Ativan Injection

Generic Name: lorazepam (Injection route)

lor-AZ-e-pam

Commonly used brand name(s)

In the U.S.

• Ativan

Available Dosage Forms:

• Solution

Therapeutic Class: Antianxiety

Pharmacologic Class: Benzodiazepine, Short or Intermediate Acting

Uses For Ativan

Lorazepam injection is used before certain medical procedures, such as surgery, to relieve anxiety. When lorazepam is used before surgery, the patient will not remember some of the details about the procedure. This medicine is also used to treat certain convulsive (seizure) disorders, such as epilepsy.

Lorazepam is a benzodiazepine. Benzodiazepines belong to the group of medicines called central nervous system (CNS) depressants, which are medicines that slow down the nervous system.

This medicine is available only with your doctor's prescription.

Before Using Ativan

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of lorazepam injection in the pediatric population. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of lorazepam injection in the elderly. However, elderly patients are more likely to have severe drowsiness, or age-related heart, liver, or kidney problems, which may require an adjustment in the dose in patients receiving lorazepam injection.

Pregnancy

	Pregnancy Category	Explanation
All Trimesters	D	Studies in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy in a life threatening situation or a serious disease, may outweigh the potential risk.

Breast Feeding

Studies in women suggest that this medication poses minimal risk to the infant when used during breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Alfentanil


• Amobarbital


• Anileridine


• Aprobarbital


• Butabarbital


• Butalbital


• Carisoprodol


• Chloral Hydrate


• Chlorzoxazone


• Codeine


• Dantrolene


• Ethchlorvynol


• Fentanyl


• Fospropofol


• Hydrocodone


• Hydromorphone


• Levorphanol


• Meperidine


• Mephenesin


• Mephobarbital


• Meprobamate


• Metaxalone


• Methocarbamol


• Methohexital


• Morphine


• Morphine Sulfate Liposome


• Oxycodone


• Oxymorphone


• Pentobarbital


• Phenobarbital


• Primidone


• Propoxyphene


• Remifentanil


• Secobarbital


• Sodium Oxybate


• Sufentanil


• Tapentadol


• Thiopental


• Zolpidem

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Probenecid


• Pyrimethamine


• St John's Wort


• Theophylline


• Valproic Acid

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

• Glaucoma, acute narrow-angle or


• Lung disease, severe or


• Sleep apnea (temporary stopping of breathing during sleep)—This medicine should not be used in patients with these conditions.

• Kidney disease—Use with caution. The effects may be increased because of slower removal of the medicine from the body.

• Lung disease, mild to moderate—Use with caution. May make this condition worse.

Proper Use of Ativan

A nurse or other trained health professional will give you this medicine. This medicine is given through a needle placed in one of your veins or given as a shot into one of your muscles.

Precautions While Using Ativan

It is very important that your doctor check your progress after you receive this medicine to make sure it is working properly and to check for any unwanted effects.

Using this medicine while you are pregnant can harm your unborn baby. If you think you have become pregnant, tell your doctor right away.

This medicine may cause drowsiness, trouble with thinking, trouble with controlling movements, or trouble with seeing clearly. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are not alert or able to think or see well.

If you develop any unusual or strange thoughts and behavior while taking lorazepam injection, be sure to discuss it with your doctor. Some changes that have occurred in people taking this medicine are like those seen in people who drink too much alcohol. Other changes might be confusion, agitation, and hallucinations (seeing, hearing, or feeling things that are not there).

This medicine will add to the effects of alcohol and other central nervous system (CNS) depressants. CNS depressants are medicines that slow down the nervous system, which may cause drowsiness or make you less alert. Some examples of CNS depressants are antihistamines or medicine for hay fever, allergies, or colds; sedatives, tranquilizers, or sleeping medicine; prescription pain medicine or narcotics; barbiturates (used for seizures); muscle relaxants; or anesthetics (numbing medicines), including some dental anesthetics. This effect may last for a few days after you stop taking this medicine. Check with your doctor before taking any of the above while you are using this medicine.

Ativan Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

More common

• Blue lips, fingernails, or skin


• blurred vision


• confusion


• difficult or troubled breathing


• dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly


• irregular, fast or slow, or shallow breathing


• shortness of breath


• sleepiness or unusual drowsiness


• sweating


• unusual tiredness or weakness

Less common

• Decreased awareness or responsiveness


• not breathing


• severe sleepiness

Rare

• Bleeding, blistering, burning, coldness, discoloration of skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at the injection site


• bloody or cloudy urine


• change in consciousness


• convulsions


• cough or hoarseness


• deep or fast breathing with dizziness


• delusions


• dementia


• difficult, burning, or painful urination


• extremely shallow or slow breathing


• fever or chills


• frequent urge to urinate


• headache


• loss of consciousness


• lower back or side pain


• numbness of feet, hands and around mouth


• painful or difficult urination


• problems with movement, walking, or speech


• vomiting

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Rare

• Nausea

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Ativan Injection side effects (in more detail)

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More Ativan Injection resources

• Ativan Injection Side Effects (in more detail)
• Ativan Injection Use in Pregnancy & Breastfeeding
• Drug Images
• Ativan Injection Drug Interactions
• Ativan Injection Support Group
• 125 Reviews for Ativan Injection - Add your own review/rating

Compare Ativan Injection with other medications

• Anxiety
• Cervical Dystonia
• Dysautonomia
• ICU Agitation
• Insomnia
• Light Anesthesia
• Nausea/Vomiting
• Nausea/Vomiting, Chemotherapy Induced
• Panic Disorder
• Sedation
• Status Epilepticus

Ativan

Generic Name: Lorazepam
Class: Benzodiazepines
VA Class: CN302
CAS Number: 846-49-1

Introduction

Benzodiazepine; anticonvulsant, anxiolytic, and sedative.^{a b c d}

Uses for Ativan

Anxiety Disorders

Management of anxiety disorders and short-term relief of anxiety or anxiety associated with depressive symptoms.^{a c}

Preoperative Sedation, Anxiolysis, and Anterograde Amnesia

Preoperatively, to produce sedation, relieve anxiety, and provide anterograde amnesia.^{a d}

Status Epilepticus

A drug of choice in the management of status epilepticus.^a

Sedation in Critical-care Settings

Sedation† of intubated and mechanically ventilated patients in a critical care setting. Other agents with more rapid onset (e.g., diazepam, midazolam) preferred for rapid sedation of acute agitated patients.

Schizophrenia

Has been used in management of schizophrenia; may be helpful for management of anxiety, agitation, and sleep disturbances that are often present during the acute phase of schizophrenia in patients receiving antipsychotic therapy.

May be helpful in patients experiencing akathisia† while receiving antipsychotic drugs (e.g., for management of schizophrenia).

Also has been used for treatment of acute catatonic reactions†, whether associated with schizophrenia or other conditions.

Cancer Chemotherapy-induced Nausea and Vomiting

Alone or as adjunctive therapy for the management of nausea and vomiting† associated with emetogenic cancer chemotherapy (including cisplatin).

Delirium

Management of delirium† alone or in combination with an antipsychotic agent (e.g., haloperidol).

