Codeine; Guaifenesin: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Lorazepam, and possibly other benzodiazepines, should be used cautiously in patients receiving loxapine. Esophageal dilation occurred in rats treated with lorazepam for more than one year at 6 mg/kg/day. Consequently, appropriate precautions (e.g., limiting the total prescription size and increased monitoring for suicidal ideation) should be considered. Lorazepam is an UGT substrate and ombitasvir is an UGT inhibitor. Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. Dose range: 0.025 to 0.1 mg/kg/dose. [64020]Lorazepam stability is very specific to the product used and is concentration-dependent. Dimenhydrinate: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Administer the morning after the day of discontinuation of a lorazepam immediate-release (IR) product. Lortab Elixir CII (hydrocodone bitartrate and acetaminophen oral solution) Loteprednol Etabonate Ophthalmic Gel. Use caution with this combination. Studies in healthy volunteers show that in single high doses, lorazepam has a tranquilizing action on the central nervous system with usually no appreciable effect on the respiratory or cardiovascular systems. 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. In animal studies, melatonin has been shown to increase benzodiazepine binding to receptor sites. Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Liquid (solution): Store in a refrigerator. Find patient medical information for Lorazepam Intensol oral on WebMD including its uses, side effects and safety, interactions, pictures, warnings and user ratings. The degree of sedation is dependent on the dose administered and the presence or absence of other medications. Use caution with this combination. 1981; 38:879-81. Use of more than 1 agent for hypnotic purposes may increase the risk for over-sedation, CNS effects, or sleep-related behaviors. Abrupt discontinuation of product should be avoided and a gradual dosage-tapering schedule followed after extended therapy. If such therapy is initiated or discontinued, monitor the clinical response to the benzodiazepine. Last updated on Aug 22, 2022. Limit the use of mixed opiate agonists/antagonists with benzodiazepines to only patients for whom alternative treatment options are inadequate. If a benzodiazepine is prescribed for an indication other than epilepsy in a patient taking an opiate agonist, use a lower initial dose of the benzodiazepine and titrate to clinical response. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Max: 4 mg/dose. All Background How long is lorazepam stable out of the refrigerator? Educate patients about the risks and symptoms of respiratory depression and sedation. Consider the benefits of appropriate anesthesia in young children against the potential risks, especially for procedures that may last more than 3 hours or if multiple procedures are required during the first 3 years of life. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. However, in one study involving single intravenous doses of 1.5 mg to 3 mg of lorazepam injection, mean total body clearance of lorazepam decreased by 20% in 15 elderly subjects of 60 to 84 years of age compared to that in 15 younger subjects of 19 to 38 years of age. Alfentanil: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. The use of benzodiazepines, including lorazepam, may lead to physical and psychological dependence. 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. Guanabenz: (Moderate) Guanabenz is associated with sedative effects. Am J Health Syst Pharm. (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. and out of reach of children. Benzhydrocodone; Acetaminophen: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Refrigerate at 2 to 8C (36 to 46F), Dispense only in the bottle and only with. When used for the right reasons, they're quite effective for treating anxiety.. If a benzodiazepine is prescribed for an indication other than epilepsy in a patient taking an opiate agonist, use a lower initial dose of the benzodiazepine and titrate to clinical response. The severity of this interaction may be increased when additional CNS depressants are given. Unauthorized use of these marks is strictly prohibited. Solutions of lorazepam 1 and 2 mg/mL in glass bottles and polypropylene syringes were prepared.
