; Promethazine: Major Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death.

Meprobamate: Moderate Concomitant administration of benzodiazepines with meprobamate can potentiate the CNS effects e. Methadone: Major Concurrent use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death.

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. Methocarbamol: Moderate Concurrent use of benzodiazepines and other CNS active medications including skeletal muscle relaxants, can potentiate the CNS effects of either agent.

Lower doses of one or both agents may be required. The severity of this interaction may be increased when additional CNS depressants are given. Methscopolamine: Moderate CNS depression can be increased when methscopolamine is combined with other CNS depressants such as any anxiolytics, sedatives, and hypnotics.

Methyldopa: Moderate Methyldopa is associated with sedative effects. Metoclopramide: 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. Metyrosine: Moderate The concomitant administration of metyrosine with benzodiazepines can result in additive sedative effects.

Milnacipran: 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.

Minocycline: 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. Mirtazapine: 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. Molindone: 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.

In addition, MAOIs can cause a variable change in seizure patterns, so careful monitoring of patients with epilepsy is required when benzodiazepines are used in the treatment of epilepsy. Morphine: Major Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. 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. Morphine; Naltrexone: Major Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Additive drowsiness and CNS depression can occur. Nitroglycerin: 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. Norethindrone Acetate; Ethinyl Estradiol; Ferrous fumarate: Minor Ethinyl estradiol may enhance the metabolism of lorazepam.