Drug-induced Cardiovascular Emergencies

Adjunct in the management of certain drug-induced cardiovascular emergencies† (e.g., drug-induced hemodynamically significant tachycardia†, hypertensive emergency†, acute coronary syndrome†, or acute anticholinergic syndrome†) when standard emergency cardiovascular care (ECC) guidelines may not be optimal or appropriate. Adjunct in the initial treatment of cocaine-induced acute coronary syndrome†.

Ativan Dosage and Administration

General

• 
  

  Use smallest effective dosage to avoid oversedation.^{a b}

  
  


• 
  

  In patients who have received prolonged (e.g., for several months) therapy, avoid abrupt discontinuance, since manifestations of withdrawal can be precipitated; gradually taper dosage.^a

  
  

Administration

Administer orally, IM, or by IV injection or continuous infusion.^{a b c d} Avoid intra-arterial injection (arteriospasm may cause gangrene, possibly requiring amputation).^{a d}

Oral Administration

Dilute dose of oral concentrate solution in 30 mL or more of diluent (e.g., water, juice, carbonated or soda-like beverages) or mix with semi-solid foods (e.g., applesauce, pudding) just prior to administration.^a

IM Administration

Administer undiluted injection deeply into a large muscle mass. IM administration is not usually recommended, but may be used if IV access is not available.

IV Administration

For solution and drug compatibility see Compatibility under Stability.

Direct injection should be made with repeated aspiration to ensure that none of the drug is injected intra-arterially and that perivascular extravasation does not occur.^{a d} If pain occurs during the injection, immediately stop the injection and determine whether intra-arterial injection or extravasation has occurred.^d

Equipment necessary to maintain a patent airway and to support respiration and ventilation should be immediately available prior to IV administration. Monitor vital signs during IV infusion of the drug.

Dilution

For administration as a direct injection, dilute 2-mg/mL injection with an equal volume of compatible diluent (e.g., sterile water for injection, 0.9% sodium chloride injection, or 5% dextrose injection) immediately prior to IV administration.^{a d}

For administration as a continuous infusion, dilute the 2-mg/mL injection in a glass container to a concentration of ≤1 mg/mL with a compatible IV fluid. (See Solution Compatibility under Stability.)

Alternatively, 2-mg/mL injection may be administered undiluted as an infusion using a patient-controlled analgesia (PCA) device.

Rate of Administration

Administer by direct injection into a vein or the tubing of a free-flowing compatible IV infusion at a rate ≤2 mg/minute.^a (See Solution Compatibility under Stability.)

Dosage

Pediatric Patients

Status Epilepticus†

IV

Initially, 0.05–0.1 mg/kg.

Sedation in Critical-care Settings†

IV

Children ≤12 years of age: Dosages of 0.025–0.05 mg/kg (up to 2 mg as initial dose) every 2–4 hours have been used. Alternatively, 0.025 mg/kg per hour (up to 2 mg/hour) as a continuous infusion; titrate infusion rate as necessary or supplement with rapid injections of the drug to provide the desired level of sedation. Children <2 months of age: Reduce initial dose by 50% because of wide interpatient variations in dosage requirements and low hepatic metabolic function.

Children >12 years of age: 0.02–0.06 mg/kg given every 2–6 hours. Alternatively, 0.01–0.1 mg/kg per hour as a continuous infusion; titrate infusion rate to the lowest dosage that provides desired level of sedation.

Adults

Anxiety

Oral

Initially, 2–3 mg daily divided in 2 or 3 doses.^{a c} Maintenance dosage of 1–10 mg daily (usually 2–6 mg) in divided doses, with the largest dose administered at bedtime.^{a c} Increase dosage gradually if higher dosage is indicated; increase the evening dose before the daytime doses.^a

For insomnia caused by anxiety, 2–4 mg as a single daily dose at bedtime.^{a c}

Preoperative Sedation, Anxiolysis, and Anterograde Amnesia

IM

0.05 mg/kg (up to 4 mg) at least 2 hours prior to surgery.^{a d}

IV

Initially, 0.044 mg/kg (up to 2 mg) 15–20 minutes prior to surgery; do not routinely exceed this dosage in patients >50 years of age.^{a d} For amnesic effects, doses up to 0.05 mg/kg (maximum 4 mg) may be administered.^{a d}

Status Epilepticus

IV

Initially, 4 mg. If seizures continue or recur after a 10- to 15-minute observation period, administer an additional 4-mg dose. Manufacturer states that experience with administration of additional doses is limited.

Sedation in Critical-care Settings†

IV

0.02–0.06 mg/kg given every 2–6 hours.

Alternatively, 0.01–0.1 mg/kg per hour as a continuous infusion; titrate infusion rate to the lowest dosage that provides desired level of sedation.

Cancer Chemotherapy-induced Nausea and Vomiting†

Oral

2.5 mg the evening before and just after initiation of chemotherapy.

IV

1.5 mg/m² (up to 3 mg) over 5 minutes, given 45 minutes before administration of chemotherapy.^a

Delirium†

IV

0.5–1 mg, immediately following 3 mg of haloperidol.

Prescribing Limits

Adults

Preoperative Sedation, Anxiolysis, and Anterograde Amnesia

IM

4 mg.^{a d}

IV

2 mg for sedation and relief of anxiety.^{a d} For amnesic effects, 4 mg;^{a d} 3 mg for management of chemotherapy-induced nausea and vomiting.^a

Special Populations

Hepatic Impairment

Dosage adjustments are not required for parenteral administration.

Adjust oral dosage carefully in patients with severe hepatic insufficiency because oral therapy may exacerbate hepatic encephalopathy; lower than recommended dosages may be sufficient in these patients.

Renal Impairment

Dosage adjustment is not required for single doses of lorazepam injection; however, exercise caution with administration of multiple doses over a short period of time.

Geriatric Patients

Cautious dosage selection recommended because of greater sensitivity and possible age-related decreases in hepatic or renal function; initiate therapy at the lower end of the usual range.

Anxiety Disorders

Oral

Initially, 1–2 mg daily divided in 2 or 3 doses.^a

Preoperative Sedation, Anxiolysis, and Anterograde Amnesia

IM or IV

Patients >50 years of age generally should not receive initial dose >2 mg unless enhanced suppression of recall is desired.^{a d} Excessive and prolonged sedation may occur.

Cautions for Ativan

Contraindications

• 
  

  Known hypersensitivity to benzodiazepines or any ingredient in the formulation (e.g., benzyl alcohol, polyethylene glycol, or propylene glycol in the injection).

  
  


• 
  

  Acute angle-closure glaucoma (but may be administered to patients with open-angle glaucoma who are receiving appropriate therapy);^{c d} however, clinical rationale for this contraindication has been questioned.^b

  
  


• 
  

  Injection contraindicated in patients with sleep apnea.

  
  


• 
  

  Injection contraindicated in patients with severe respiratory insufficiency, except in those patients receiving mechanical ventilation requiring relief of anxiety and/or diminished recall of events.

  
  

Warnings/Precautions

Warnings

Respiratory and Cardiovascular Effects

Use oral lorazepam with caution in patients with compromised respiratory function (e.g., chronic pulmonary insufficiency, sleep apnea).^{b c}

Possible apnea, hypotension, bradycardia, or cardiac arrest with parenteral administration, particularly in geriatric or severely ill patients, in patients with limited pulmonary reserve or unstable cardiovascular status, or if the drug is administered IV too rapidly.^b

Concomitant use of other CNS depressants may increase the risk of apnea.^{a c}

Administer IV only in settings in which continuous monitoring of respiratory and cardiac function (i.e., pulse oximetry) is possible. Monitoring of vital signs should continue during recovery period.

