Journal article
Surge of Midazolam Use in the Midst of Lorazepam Shortage
Journal of clinical psychopharmacology, v 43(6), pp 520-526
01 Nov 2023
PMID: 37930205
Abstract
BackgroundLorazepam is a widely prescribed benzodiazepine that is used to manage anxiety, insomnia, and status epilepticus and is used for pre-anesthetic care as well as several off-label indications including aggression, alcohol withdrawal, panic disorder, chemotherapy-associated anticipatory nausea, and catatonia. Recent increases in demand, manufacturing changes, and quality control issues have resulted in a shortage of injectable and oral lorazepam, prompting clinicians to use alternatives. One such alternative is midazolam, a drug that has been used primarily in the intensive care unit and anesthesia settings.ProceduresThis article examines the significant pharmacologic differences between lorazepam and midazolam. In addition, this article provides dosage guidelines based on the current scientific knowledge and recommendations for conversion equivalencies.ResultsThe clinical preference for lorazepam can be attributed to its simpler metabolism with no active metabolites, better suitability for patients with less severe hepatic and renal impairment, less risk of adverse reactions, fewer drug-drug interactions, and greater desirability for special populations. In periods of shortages, midazolam has been shown to be effective for a number of off-label uses. To manage conditions that have not been extensively studied, clinicians may opt to use conversion equivalencies, with the caveat that guidelines may vary greatly between institutions and online sources; therefore, it would be best to start low and titrate slowly.ConclusionsOur goal is to aid clinicians in safely and effectively prescribing midazolam during the shortage of injectable lorazepam so that patients are provided the same effects and benefits.
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Details
- Title
- Surge of Midazolam Use in the Midst of Lorazepam Shortage
- Creators
- Tonia T. Liu - Rowan UniversityEmma D. Frost - Cooper Univ Hlth Care, Cooper Neurol Inst, Dept Neurol Surg, Camden, NJ USAJack Donlon - Rowan UniversityRoshni M. Gandhi - Rowan UniversityTarannum Mohammadi - Drexel Univ, Coll Med, Philadelphia, PA USABriana P. Murray - Correct Rx Pharm Serv Inc, Hanover, MD USAMujeeb U. Shad - University of Nevada, Las VegasMaju Mathew Koola - Rowan University
- Publication Details
- Journal of clinical psychopharmacology, v 43(6), pp 520-526
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 7
- Grant note
- The authors have no conflicts of interest to disclose. There was no funding for this manuscript preparation.
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- College of Medicine
- Web of Science ID
- WOS:001096680700008
- Scopus ID
- 2-s2.0-85176339700
- Other Identifier
- 991022207069604721