Akorn Pharmaceuticals - Products Primidone: (Moderate) Additive CNS and/or respiratory depression may occur with concurrent use. Aspirin, ASA; Caffeine; Orphenadrine: (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. Some patients on lorazepam have developed leukopenia, and some have had elevations of LDH. Concurrent use may result in additive CNS depression. [25032] A single dose should not exceed 4 mg IV. Due to CNS depressive effects, patients should be cautioned against driving or operating machinery until they know how lorazepam may affect them. 4.2 Posology and method of administration. Bottles and syringes were stored at 22C under normal room light. Avoid prescribing opiate cough medications in patients taking benzodiazepines. In a separate report, a woman taking lorazepam 2.5 mg PO twice daily for the first 5 days postpartum had milk concentrations of free and conjugated lorazepam of 12 and 35 mcg/L, respectively, at an unspecified time on day 5, and her infant showed no signs of sedation. Aldesleukin, IL-2: (Moderate) Aldesleukin, IL-2 may affect CNS function significantly. 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. If hydrocodone is initiated in a patient taking a benzodiazepine, reduce initial dosage and titrate to clinical response; for hydrocodone extended-release products, initiate hydrocodone at 20% to 30% of the usual dosage. Extension of expiration time for lorazepam injection at room temperature. Lorazepam 1 mg extended-release capsules are contraindicated in patients with tartrazine dye hypersensitivity. Therefore, caution is advisable when combining anxiolytics, sedatives, and hypnotics or other psychoactive medications with these medications. The average pH was 7.30 0.23 (minimum 7.06, maximum 7.54), and average spectrophotometric measurements at 350, 410, and 550 nm were 0.07 0.001, 0.001 0.0007, and 0.00003 0.0001, respectively. The peak plasma level of lorazepam from a 2 mg dose is approximately 20 ng/mL. All sleep medications should be used in accordance with approved product labeling. A potential risk of abuse should not preclude appropriate treatment in any patient, but requires more intensive counseling and monitoring. 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. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. There is a possibility of interaction with valerian at normal prescription dosages of anxiolytics, sedatives, and hypnotics (including barbiturates and benzodiazepines). Extension of Expiration Time for Lorazepam Injection at Room Temperature Brian E. Jahns, Pharm.D., Cindy M. Bakst, Pharm.D. Date: 16.01.2012 AUTHOR: raaroafi lorazepam left out of fridge Stability of Refrigerated and Frozen Drugs unopened bottles left out of refrigerator are stable (up to 86F or 30C) for up to six. Anxiolytics should be used for delirium, dementia, or other cognitive disorders only when there are associated behaviors that are 1) quantitatively and objectively documented, and 2) are persistent, and 3) are not due to preventable or correctable reasons, and 4) constitute clinically significant distress or dysfunction to the LTCF resident or represent a danger to the resident or others. 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. 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. Average dose: 14 mg/hour. Dilutions not prepared in a sterile environment should not be stored; discard immediately. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. If a mixed opiate agonist/antagonist is initiated in a patient taking a benzodiazepine, use a lower initial dose of the mixed opiate agonist/antagonist and titrate to clinical response. Use lorazepam with caution in patients with a history of alcoholism or substance abuse due to the potential for psychological dependence. If a benzodiazepine is prescribed for an indication other than epilepsy in a patient taking an opiate agonist, use a lower initial dose of the benzodiazepine and titrate to clinical response. Lorazepam is an UGT substrate and sorafenib is an UGT inhibitor. To minimize potential for interactions, consider administering oral anticonvulsants at least 1 hour before or at least 4 hours after colesevelam. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Educate patients about the risks and symptoms of respiratory depression and sedation. Lorazepam 1 and 2 mg/mL in 5% dextrose injection was stable for 28 hours at room temperature in glass bottles when the 2 mg/mL and 4 mg/mL lorazepam preparations, respectively, were used. Topiramate: (Moderate) Topiramate has the potential to cause CNS depression as well as other cognitive and/or neuropsychiatric adverse reactions. Crystallization was also detected after 7 days in syringes at room temperature, 3 days in bottles at 5 3C, and 2 days in bottles at room temperature. Exceptions to the OBRA provisions include: single dose sedative use for a dental or medical procedure or short-term sedative use during initiation of treatment for depression, pain, or other comorbid condition until symptoms improve or the underlying causative factor can be identified and/or effectively treated. Off-label information indicates unopened bottle stable when maintained at continuous room temperature 77 o F for 12 months. Oral dosage (immediate-release formulations) Adults Initially, 