Facilities, age- and size-appropriate equipment for bag/mask/valve ventilation and intubation, drugs, and skilled personnel necessary for ventilation and intubation, administration of oxygen, assisted or controlled respiration, airway management, and cardiovascular support should be immediately available when lorazepam is administered IV.^d

Status Epilepticus

Should be used for the treatment of status epilepticus only by clinicians experienced in the comprehensive management of the disease.

Careful monitoring of respiratory rate and maintenance of an adequate, patent airway is required; ventilatory support may be necessary.

Because of the prolonged duration of action, sedative effects of lorazepam (especially after multiple doses) may increase impairment of consciousness observed in the postictal state.

CNS Effects

Performance of activities requiring mental alertness and physical coordination (operating machinery, driving a motor vehicle) may be impaired.^{a b c} Impairment may persist for 24–48 hours following parenteral administration.^{a d} Premature ambulation may result in falls.^d

Concurrent use of other CNS depressants may cause additive or potentiated CNS depression.^{a b c d} (See Specific Drugs under Interactions.)

May interfere with assessment of level of anesthesia when administered IV prior to regional or local anesthesia, especially when given at doses >0.5 mg/kg or when opiate agonists or partial agonists are used coincomitantly with recommended lorazepam doses.^{a d}

Psychiatric Indications

Do not use in patients with depressive neuroses or psychotic reactions in which anxiety is not prominent.^{a c}

Abuse Potential

Possible tolerance, psychologic dependence, and physical dependence following prolonged administration.^b

Patients with a history of drug or alcohol dependence or abuse are at risk of habituation or dependence; use only with careful surveillance in such patients.^{b c}

Withdrawal

Symptoms of withdrawal (similar to barbiturates or alcohol) may occur if discontinued abruptly.^{a c} Symptoms may be relieved by tapering the dosage.^{a c}

Endoscopic Procedures

Insufficient data to support use for outpatient endoscopic procedures; when used for inpatient endoscopic procedures, adequate recovery room observations required.^d

General Precautions

Suicide

Possibility of suicide in depressed patients; prescribe drug in the smallest feasible quantity.^{b c}

Paradoxical Reactions

Paradoxical reactions (e.g., anxiety, excitation, hostility, aggression, rage, sleep disturbances/insomnia, sexual arousal, hallucinations) may occur, particularly in children and geriatric patients.^{b c} Discontinue drug if such reactions occur.^{b c}

Propylene Glycol or Polyethylene Glycol Toxicity

Possible adverse effects associated with propylene glycol (e.g., lactic acidosis, hyperosmolality, hypotension) or polyethylene glycol (e.g., acute tubular necrosis) in patients receiving higher than recommended parenteral dosages. More likely to occur in patients with renal impairment.

Specific Populations

Pregnancy

Category D.^d

Lactation

Distributed into milk.^d

Administer orally to nursing women only if the potential benefits to the woman outweigh the possible risk to the infant. Monitor nursing infants for adverse effects (e.g., sedation, irritability).

Do not administer lorazepam injection to nursing women, because of possible adverse effects (e.g., sedation).

Pediatric Use

Safety and efficacy of tablets and oral concentrate solution not established in children <12 years of age.

Safety of the injection for treatment of status epilepticus or efficacy for preoperative sedation not established in children <18 years of age.

Paradoxical excitation (e.g., tremors, agitation, euphoria, logorrhea, brief episodes of visual hallucinations) reported in 10–30% of children <8 years of age.

Seizures and myoclonus reported in pediatric patients, especially low birth weight neonates, receiving lorazepam injection. Brief tonic-clonic seizures reported in children receiving lorazepam for the management of atypical petit mal status epilepticus.

Some pediatric patients (premature and low-birth weight infants or those receiving high doses of the injection) may be susceptible to adverse effects associated with benzyl alcohol, polyethylene glycol, and propylene glycol. Large amounts of benzyl alcohol (i.e., 100–400 mg/kg daily) have been associated with toxicity in neonates; each mL of lorazepam injection contains 2 mg of benzyl alcohol.^d (See Propylene Glycol or Polyethylene Glycol Toxicity under Cautions.)

Geriatric Use

Insufficient experience in patients ≥65 years of age to determine whether geriatric patients respond differently than younger adults. Possibility of greater sensitivity to the drug (e.g., respiratory or CNS depression) in some geriatric individuals.^d

Select initial dosages at the lower end of the usual range because of potential for greater sensitivity and age-related decreases in hepatic or renal function. (See Geriatric Patients under Dosage and Administration.)

May cause excessive sedation for 6–8 hours or longer after surgery in this population.

Possible paradoxical excitation (e.g., anxiety, excitation, hostility, aggression, rage, sleep disturbances/insomnia, sexual arousal, hallucinations).^{b c}

Hepatic Impairment

Lorazepam injection is not recommended for use in patients with hepatic failure; may be used in patients with mild to moderately severe hepatic disease.^d (See Hepatic Impairment under Dosage and Administration.)

Oral lorazepam may exacerbate hepatic encephalopathy; therefore, use with caution in patients with severe hepatic insufficiency and/or encephalopathy.

Renal Impairment

Lorazepam injection is not recommended for use in renal failure; use with caution in patients with mild to moderate renal disease.^{a d} (See Renal Impairment under Dosage and Administration.)

Common Adverse Effects

With oral therapy, sedation, dizziness, weakness, unsteadiness.^c

With parenteral therapy for the management of status epilepticus, hypotension, somnolence, respiratory failure; with parenteral therapy for preoperative use, excessive sleepiness, drowsiness.^d

Interactions for Ativan

Specific Drugs

Drug	Interaction	Comments
Cimetidine	Effect on lorazepam pharmacokinetics unlikelyd	No dosage adjustment of lorazepam requiredd
Disulfiram	Effect on lorazepam pharmacokinetics unlikelyd	No dosage adjustment of lorazepam requiredd
Clozapine	Marked sedation, excessive salivation, ataxia, and, rarely, death reportedc d	Use with cautionc d
CNS depressants (e.g., opiates or other analgesics, barbiturates, sedatives, anticonvulsants, alcohol)	Additive CNS effectsc d	Use with caution to avoid overdosagec d
Contraceptives, oral	Possible increased clearance of parenteral lorazepamd	Dosage of parenteral lorazepam may need to be increased d
Haloperidol	Apnea, coma, bradycardia, arrhythmia, heart arrest, and death reportedd	Use with cautiond
Loxapine	Respiratory depression, stupor, and/or hypotension reported rarelyd	Use with cautiond
Metoprolol	Effect on lorazepam pharmacokinetics unlikelyd	No dosage adjustment of lorazepam requiredd
Metronidazole	Effect on lorazepam pharmacokinetics unlikelyd	No dosage adjustment of lorazepam requiredd
Probenecid	Decreased lorazepam clearancec d	Reduce lorazepam dosage by 50%c d
Propoxyphene	Effect on lorazepam pharmacokinetics unlikelyd	No dosage adjustment of lorazepam requiredd
Propranolol	Effect on lorazepam pharmacokinetics unlikelyd	No dosage adjustment of lorazepam requiredd
Ranitidine	Effect on lorazepam pharmacokinetics unlikelyd	No dosage adjustment of lorazepam requiredd
Scopolamine	Possible increased sedation, hallucinations, and irrational behaviord	No additional benefit from the combinationd
Theophylline	Decreased sedative effectsd
Valproate	Increased plasma lorazepam concentrationd	Reduce usual lorazepam dosage by 50%d

