Parenteral Benzodiazepines
As with many tools available to clinicians, they are imperfect but are potentially beneficial - Jerrold F. Rosenbaum MD
HWN Suggests
The ABCs of BZDs: What You Need To Know About Benzodiazepines
BZDs are first-line agents for status epilepticus, and lorazepam and diazepam have similar efficacy. For seizing patients without IV access, consider midazolam via intramuscular, buccal, or intranasal routes. For alcohol withdrawal, select a long-acting BZD like diazepam or chlordiazepoxide, but choose a more moderate-acting BZD like lorazepam if there is significant liver disease.
For procedural sedation, midazolam is the BZD of choice. Use caution with BZDs in the elderly. Start at half the usual dose, and avoid prescribing for chronic use. BZDs are great for use in the ED, but be very wary of prescribing for long-term use, due to the risk of dependence, abuse, and addict
Featured
Deadly Drug Interactions in the ED
IM Zyprexa and parenteral Ativan...
Articles of Interest
Becoming Well-Versed with Benzos
In my practice I have started using midazolam more and have found satisfactory results. I use a rough rule of 1.5-2 mg of midazolam for every 1 mg of lorazepam that I would have otherwise given. This also allows for reassessment of your patient in a few hours, instead of providing a 6 hour nap. Next time you have an agitated patient, give midazolam a try!
Does the Combination of Parenteral Olanzapine with Benzodiazepines for Agitation in the ED Increase the Risk of Adverse Events?
Separating IV/IM olanzapine from parenteral benzodiazepines by 60 minutes is likely a safe practice, if co-administration of these medications is necessary or desired to treat agitated patients. Patients with ethanol on board are at a higher risk of adverse events [7, 8]. Monitoring should be commensurate with the patient situation and medication(s) chosen.
Olanzapine + Benzodiazepines
What’s the FDA’s stance? “Concomitant administration of intramuscular olanzapine along with benzodiazepines is not recommended due to the potential for excessive sedation and cardiorespiratory depression.” If you’ve already used olanzapine, and you’re looking for an additional agent, ketamine is likely a safer option.
Parenteral Benzodiazepines
Lorazepam requires a longer time to reach peak effect than either midazolam or diazepam and may lead to stacking doses. When IV access is not available, IM midazolam (Versed) is preferred
The Art of the ED Takedown
Often used in patients with agitation from an unknown cause, alcohol or drug intoxication, or withdrawal symptoms. They are preferable due to rapid onset of action and short half-life. Patients should be monitored for respiratory depression and somnolence. Most agitated patients will require IV or IM administration. However equivalent PO dosing is favorable in agitated patients who are still somewhat cooperative.