2 to 3 mg/day PO given in 2 to 3 divided doses. Followup: At 0, 1, 2, 4, 8, and 28 hours, Solution color, clarity, precipitation, and pH. After 60 days, lorazepam maintained a clinically acceptable concentration. Hydroxychloroquine: (Moderate) Monitor persons with epilepsy for seizure activity during concomitant lorazepam and hydroxychloroquine use. Avoid opiate cough medications in patients taking benzodiazepines. drug stability; drug storage; medication errors; pharmaceutical preparations; refrigeration; safety. Aspirin, ASA; Butalbital; Caffeine: (Moderate) Additive CNS and/or respiratory depression may occur with concurrent use. If used together, a reduction in the dose of one or both drugs may be needed. Acetaminophen; Diphenhydramine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Levocetirizine: (Moderate) Concurrent use of cetirizine/levocetirizine with benzodiazepines should generally be avoided. 0.05 to 0.1 mg/kg/dose (Max: 2 mg/dose) IM every 30 to 60 minutes as needed.[64934]. Unable to load your collection due to an error, Unable to load your delegates due to an error. The incidence of sedation and unsteadiness increased with age. Dose reductions may be required. When temperature excursion data was unavailable in published form, product manufacturers were surveyed via telephone and/or email. These interactions are probably pharmacodynamic in nature. If a benzodiazepine is prescribed for an indication other than epilepsy in a patient taking an opiate agonist, use a lower initial dose of the benzodiazepine and titrate to clinical response. In the event of an inadvertent temperature excursion the following data may be used: The product is stable when exposed to the following conditions: 48 hours at temperatures up to 25C. Coadministration of lorazepam with probenecid may cause a more rapid onset or prolonged effect of lorazepam due to increased half-life and decreased total clearance. Secobarbital: (Moderate) Additive CNS and/or respiratory depression may occur with concurrent use. Lorazepam dosage should be modified depending on clinical response and degree of renal impairment. Recent case-control and cohort studies of benzodiazepine use during pregnancy have not confirmed increased risks of congenital malformations previously reported with early studies of benzodiazepines, including diazepam and chlordiazepoxide. The aim of this review was to build upon previous literature describing the maximum duration for which refrigerated medications can tolerate room temperature excursions while maintaining stability and potency. Am J Health Syst Pharm.
Prehospital stability of diazepam and lorazepam - PubMed Dronabinol: (Moderate) Use caution if the use of benzodiazepines are necessary with dronabinol, and monitor for additive dizziness, confusion, somnolence, and other CNS effects.
Lorazepam - Medicines - SPS - Specialist Pharmacy Service - The first . Mean area under concentration curve (AUCTau), Cmax, and Cmin were 765 ng x hour/mL, 41 ng/mL and 29 ng/mL, respectively, following 3 times daily administration of 1 mg tablets. Avoid prescribing opiate cough medications in patients taking benzodiazepines. Coadministration may increase the risk of CNS depressant-related side effects. Benzodiazepines act at the level of the limbic, thalamic, and hypothalamic regions of the CNS, and can produce any level of CNS depression required including sedation, hypnosis, skeletal muscle relaxation, anticonvulsant activity, and coma. An initial infusion rate of 0.025 to 0.05 mg/kg/hour IV is recommended by some experts. [3], A study evaluated lorazepam 2 mg/mL injectable solutions in clear glass syringes under refrigeration (4-10 C), at ambient temperatures (15-30 C), and at oven-heated temperatures (38 C) for up to 210 days (see Table 2). Please review labeling for expiration date. Acetaminophen; Oxycodone: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. In patients with depression, a possibility for suicide should be borne in mind; benzodiazepines should not be used in such patients without adequate antidepressant therapy. No specific dosage adjustments are recommended for renal impairment or renal failure. Lorazepam is a UGT2B7 substrate. Drugs that can cause CNS depression, if used concomitantly with olanzapine, can increase both the frequency and the intensity of adverse effects such as drowsiness, sedation, dizziness, and orthostatic hypotension. Oliceridine: (Major) Concomitant use of oliceridine with lorazepam may cause respiratory depression, hypotension, profound sedation, and death. When lorazepam is used as a sedative, factors potentially causing insomnia should be evaluated before medication initiation (e.g., sleep environment, inadequate physical activity, provision of care disruptions, caffeine or medications, pain and discomfort, or other underlying conditions that cause insomnia). The time taken for the original concentration of potassium clavulanate to drop to 90% of its value at room temperature of 20C is 2 days (Mehta et al., 2008). Educate patients about the risks and symptoms of respiratory depression and sedation. Nabilone: (Major) Nabilone should not be taken with benzodiazepines or other sedative/hypnotic agents because these substances can potentiate the central nervous system effects of nabilone.