Ativan Pharmacokinetics

Absorption

Bioavailability

Readily absorbed from the GI tract following oral administration; absolute bioavailability is 90%.^c

Completely and rapidly absorbed following IM administration.^d

Peak plasma concentrations are attained in approximately 2 hours following oral administration^c and within 3 hours following IM administration.^d

Onset

After IV administration, the onset of anticonvulsant, anxiolytic, or sedative action occurs in 1–5 minutes.^b

After IM administration, the onset of action is 15–30 minutes.^b

Duration

After IV or IM administration, the duration of anticonvulsant, anxiolytic, or sedative action is 12–24 hours.^b

Distribution

Extent

Widely distributed into body tissues; crosses the blood-brain barrier.^{b d}

Crosses the placenta and is distributed into milk.^{b d}

Plasma Protein Binding

Approximately 85–91%.^{b c d}

Elimination

Metabolism

Extensively metabolized in the liver to inactive metabolites.^{c d}

Elimination Route

Excreted prinicipally in urine as metabolites.^{c d}

Half-life

10–20 hours.^{b c d}

Special Populations

In neonates, clearance reduced by 80% compared with healthy adults.^d

In geriatric patients or patients with hepatic cirrhosis, clearance not substantially altered.^{b d}

In patients with renal impairment, clearance of lorazepam glucuronide is reduced, but total clearance of lorazepam is not altered following single IV dose.^d

Stability

Storage

Oral

Tablets

Tight containers at 20–25°C.^c

Concentrate Solution

2–8°C; protect from light.^a

Parenteral

Injection

2–8°C; protect from light.^d

Compatibility

For information on systemic interactions resulting from concomitant use, see Interactions.

Parenteral

Solution Compatibility^e

Variable
Dextrose 5% in water
Ringer’s injection, lactated
Sodium chloride 0.9%

Drug Compatibility

Admixture Compatibilitye

Incompatible
Dexamethasone sodium phosphate with diphenhydramine HCl and metoclopramide HCl

Y-Site Compatibilitye

Compatible
Acyclovir sodium
Albumin human
Allopurinol sodium
Amifostine
Amikacin sulfate
Amiodarone HCl
Amphotericin B cholesteryl sulfate complex
Amsacrine
Atracurium besylate
Bivalirudin
Bumetanide
Cefepime HCl
Cefotaxime sodium
Ciprofloxacin
Cisplatin
Cladribine
Clonidine HCl
Co-trimoxazole
Cyclophosphamide
Cytarabine
Dexamethasone sodium phosphate
Dexmedetomidine HCl
Diltiazem HCl
Dobutamine HCl
Docetaxel
Dopamine HCl
Doxorubicin HCl
Doxorubicin HCl liposome injection
Epinephrine HCl
Erythromycin lactobionate
Etomidate
Etoposide phosphate
Famotidine
Fenoldopam mesylate
Fentanyl citrate
Filgrastim
Fluconazole
Fludarabine phosphate
Fosphenytoin sodium
Furosemide
Gatifloxacin
Gemcitabine HCl
Gentamicin sulfate
Granisetron HCl
Haloperidol lactate
Heparin sodium
Hetastarch in lactated electrolyte injection (Hextend)
Hydrocortisone sodium succinate
Hydromorphone HCl
Ketanserin tartrate
Labetalol HCl
Levofloxacin
Linezolid
Melphalan HCl
Methadone HCl
Methotrexate sodium
Metronidazole
Midazolam HCl
Milrinone lactate
Morphine HCl
Morphine sulfate
Nicardipine HCl
Nitroglycerin
Norepinephrine bitartrate
Paclitaxel
Pancuronium bromide
Piperacillin sodium–tazobactam sodium
Potassium chloride
Propofol
Ranitidine HCl
Remifentanil HCl
Tacrolimus
Teniposide
Thiotepa
Vancomycin HCl
Vecuronium bromide
Vinorelbine tartrate
Zidovudine
Incompatible
Aldesleukin
Aztreonam
Floxacillin sodium
Idarubicin HCl
Imipenem–cilastatin sodium
Omeprazole sodium
Ondansetron HCl
Sargramostim
Sufentanil citrate
Variable
Foscarnet sodium
Thiopental sodium

ActionsActions

• 
  

  Effects appear to be mediated through the inhibitory neurotransmitter GABA; the site and mechanism of action within the CNS appear to involve a macromolecular complex (GABA_A-receptor-chloride ionophore complex) that includes GABA_A receptors, high-affinity benzodiazepine receptors, and chloride channels.

  
  

Advice to Patients

• 
  

  Potential for drug to impair mental alertness or physical coordination; avoid driving or operating machinery until effects on individual are known.^{c d} Following parenteral dose, wait 24–48 hours or until drowsiness subsides before participating in such activities.^d

  
  


• 
  

  Importance of informing patients of the pharmacologic effects of lorazepam (e.g., sedation, relief of anxiety, lack of recall) and the duration of these effects (≥8 hours) so that they may understand the risks and benefits.^{c d}

  
  


• 
  

  Importance of avoiding premature ambulation (within 8 hours of dose) in patients receiving parenteral lorazepam.^{a d}

  
  


• 
  

  Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs.^c Importance of avoiding alcohol-containing beverages or products (for at least 24–48 hours after parenteral administration).^{b d}

  
  


• 
  

  Importance of informing clinicians about any concomitant illnesses (e.g., depression, respiratory disorders).^c

  
  


• 
  

  Importance of taking only as prescribed; do not increase dosage or duration of therapy unless otherwise instructed by a clinician.^c

  
  


• 
  

  Importance of not abruptly discontinuing therapy; consult clinician about discontinuing use.^c

  
  


• 
  

  Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.^{c d}

  
  


• 
  

  Importance of informing patients of other important precautionary information.^{c d} (See Cautions.)

  
  

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Lorazepam is subject to control under the Federal Controlled Substances Act of 1970 as a schedule IV (C-IV) drug.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Lorazepam

Routes	Dosage Forms	Strengths	Brand Names	Manufacturer
Oral	For solution, concentrate	2 mg/mL*	Lorazepam Intensol (C-IV)	Roxane
	Tablets	0.5 mg*	Ativan (C-IV)	Biovail
		1 mg*	Ativan (C-IV; scored)	Biovail
		2 mg*	Ativan (C-IV; scored)	Biovail
Parenteral	Injection	2 mg/mL*	Ativan (C-IV)	Akorn, Baxter
			Lorazepam Injection (C-IV; available as Carpuject cartridges and vials)
		4 mg/mL*	Ativan (C-IV)	Baxter
			Lorazepam Injection (C-IV; available as Carpuject cartridges and vials)

Comparative Pricing

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 03/2011. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.

