About six months ago, we informed you about the shortage of injectable lorazepam presentations. At the time, most back-ordered products were expected to be available by, at the latest, January 2012. However, it appears that the shortage of injectable lorazepam has gotten worse, not better, since then. According to the American Society of Health-Systems Pharmacists (ASHP) website, there are no injectable lorazepam presentations fully available – all have been discontinued or are in short supply.
Estimated release dates are as follows:
West-Ward has Ativan injection on back order with an estimated release date of mid-May, 2012. Lorazepam 4 mg/mL 1 mL and 10 mL vials and lorazepam 2 mg/mL 1 mL vials are on back order until mid-to-late May, 2012. All other lorazepam presentations are on back order and the company cannot estimate a release date.
Hospira has all lorazepam presentations on back order. The 4 mg/mL 1 mL Carpuject syringes have an estimated release date of 2013. Lorazepam 2 mg/mL 1 mL and 10 mL vials and 4 mg/mL 1 mL vials have an estimated release date of June, 2012. Lorazepam 4 mg/mL 10 mL vials have an estimated release date of July, 2012. Lorazepam 2 mg/mL 1 mL Carpuject syringes have an estimated release date of mid-to-late May, 2012.
Akorn is allocating lorazepam 2 mg/mL 1 mL vials.
During the shortage, ASHP recommends using alternative injectable benzodiazepines, such as diazepam or midazolam.
Can be given IV into a large peripheral vein, followed by a saline flush to decrease local venous irritation. The maximum IV rate is 5 mg per minute. Can NOT be given IM – absorption is erratic and unreliable.
Has a more rapid onset than lorazepam and a similar duration of action.
Normal maintenance dosing is in the range of 2-10 mg IV every 3-4 hours PRN. However, patients with severe anxiety, muscle spasm, or status epilepticus may require a loading dose (such as 10 mg IV x 1), followed by more frequent PRN dosing, to initially get symptoms under control.
Diazepam is very lipid soluble, so it rapidly distributes into fat tissue, and stays there. So, while its duration of action is not very long, its half-life in the body can range from around 24 hours to more than 2 days. The half-life is prolonged in the elderly and in patients with liver disease. This means that it may take days to even weeks for diazepam to be completely cleared from the system when routine administration is stopped.
Can be given IV or IM
Has a more rapid onset but shorter duration of action than lorazepam. The half-life is only about 2 hours, so midazolam is frequently given by continuous infusion since it needs to be dosed so frequently.
Midazolam dosing is very patient-specific and will need to be carefully titrated based on the patient’s response. A good starting point would be 0.25-0.5 mg IV, given slowly over 2 minutes, followed by slowly titrating to effect by repeating doses every 2-3 minutes if needed. If given intramuscularly, dosing requirements will be higher; if the patient is also taking narcotics, dosing requirements will be lower. Maintenance dosing is usually ~25% of the total dose required to reach the desired sedative effect.
For more information about the shortage, see the ASHP website at http://www.ashp.org/drugshortages/current/bulletin.aspx?id=747.
Let us know… has your hospice been impacted by the injectable lorazepam shortage?
|not to have surgery beuasce all thoracic surgeries must go through the chest from the front and is very risky and will put tremendous strain on discs above and below and I have been told be all that if I have surgery to expect to have to fuse above and below about every 1-2 years until I'm totally fused. The alternative treatments I've tried have caused so many other health issues I can't begin to count. So not all injuries are self healing. The spine, discs, vertabre, etc don't just heal. I'm lucy to be able to walk and have fallen from my back and not only injured my head in the original accident but several times since in falls and now have seizures, and between the pinched nreves in the spinal cord and the seizures I lose bladder control several times a week, awake or asleep and I get treated like crap by other Dr's. I had a bad car accident, stopped breathing and heart stopped and I was dead and brought back and wish they had known I was a DNR but I was in critical ICU and 12 hours later discharges and told they could not help me and my pain and I needed to go home and treat myself. What a load of crap these Dr's are.
Posted 12/30/2012 02:13:43 AM
|I don't understand how pepole get addicted to this stuff. I have been on a script for over a year, taking 40mg of oxycodone + 40mg of hydrocodone. When I take a few days off the medications all I feel is the pain from my injury, not whole body aches, no sweating, no flinching, no fever, just pain associated with the injuries. Maybe its different for pepole who take it without high levels of pain, but I never crave this medicine. All it does is take the edge off pain. In fact it doesn't even bring anywhere near 100% relief. I don't get buzzed or high either. I have not taken oxycontin though I have been offered it from my doctor. These stories scare the crap out of me and once workers compensation approves my surgery I have a security sensitive job to get back to (pilot). So, out of fear of the contin medications I am in constant pain If I could find the truth about the medication I might be willing to get that much needed relief. I was hoping to find data to correlate pepole with addiction problems having issues with oxycontin or is it everybody. If I am not addicted to codone, will contin be THAT much different? Im not looking for more pain later down the road so if its really THAT bad I rather just have the physical pain that keeps me from enjoying life, sleep, think, etc etc than the pain of hardcore withdrawal and addiction. I don't need that in my life. Is there a valid use for this medication at all? All I keep hearing is how bad these meds are and its keeping me from having any lasting comfort (beyond 20 minutes per dose).
Posted 8/5/2012 10:20:39 PM
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