PDF Lorazepam 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. Central benzodiazepine receptors interact allosterically with GABA receptors, potentiating the effects of GABA and thereby increasing the inhibition of the ascending reticular activating system. Lorazepam Macure . Teduglutide has direct effects on the gut that may increase benzodiazepine exposure by improving oral absorption. Caution should be exercised during simultaneous use of these agents due to potential excessive CNS effects or additive hypotension. COPD, sleep apnea syndrome). Carefully monitor respiratory status and oxygen saturation in at risk patients. Clinical circumstances, some of which may be more common in the elderly, such as hepatic or renal impairment, should be considered. 30000010 343. For the 2 mg/mL solution, 20 mL of the 4 mg/mL lorazepam preparation and 20 mL of 5% dextrose injection were added to a 250 mL evacuated bottle. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Consider alternatives to benzodiazepines for conditions such as anxiety or insomnia during methadone maintenance treatment. Extension of expiration time for lorazepam injection at room temperature. Doses of other central-nervous-system-depressant drugs ordinarily should be reduced. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. May start 12 to 24 hours prior to chemotherapy.
How long is lorazepam stable at room temperature? - InpharmD Acetaminophen; 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. Human studies suggest that a single short exposure to a general anesthetic in young pediatric patients is unlikely to have negative effects on behavior and learning; however, further research is needed to fully characterize how anesthetic exposure affects brain development. Also, droperidol and benzodiazepines can both cause CNS depression. Injectable lorazepam is contraindicated for intraarterial administration due to the possibility of arteriospasm and resultant gangrene that may require amputation. The benzodiazepines, including lorazepam, produce increased CNS-depressant effects when administered with other CNS depressants such as alcohol, barbiturates, antipsychotics, sedative/hypnotics, anxiolytics, antidepressants, narcotic analgesics, sedative antihistamines, anticonvulsants, and anesthetics. (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. Please enable it to take advantage of the complete set of features! 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. Throw away any liquid not used within 90 days. Use an initial morphine; naltrexone dose of 20 mg/0.8 mg PO every 24 hours. Monitor patients for decreased pressor effect if these agents are administered concomitantly. Route of administration: oral. Use caution with this combination. Titrate to desired level of sedation. Use caution with this combination. Concurrent administration of lorazepam with a UGT inhibitor may result in increased plasma concentrations, reduced clearance, and prolonged half-life of lorazepam. 1 to 20 mg/hour continuous IV infusion. Intensity of sedation and orthostatic hypotension were greater with the combination of oral aripiprazole and lorazepam compared to aripiprazole alone. Pentazocine: (Major) Concomitant use of mixed opiate agonists/antagonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Mirtazapine: (Moderate) Monitor for unusual drowsiness and sedation during coadministration of benzodiazepines and mirtazapine due to the risk for additive CNS depression. Sorafenib: (Moderate) Monitor for an increase in lorazepam-related adverse reactions and consider reducing the dose of lorazepam if concomitant use of lorazepam and sorafenib is necessary. Chlorpheniramine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Thalidomide frequently causes drowsiness and somnolence. The recom- mended storage temperatures in the product labelings are 15 to 30 for diazepam and 2 to 8 for lorazepam.2,3 Although recommended for storage under refrigeration, lorazepam has been found to be stable for 60 days at room temperature.4 Controlled stability studies of the parenteral solutions for either drug stored in glass syringes as a Limit the use of mixed opiate agonists/antagonists with benzodiazepines to only patients for whom alternative treatment options are inadequate. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. To assure the safe and effective use of lorazepam, patients should be informed that, since benzodiazepines may produce psychological and physical dependence, it is advisable that they consult with their physician before either increasing the dose or abruptly discontinuing this drug. If a higher dosage is needed, increase the evening dose before the daytime doses. Lorazepam, a benzodiazepine with antianxiety, sedative, and anticonvulsant effects, is intended for the intramuscular or intravenous routes of administration. Chlorpheniramine; Ibuprofen; Pseudoephedrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Keep lid tightly closed. Educate patients about the risks and symptoms of respiratory depression and sedation. Reserve concomitant use of these drugs for patients in whom alternative treatment options are inadequate. Long-Term Stability of Lorazepam in Sodium Chloride 0.9% Stored at Different Temperatures in Different Containers. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Efficacy of long-term use (more than 4 months) for anxiety disorders has not been evaluated. The Beers Criteria are not meant to apply to patients at the end of life or receiving palliative care, when risk-benefit considerations of drug therapy can be different. The mean half-life of unconjugated lorazepam in human plasma is about 12 hours and for its major metabolite, lorazepam glucuronide, about 18 hours. No quantitative recommendations are available. After reconstitution, refrigerated solution (5 mg/mL concentration, diluted with Sterile Water for Injection) stable for one week. The manufacturer has no labeling that says excursions are permitted. Sedating H1-blockers: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Lorazepam is a generic medication also available under the trade name Ativan. Max: 2 mg/day PO, unless documentation of need for higher doses is provided. Draw into the dropper the amount prescribed for a single dose. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Use caution with this combination. Hydroxychloroquine can lower the seizure threshold; therefore, the activity of antiepileptic drugs may be impaired with concomitant use. Azelastine; Fluticasone: (Moderate) Monitor for excessive sedation and somnolence during coadministration of azelastine and benzodiazepines. Am J Health Syst Pharm. Dextromethorphan; Guaifenesin; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. Protect . In debilitated patients give 1 to 2 mg/day PO in 2 to 3 divided doses initially. Lorazepam is an UGT substrate and indinavir is an UGT inhibitor. Lorazepam has been detected in human breast milk; therefore, it should not be administered to breast-feeding women, unless the expected benefit to the woman outweighs the potential risk to the infant. The possibility that a woman of childbearing potential may be pregnant at the time of institution of therapy should be considered. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Clobazam: (Major) Use clobazam with other benzodiazepines with caution due to the risk for additive CNS depression.