Ativan 0.5MG Tablets (VALEANT): 30/$85.95 or 90/$214.88

Ativan 1MG Tablets (VALEANT): 30/$100.11 or 90/$266.95

Ativan 2MG Tablets (VALEANT): 30/$155.99 or 90/$445.99

LORazepam 2MG Tablets (ACTAVIS ELIZABETH): 30/$21.99 or 90/$65.98

LORazepam Intensol 2MG/ML Concentrate (ROXANE): 30/$44.99 or 90/$122.55

Disclaimer

This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.

The American Society of Health-System Pharmacists, Inc. and Drugs.com represent that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. and Drugs.com make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. and Drugs.com do not endorse or recommend the use of any drug. The information is not a substitute for medical care.

AHFS Drug Information. © Copyright, 1959-2011, Selected Revisions July 2009. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

a. AHFS drug information 2004. McEvoy GK, ed. Lorazepam. Bethesda, MD: American Society of Hospital Pharmacists; 2004:2388-91.

b. AHFS drug information 2004. McEvoy GK, ed. Benzodiazepine general statement. Bethesda, MD: American Society of Hospital Pharmacists; 2004:2372-80.

c. Wyeth Laboratories. Ativan (lorazepam) tablets prescribing information. Philadelphia, PA; 1999 Feb.

d. Wyeth Laboratories. Ativan (lorazepam) injection prescribing information. In: Physicians’ desk reference. 55th ed. Montvale, NJ: Medical Economics Company Inc; 2001: 3344-8.

e. Trissel LA. Handbook on injectable drugs. 13th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2005:934-941.

More Ativan resources

• Ativan Side Effects (in more detail)
• Ativan Use in Pregnancy & Breastfeeding
• Drug Images
• Ativan Drug Interactions
• Ativan Support Group
• 125 Reviews for Ativan - Add your own review/rating

• Ativan Prescribing Information (FDA)


• Ativan Consumer Overview


• Ativan Advanced Consumer (Micromedex) - Includes Dosage Information


• Ativan MedFacts Consumer Leaflet (Wolters Kluwer)


• Lorazepam Prescribing Information (FDA)


• Lorazepam Professional Patient Advice (Wolters Kluwer)

Compare Ativan with other medications

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• Panic Disorder
• Sedation
• Status Epilepticus

Ativan Solution

Pronunciation: lor-AZ-e-pam
Generic Name: Lorazepam
Brand Name: Ativan

Ativan Solution is used for:

Treating anxiety and causing drowsiness before certain medical procedures and treating certain types of seizures. It may also be prescribed for other conditions as determined by your doctor.

Ativan Solution is a benzodiazepine. It works by slowing down the movement of chemicals in the brain. This results in a reduction in nervous tension (anxiety) and causes sedation.

Do NOT use Ativan Solution if:

• you are allergic to any ingredient in Ativan Solution or any other benzodiazepine (eg, alprazolam)


• you have narrow-angle glaucoma, psychosis, sleep apnea, or severe liver disease


• you are taking sodium oxybate (GHB)

Contact your doctor or health care provider right away if any of these apply to you.

Video: Treatment for Depression

Treatments for depression are getting better everyday and there are things you can start doing right away.

Before using Ativan Solution:

Some medical conditions may interact with Ativan Solution. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

• if you are pregnant, planning to become pregnant, or are breast-feeding


• if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement


• if you have allergies to medicines, foods, or other substances


• if you are taking any other medicine that causes drowsiness (eg, narcotics, some antidepressants)


• if you have lung function problems, chronic obstructive pulmonary disease (COPD), muscle weakness or fatigue, glaucoma, liver or kidney problems, a blood disorder, depression, or suicidal thoughts


• if you have a history of alcohol or substance abuse or dependence

Some MEDICINES MAY INTERACT with Ativan Solution. Tell your health care provider if you are taking any other medicines, especially any of the following:

• Hydantoins (eg, phenytoin) or theophyllines because they may decrease Ativan Solution's effectiveness


• Clozapine, haloperidol, kava, loxapine, narcotic pain relievers (eg, morphine, codeine), sodium oxybate (GHB), or valproic acid because side effects, such as extreme sedation, slowed breathing, confusion, or memory problems, may occur


• Digoxin, hydantoins (eg, phenytoin), narcotic pain relievers (eg, morphine, codeine), nondepolarizing muscle relaxants (eg, vecuronium), or sodium oxybate (GHB) because the risk of their side effects may be increased by Ativan Solution


• Nondepolarizing muscle relaxants (eg, vecuronium) because they may decrease Ativan Solution's effectiveness

This may not be a complete list of all interactions that may occur. Ask your health care provider if Ativan Solution may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Ativan Solution:

Use Ativan Solution as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Ativan Solution is usually given as an injection at your doctor's office, hospital, or clinic. If you will be using Ativan Solution at home, a health care provider will teach you how to use it. Be sure you understand how to use Ativan Solution. Follow the procedures you are taught when you use a dose. Contact your health care provider if you have any questions.


• Do not use Ativan Solution if it contains particles, is cloudy or discolored, or if the vial is cracked or damaged.


• Ativan Solution should not be injected into an artery because serious side effects may occur.


• Keep this product, as well as syringes and needles, out of the reach of children and pets. Do not reuse needles, syringes, or other materials. Ask your health care provider how to dispose of these materials after use. Follow all local rules for disposal.


• If you miss a dose of Ativan Solution, use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not use 2 doses at once.

Ask your health care provider any questions you may have about how to use Ativan Solution.

Important safety information:

• Ativan Solution may cause drowsiness, dizziness, and blurred vision. These effects may be worse if you take it with alcohol or certain medicines. Use Ativan Solution with caution. Do not drive or perform other possibly unsafe tasks for up to 48 hours after use.


• Do not drink alcohol for at least 24 to 48 hours after using Ativan Solution. Do not use medicines that may cause drowsiness (eg, sleep aids, muscle relaxers) while you are using Ativan Solution; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness.


• Effects, such as drowsiness, relief of anxiety, and lack of remembering and recognizing events the day of surgery, will last about 8 hours.


• Other types of sedatives, tranquilizers, and narcotic pain relievers may cause a longer and more intense effect when taken with Ativan Solution. Excessive sleepiness, drowsiness, and memory problems (eg, difficulty remembering and recognizing events the day of and the day after surgery) may occur.


• Do not attempt to get out of bed without help. Trying to get out of bed within 8 hours of receiving Ativan Solution may result in falling or injury.


• Use Ativan Solution with caution in the ELDERLY; they may be more sensitive to its effects.


• Ativan Solution should not be used in CHILDREN younger than 18 years old; safety and effectiveness in these children have not been confirmed.


• PREGNANCY and BREAST-FEEDING: Ativan Solution has been shown to cause harm to the fetus. Do not become pregnant while you are using it. If you think you may be pregnant, contact your doctor. You will need to discuss the benefits and risks of using Ativan Solution while you are pregnant. Ativan Solution is found in breast milk. Do not breast-feed while taking Ativan Solution.

Some people who use Ativan Solution for a long time may develop a need to continue taking it. People who take high doses are also at risk. This is known as DEPENDENCE or addiction.

If you stop taking Ativan Solution suddenly, you may have WITHDRAWAL symptoms. These may include agitation, anxiety, irritability, occasional seizures, or sleeplessness may occur if Ativan Solution is suddenly stopped. If you need to stop Ativan Solution, your doctor will lower your dose over time.

Possible side effects of Ativan Solution:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Blurred vision; dizziness; dry mouth; excessive sleepiness and drowsiness; headache; pain, swelling, or redness at the injection area; short-term memory loss; weakness.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue).

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

See also: Ativan side effects (in more detail)

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms of overdose may include clumsiness; confusion; deep sleep; loss of consciousness; slow reflexes.

Proper storage of Ativan Solution:

Store Ativan Solution in a refrigerator at 36 to 46 degrees F (2 to 8 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Store in original packaging until just before use. Keep Ativan Solution out of the reach of children and away from pets.

General information:

• If you have any questions about Ativan Solution, please talk with your doctor, pharmacist, or other health care provider.


• Ativan Solution is to be used only by the patient for whom it is prescribed. Do not share it with other people.


• If your symptoms do not improve or if they become worse, check with your doctor.


• Check with your pharmacist about how to dispose of unused medicine.

This information is a summary only. It does not contain all information about Ativan Solution. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

Issue Date: February 1, 2012

Database Edition 12.1.1.002

Copyright © 2012 Wolters Kluwer Health, Inc.

More Ativan resources

• Ativan Side Effects (in more detail)
• Ativan Use in Pregnancy & Breastfeeding
• Drug Images
• Ativan Drug Interactions
• Ativan Support Group
• 125 Reviews for Ativan - Add your own review/rating

Compare Ativan with other medications

• Anxiety
• Cervical Dystonia
• Dysautonomia
• ICU Agitation
• Insomnia
• Light Anesthesia
• Nausea/Vomiting
• Nausea/Vomiting, Chemotherapy Induced
• Panic Disorder
• Sedation
• Status Epilepticus

Atreza

Pronunciation: AT-row-peen
Generic Name: Atropine
Brand Name: Atreza and Sal-Tropine

Atreza is used for:

Treating spasms in the stomach, intestines, and other organs. It may also be used to decrease the production of saliva and secretions of the airway or for other conditions as determined by your doctor.

Atreza is an anticholinergic. It works by blocking the effects of a chemical in the body (acetylcholine) in the nervous system, stomach, intestines, certain glands (eg, salivary gland), urinary tract, and other tissues.

Do NOT use Atreza if:

• you are allergic to any ingredient in Atreza


• you have adhesions between the iris and lens of the eyes, asthma, blocking of the stomach or bowel, ulcerative colitis, bleeding, angle-closure glaucoma, myasthenia gravis, difficulty urinating due to a blockage, excess acid in the stomach or throat, esophagus problems (difficulty swallowing), or bowel muscle weakness

Contact your doctor or health care provider right away if any of these apply to you.

Before using Atreza:

Some medical conditions may interact with Atreza. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

• if you are pregnant, planning to become pregnant, or are breast-feeding


• if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement


• if you have allergies to medicines, foods, or other substances


• if you have a history of megacolon or a predisposition to angle-closure glaucoma


• if you have numbness due to nerve damage, prostate problems (enlarged prostate), blockage of the bladder, trouble urinating, heart problems (congestive heart failure), hiatal hernia, or open-angle glaucoma

Some MEDICINES MAY INTERACT with Atreza. Tell your health care provider if you are taking any other medicines, especially any of the following:

• Antihistamines (eg, diphenhydramine), medicine for Parkinson disease (eg, benztropine), or tricyclic antidepressants (eg, amitriptyline) because they may increase the risk of Atreza's side effects

This may not be a complete list of all interactions that may occur. Ask your health care provider if Atreza may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Atreza:

Use Atreza as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Take Atreza by mouth with or without food.


• If you miss a dose of Atreza, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Atreza.

Important safety information:

• If your symptoms do not get better within a few days or if they get worse, check with your doctor.


• Atreza may cause drowsiness or blurred vision. These effects may be worse if you take it with alcohol or certain medicines. Use Atreza with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.


• Do not drink alcohol or use medicines that may cause drowsiness (eg, sleep aids, muscle relaxers) while you are using Atreza; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness.


• Do not become overheated in hot weather or while you are being active; heatstroke may occur.


• Report any symptoms of fluid or electrolyte loss to your doctor: dry mouth; thirst; weakness; lethargy; drowsiness; restlessness; muscle pain or cramps; muscle weakness; low blood pressure; infrequent urination; rapid heartbeat; stomach disorders such as nausea and vomiting.


• Atreza may make your eyes more sensitive to sunlight. It may help to wear sunglasses.


• Tell your doctor or dentist that you take Atreza before you receive any medical or dental care, emergency care, or surgery.


• Use Atreza with caution in the ELDERLY; they may be more sensitive to its effects.


• Atreza should be used with extreme caution in CHILDREN younger than 13 years old; safety and effectiveness in these children have not been confirmed.


• PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Atreza while you are pregnant. It is not known if Atreza is found in breast milk. If you are or will be breast-feeding while you use Atreza, check with your doctor. Discuss any possible risks to your baby.

Possible side effects of Atreza:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Blurred vision; constipation; decreased salivation; decreased sweating; difficulty sleeping; difficulty swallowing; dilation of the pupils; dizziness; drowsiness; excitement; fever; headache; hot, flushed, dry skin; loss of taste; mild to severe dryness of the nose and mouth; nausea; nervousness; thirst.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); changes in heartbeat; confusion; delirium; diarrhea; difficulty focusing your eyes; difficulty urinating; fast/irregular heartbeat; hallucinations; rash; restlessness with weakness; speech disturbance; unusual weakness; vomiting.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

See also: Atreza side effects (in more detail)

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include anxiety; coma; difficulty breathing; dilated pupils; disorientation; hallucinations; high blood pressure; high body temperature; hyperactivity; muscle weakness; restlessness; seizures; severe dizziness; urinary retention; vomiting.

Proper storage of Atreza:

Store Atreza at room temperature, between 68 and 77 degrees F (20 and 25 degrees C). Brief storage at temperatures between 59 and 86 degrees F (15 and 30 degrees C) is permitted. Store away from heat, moisture, and light. Do not store in the bathroom. Keep Atreza out of the reach of children and away from pets.

General information:

• If you have any questions about Atreza, please talk with your doctor, pharmacist, or other health care provider.


• Atreza is to be used only by the patient for whom it is prescribed. Do not share it with other people.


• If your symptoms do not improve or if they become worse, check with your doctor.


• Check with your pharmacist about how to dispose of unused medicine.

This information is a summary only. It does not contain all information about Atreza. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

Issue Date: February 1, 2012

Database Edition 12.1.1.002

Copyright © 2012 Wolters Kluwer Health, Inc.

More Atreza resources

• Atreza Side Effects (in more detail)
• Atreza Use in Pregnancy & Breastfeeding
• Atreza Drug Interactions
• Atreza Support Group
• 0 Reviews for Atreza - Add your own review/rating

• Atreza Concise Consumer Information (Cerner Multum)


• Atropine Prescribing Information (FDA)


• Atropine Monograph (AHFS DI)


• Atropine Professional Patient Advice (Wolters Kluwer)


• Atropine Advanced Consumer (Micromedex) - Includes Dosage Information


• AtroPen Prescribing Information (FDA)

Compare Atreza with other medications

• Anticholinesterase Poisoning
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Atropine/Diphenoxylate Solution

Pronunciation: AT-row-peen/dye-fen-OX-i-late
Generic Name: Atropine/Diphenoxylate
Brand Name: Lomotil

Atropine/Diphenoxylate Solution is used for:

Treating diarrhea. It may also be used for other conditions as determined by your doctor.