Benzodiazepines | Johns Hopkins Psychiatry Guide 0.04 to 0.05 mg/kg IV as a single dose administered 30 minutes prior to chemotherapy. Lorazepam (2 mg/mL) injectable solutions were stored for up to 210 days in clear glass syringes at three conditions: 4C to 10C (refrigerated); 15C to 30C (on-ambulance ambient temperature); and 37C (oven heated). Initially, 2 to 3 mg/day PO given in 2 to 3 divided doses. Specific maximum dosage information not available; the dose required is dependent on route of administration, indication, and clinical response. According to the Beers Criteria, benzodiazepines are considered potentially inappropriate medications (PIMs) in geriatric adults and avoidance is generally recommended, although some agents may be appropriate for seizures, rapid eye movement sleep disorders, benzodiazepine or ethanol withdrawal, severe generalized anxiety disorder, or peri-procedural anesthesia. al. The effect was reversible only when the treatment was withdrawn within two months of first observation of the phenomenon. (Or that's how it was when I worked in pharmacy) Haha our ativan drawer was restocked like q 2-3 days when I worked in the hospital, that never would have been an issue. Educate patients about the risks and symptoms of respiratory depression and sedation. Nitroglycerin: (Minor) Nitroglycerin can cause hypotension. Patients should be warned of the possibility of drowsiness that may impair performance of potentially hazardous tasks such as driving an automobile or operating machinery. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. 2016;35(4):247-50. If the sleep agent is used routinely and is beyond the manufacturer's recommendations for duration of use, the facility should attempt a quarterly taper, unless clinically contraindicated as defined in the OBRA guidelines. To discourage abuse, the smallest appropriate quantity of the benzodiazepine should be prescribed, and proper disposal instructions for unused drug should be given to patients.
PDF Impact of Temperature Exposure on Stability of Drugs in a Real-World Lemborexant: (Moderate) Monitor for excessive sedation and somnolence during use of lemborexant with benzodiazepines. Diazepam (5 mg/mL) and lorazepam (2 mg/mL) injectable solutions were stored for up to 210 days in clear glass syringes at three conditions: 4 degrees C to 10 degrees C (refrigerated); 15 degrees C to 30 degrees C (on-ambulance ambient temperature); and 37 degrees C (oven-heated). Hydromorphone: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Subsequently, decrease the dosage more slowly. Chlorpheniramine; Phenylephrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. DISCONTINUATION: To discontinue, gradually taper the dose. Melatonin: (Major) Use caution when combining melatonin with the benzodiazepines; when the benzodiazepine is used for sleep, co-use of melatonin should be avoided. Thalidomide: (Major) The use of benzodiazepine anxiolytics, sedatives, or hypnotics with thalidomide may cause an additive sedative effect and should be avoided. DETERMINE THE STABILITY OF THIS SUGGESTED FORMULA. Medically reviewed by Drugs.com. COMT inhibitors: (Major) Concomitant administration of benzodiazepines with other drugs have CNS depressant properties, including COMT inhibitors, can potentiate the CNS effects of either agent.