Atropine/Diphenoxylate Solution is an antidiarrheal and anticholinergic combination. It works by decreasing the motion of muscles in the intestines and prolonging the time it takes to move the contents through the body.

Do NOT use Atropine/Diphenoxylate Solution if:

• you are allergic to any ingredient in Atropine/Diphenoxylate Solution


• you have diarrhea caused by certain conditions (eg, pseudomembranous colitis, enterotoxin-producing bacteria, food poisoning)


• you have jaundice (yellowing of the eyes or skin)


• you have a blockage of the stomach or bowel, angle-closure glaucoma, myasthenia gravis, urinary blockage, excess acid in the stomach or throat, esophagus problems (eg, difficulty swallowing, inflammation), bowel muscle weakness, or heart problems with severe bleeding


• you are taking sodium oxybate (GHB)

Contact your doctor or health care provider right away if any of these apply to you.

Before using Atropine/Diphenoxylate Solution:

Some medical conditions may interact with Atropine/Diphenoxylate Solution. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

• if you are pregnant, planning to become pregnant, or are breast-feeding


• if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement


• if you have allergies to medicines, foods, or other substances


• if you have a history of jaundice (yellowing of the eyes or skin) or megacolon


• if you have abnormal blood levels of electrolytes (eg, potassium, sodium), ulcerative colitis, liver or kidney problems, Down syndrome, numbness due to nerve damage, prostate problems (enlarged prostate), a blockage of the bladder, trouble urinating, heart problems (eg, congestive heart failure, irregular heartbeat), hiatal hernia, asthma, open-angle glaucoma, or risk factors for glaucoma


• if you are dehydrated

Some MEDICINES MAY INTERACT with Atropine/Diphenoxylate Solution. Tell your health care provider if you are taking any other medicines, especially any of the following:

• Antihistamines (eg, diphenhydramine), medicine for Parkinson disease (eg, benztropine), or tricyclic antidepressants (eg, amitriptyline) they may increase the risk of Atropine/Diphenoxylate Solution's side effects


• Barbiturates (eg, phenobarbital) or sodium oxybate (GHB) because the risk of their side effects may be increased by Atropine/Diphenoxylate Solution


• Monoamine oxidase inhibitors (MAOIs) (eg, phenelzine) because the risk of serious side effects, including severe high blood pressure, may be increased

This may not be a complete list of all interactions that may occur. Ask your health care provider if Atropine/Diphenoxylate Solution may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Atropine/Diphenoxylate Solution:

Use Atropine/Diphenoxylate Solution as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Take Atropine/Diphenoxylate Solution by mouth with or without food.


• Use the dropper than comes with Atropine/Diphenoxylate Solution to measure your dose. Ask your pharmacist for help if you are unsure of how to measure your dose.


• If you miss a dose of Atropine/Diphenoxylate Solution and you are taking it regularly, take it as soon as possible. If several hours have passed or if it is nearing time for the next dose, do not double the dose to catch up, unless advised by your health care provider. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Atropine/Diphenoxylate Solution.

Important safety information:

• Atropine/Diphenoxylate Solution may cause drowsiness, dizziness, or blurred vision. These effects may be worse if you take it with alcohol or certain medicines. Use Atropine/Diphenoxylate Solution with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.


• Do not drink alcohol or use medicines that may cause drowsiness (eg, sleep aids, muscle relaxers) while you are using Atropine/Diphenoxylate Solution; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness.


• Do NOT take more than the recommended dose or use for longer than prescribed without checking with your doctor. This could increase the risk of serious side effects.


• If your symptoms do not get better within 10 days (2 days for children) or if they get worse, check with your doctor.


• Do not become overheated in hot weather or while you are being active; heatstroke may occur.


• Report any symptoms of fluid or electrolyte loss to your doctor: dry mouth; thirst; weakness; lethargy; drowsiness; restlessness; muscle pain or cramps; muscle weakness; low blood pressure; infrequent urination; rapid heartbeat; stomach disorders such as nausea and vomiting.


• Atropine/Diphenoxylate Solution may make your eyes more sensitive to sunlight. It may help to wear sunglasses.


• Tell your doctor or dentist that you take Atropine/Diphenoxylate Solution before you receive any medical or dental care, emergency care, or surgery.


• Use Atropine/Diphenoxylate Solution with caution in the ELDERLY; they may be more sensitive to its effects, especially excitement, agitation, or drowsiness.


• Atropine/Diphenoxylate Solution should not be used in CHILDREN younger than 2 years old; safety and effectiveness in these children have not been confirmed.


• Caution is advised when using Atropine/Diphenoxylate Solution in CHILDREN 2 years of age and older; they may be more sensitive to its effects.


• PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Atropine/Diphenoxylate Solution while you are pregnant. Atropine/Diphenoxylate Solution is found in breast milk. If you are or will be breast-feeding while you use Atropine/Diphenoxylate Solution, check with your doctor. Discuss any possible risks to your baby.

When used for longer than a few weeks or at high doses, some people develop a need to continue taking Atropine/Diphenoxylate Solution. This is known as DEPENDENCE or addiction. Do NOT take more than the recommended dose or use for longer than prescribed without checking with your doctor.

Possible side effects of Atropine/Diphenoxylate Solution:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Blurred vision; constipation; decreased sweating; difficulty sleeping; dizziness; drowsiness; dry mouth, nose, or skin; headache; loss of appetite; loss of taste; nausea; nervousness.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); abdominal bloating or swelling; agitation; changes in heartbeat; confusion; continued or severe diarrhea; delirium; difficulty focusing your eyes; difficulty urinating; exaggerated sense of well-being; excitement; fast/irregular heartbeat; fever; hallucinations; numbness of the hands or feet; severely enlarged pupils; severe or prolonged restlessness; speech disturbance; unusual weakness; vomiting.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

See also: Atropine/Diphenoxylate side effects (in more detail)

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include coma; difficulty breathing; dilated or constricted pupils; disorientation; fever; flushing; hallucinations; hyperactivity; muscle weakness; restlessness; seizures; severe dizziness; unusual eye movements; urinary retention; vomiting.

Proper storage of Atropine/Diphenoxylate Solution:

Store Atropine/Diphenoxylate Solution at room temperature, between 68 and 77 degrees F (20 and 25 degrees C). Brief storage at temperatures between 59 and 86 degrees F (15 and 30 degrees C) is permitted. Store away from heat, moisture, and light. Do not store in the bathroom. Keep Atropine/Diphenoxylate Solution out of the reach of children and away from pets.

General information:

• If you have any questions about Atropine/Diphenoxylate Solution, please talk with your doctor, pharmacist, or other health care provider.


• Atropine/Diphenoxylate Solution is to be used only by the patient for whom it is prescribed. Do not share it with other people.


• If your symptoms do not improve or if they become worse, check with your doctor.


• Check with your pharmacist about how to dispose of unused medicine.

This information is a summary only. It does not contain all information about Atropine/Diphenoxylate Solution. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

Issue Date: February 1, 2012

Database Edition 12.1.1.002

Copyright © 2012 Wolters Kluwer Health, Inc.

More Atropine/Diphenoxylate resources

• Atropine/Diphenoxylate Side Effects (in more detail)
• Atropine/Diphenoxylate Use in Pregnancy & Breastfeeding
• Drug Images
• Atropine/Diphenoxylate Drug Interactions
• Atropine/Diphenoxylate Support Group
• 23 Reviews for Atropine/Diphenoxylate - Add your own review/rating

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• Diarrhea

Atorvastatin

Pronunciation: a-TOR-va-STAT-in
Generic Name: Atorvastatin
Brand Name: Lipitor

Atorvastatin is used for:

Lowering high cholesterol and triglycerides in certain patients. It also increases high-density lipoprotein (HDL, "good") cholesterol levels. It is used along with an appropriate diet. It is used in certain patients to reduce the risk of heart attack, stroke, chest pain caused by angina, or blood vessel blockage. It is also used in certain patients to reduce the risk of hospitalization for congestive heart failure, or the need for medical procedures to open blocked heart blood vessels. It may also be used for other conditions as determined by your doctor.

Atorvastatin is an HMG-CoA reductase inhibitor, also known as a "statin." It works by reducing the production of certain fatty substances in the body, including cholesterol.

Do NOT use Atorvastatin if:

• you are allergic to any ingredient in Atorvastatin


• you have liver problems or unexplained abnormal liver function tests


• you are pregnant or breast-feeding


• you are taking conivaptan, mibefradil, or telaprevir

Contact your doctor or health care provider right away if any of these apply to you.

Before using Atorvastatin:

Some medical conditions may interact with Atorvastatin. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

• if you are pregnant, planning to become pregnant, or are breast-feeding


• if you are able to become pregnant


• if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement


• if you have allergies to medicines, foods, or other substances


• if you have low blood pressure, kidney problems, diabetes, thyroid problems, muscle problems, or a serious infection


• if you have metabolism, hormonal, or electrolyte problems


• if you drink alcohol or have a history of seizures, liver problems, or alcohol abuse


• if you are scheduled for major surgery, or have recently had major surgery, a serious injury, or a stroke

Some MEDICINES MAY INTERACT with Atorvastatin. Tell your health care provider if you are taking any other medicines, especially any of the following:

• Amiodarone, azole antifungals (eg, fluconazole, itraconazole), colchicine, conivaptan, cyclosporine, daptomycin, delavirdine, diltiazem, dronedarone, fibrates (eg, clofibrate, gemfibrozil), fusidic acid, HCV protease inhibitors (eg, boceprevir, telaprevir), HIV protease inhibitors (eg, ritonavir), imatinib, macrolides (eg, clarithromycin, erythromycin), mibefradil, nefazodone, niacin, quinine, streptogramins (eg, dalfopristin), telithromycin, verapamil, or voriconazole because they may increase the risk of muscle or kidney problems


• Bosentan, carbamazepine, efavirenz, rifamycins (eg, rifampin), or St. John's wort because they may decrease Atorvastatin's effectiveness


• Cimetidine, digoxin, certain hormonal contraceptives (eg, certain birth control pills), ketoconazole, macrolide immunosuppressants (eg, tacrolimus), or spironolactone because the risk of their side effects may be increased by Atorvastatin

This may not be a complete list of all interactions that may occur. Ask your health care provider if Atorvastatin may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Atorvastatin:

Use Atorvastatin as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Take Atorvastatin by mouth with or without food.


• Swallow Atorvastatin whole. Do not break, crush, or chew before swallowing.


• Eating grapefruit or drinking grapefruit juice may increase the amount of Atorvastatin in your blood, which may increase your risk for serious side effects. The risk may be greater with large amounts of grapefruit or grapefruit juice. Avoid large amounts of grapefruit or grapefruit juice (eg, more than one quart daily). Talk with your doctor or pharmacist if you have questions about including grapefruit or grapefruit juice in your diet while you are taking Atorvastatin.


• Continue to take Atorvastatin even if you feel well. Do not miss any doses.


• If you miss a dose of Atorvastatin, take it as soon as possible if you remember within 12 hours of the missed dose. If it is more than 12 hours since the missed dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Atorvastatin.

Important safety information:

• Drinking alcohol daily or in large amounts may increase the risk of liver problems with Atorvastatin. Check with your doctor before drinking alcohol while you are taking Atorvastatin.


• Follow the diet and exercise program given to you by your health care provider.


• Tell your doctor or dentist that you take Atorvastatin before you receive any medical or dental care, emergency care, or surgery.


• Women who may become pregnant should use effective birth control while taking Atorvastatin. Check with your doctor if you have questions about using birth control.


• Report any unexplained muscle pain, tenderness, or weakness to your doctor right away, especially if you also have a fever or general body discomfort.


• Lab tests, including blood cholesterol levels, creatine phosphokinase (CPK) levels, and liver function, may be performed while you use Atorvastatin. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.


• Use Atorvastatin with caution in the ELDERLY; they may be more sensitive to its effects, especially muscle problems.


• Atorvastatin should be used with extreme caution in CHILDREN younger than 10 years old and in those who have not reached puberty; safety and effectiveness in these children have not been confirmed.


• PREGNANCY and BREAST-FEEDING: Do not use Atorvastatin if you are pregnant. It may cause harm to the fetus. Avoid becoming pregnant while you are taking it. If you think you may be pregnant, contact your doctor right away. It is not known if Atorvastatin is found in breast milk. Do not breast-feed while taking Atorvastatin.

Possible side effects of Atorvastatin:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Diarrhea; joint pain; mild sore throat; nausea; runny or stuffy nose; stomach upset.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing or swallowing; tightness in the chest; swelling of the mouth, face, lips, throat, or tongue); change in the amount of urine produced; dark urine; muscle pain, tenderness, or weakness (with or without fever or fatigue); painful, difficult, or frequent urination; pale stools; persistent loss of appetite; persistent pain, soreness, redness, or swelling of a tendon or joint; red, swollen, blistered, or peeling skin; severe or persistent nausea, vomiting, or stomach pain; unusual tiredness; yellowing of the eyes or skin.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

See also: Atorvastatin side effects (in more detail)

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately.

Proper storage of Atorvastatin:

Store Atorvastatin at room temperature, between 68 and 77 degrees F (20 and 25 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep Atorvastatin out of the reach of children and away from pets.

General information:

• If you have any questions about Atorvastatin, please talk with your doctor, pharmacist, or other health care provider.


• Atorvastatin is to be used only by the patient for whom it is prescribed. Do not share it with other people.


• If your symptoms do not improve or if they become worse, check with your doctor.


• Check with your pharmacist about how to dispose of unused medicine.

This information is a summary only. It does not contain all information about Atorvastatin. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

Issue Date: February 1, 2012

Database Edition 12.1.1.002

Copyright © 2012 Wolters Kluwer Health, Inc.

More Atorvastatin resources

• Atorvastatin Side Effects (in more detail)
• Atorvastatin Use in Pregnancy & Breastfeeding
• Atorvastatin Drug Interactions
• Atorvastatin Support Group
• 26 Reviews for Atorvastatin - Add your own review/rating

• atorvastatin Advanced Consumer (Micromedex) - Includes Dosage Information


• Atorvastatin Prescribing Information (FDA)


• Atorvastatin Calcium Monograph (AHFS DI)


• Lipitor Prescribing Information (FDA)


• Lipitor Consumer Overview

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