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Lorazepam injectable presentations

[26 August 2015]

Products Affected - Description

Lorazepam, Akorn
2 mg/mL, 1 mL vial, 10 count (NDC 17478-0040-01)
 
Ativan, West-Ward
2 mg/mL, 10 mL vial, 10 count (NDC 00641-6000-10)

Reason for the Shortage

  • Bedford discontinued lorazepam in May, 2011 to concentrate on the manufacturing of other products.1
  • West-Ward acquired Baxter’s lorazepam injection products in May, 2011. NDC numbers for the lorazepam and Ativan products were changed in April, 2012.
  • West-Ward had Ativan on back order due to increase surplus of the lorazepam presentations.2
  • Hospira has consistent supply of lorazepam injection.3
  • Akorn increased production to help meet demand.4
  • Amphastar had lorazepam 2 mg/mL vials on shortage due to increased demand.5

Available Products

Lorazepam, Amphastar
2 mg/mL, 10 mL vial, 10 count (NDC 76329-8261-01)

Lorazepam, Hospira
2 mg/mL, 1 mL Carpuject syringes, 10 count (NDC 00409-1985-30)
2 mg/mL, 1 mL vial, 10 count (NDC 00409-6778-02)
2 mg/mL, 10 mL vial, 10 count (NDC 00409-6780-02)
4 mg/mL, 1 mL vial, 10 count (NDC 00409-6779-02)
4 mg/mL, 1 mL Carpuject syringes, 10 count (NDC 00409-1539-31)
4 mg/mL, 10 mL vial, 10 count (NDC 00409-6781-02)
 
Lorazepam, West-Ward
2 mg/mL, 1 mL vial, 25 count (NDC 00641-6044-25)
2 mg/mL, 10 mL vial, 10 count (NDC 00641- 6046-10)
4 mg/mL, 1 mL vial, 25 count (NDC 00641-6045-25)
4 mg/mL, 10 mL vial, 10 count (NDC 00641-6047-10)

Ativan, West-Ward
2 mg/mL, 1 mL vial, 25 count (NDC 00641-6001-25)
4 mg/mL, 1 mL vial, 25 count (NDC 00641-6003-25)
4 mg/mL, 10 mL vial, 10 count (NDC 00641-6002-10)

Estimated Resupply Dates

  • Akorn has lorazepam 2 mg/mL 1 mL vials available in limited supply.4
  • West-Ward has Ativan 2 mg/mL 10 mL vials available with short expiration dating (May 2016). West-Ward estimates additional supplies will be released in September 2015.2

Implications for Patient Care

Lorazepam injection is labeled for treatment of status epilepticus and as premedication for the relief of anxiety and tension in patients undergoing surgical procedures. Off-label uses of lorazepam injection include sedation in the critical care setting for patients on mechanical ventilation, treatment of acute delirium, and adjunctive treatment of chemotherapy induced nausea and vomiting.6,7,8

Alternative Agents & Management

  • During this shortage, use alternative injectable benzodiazepines.
  • There are no direct dosage conversions between the benzodiazepines because each has a distinct pharmacokinetic profile that dictates the agent’s therapeutic use and dosing. The table below compares the pharmacokinetics of injectable benzodiazepines.
Table. Pharmacokinetics of Injectable Benzodiazepines7,8,9,10,11
 

Agent

Onset of Action
Intravenous (min)

Onset of Action
Intramuscular (min)

Duration of Action
Intravenous (hours)

Duration of Action
Intramuscular (hours)

Half-life (hours)

Active Metabolites

Diazepam

1 to 5

Intramuscular administration results
in slow and erratic absorption

0.3 to 0.5

Intramuscular administration results
 in slow and erratic absorption

20 to 120

Yes

Lorazepam

5 to 20

15 to 30

6 to 8

6 to 8

8 to 15

No

Midazolam

1 to 5

5 to 15

< 2a

2a

3 to 11

Yes

 
a The pharmacologic effect of midazolam may last up to 6 hours in some patients.

Related Shortages

References

  1. Bedford (personal communications). April 4 and 20, May 3 and 18, and July 6, 2011.
  2. West-Ward (personal communications). April 4 and 20, May 18, June 13, July 5, August 10, September 23, October 25, November 23 and 30, December 15 and 20, 2011; and January 12 and 20, February 29, March 28, April 20, May 17, June 21, July 5, 2012, August 6 and 16, September 4 and 26, October 11, November 5, 16, and 30, December 17, 2012; January 23, March 27, April 1 and 17, May 22, June 13, July 10, August 5, September 12 and 23, October 4 and 28, November 22, 2013; January 14, 18, and 31, February 14, March 3, 7, 20, and 28, April 11 and 28, May 16 and 30, June 18, July 10, August 8, September 3 and 24, October 29, November 5, 19, and 26, 2014; January 7, February 4, March 4 and 18, and April 8, May 13, June 17, July 8, and August 19, 2015.
  3. Hospira (personal communications and website). April 4 and 22, and May 20, June 17, August 8, September 22, October 25, November 23 and 30, December 12 and 20, 2011; and January 9 and 26, February 29, March 28, April 17, May 17, June 18, July 3 and 24, August 6 and 27, September 5 and 24, October 11, November 5 and 14, December 5 and 19, 2012; January 23, March 27, April 1 and 17, May 14, June 12, July 10, August 5, September 12 and 23, October 2 and 28, December 2, 2013; January 8 and 22, February 6 and 14, March 5, 10, and 20, April 1, 14, and 29, May 19, June 2 and 26, July 11, August 8, September 11 and 26, October 29, November 5 and 19, December 1, 2014; January 7 and 26, February 4, March 9 and 31, April 13, May 15, June 18, and July 16, 2015.
  4. Akorn (personal communications). December 16 and 20, 2011; January 11 and 26, March 30, April 17, May 9, June 12, July 26, August 9 and 16, September 5, October 11, 2012; May 22, June 15, September 9 and 23, December 2, 2013; January 8, March 3, April 14, May 19, June 23, August 8, September 11 and 25, November 3 and 21, 2014; January 7, March 9 and 31, April 13, and May 13, 2015.
  5. Amphastar (personal communications). November 9, 2012; January 7, April 17, May 13, June 10 and 25, July 22, September 12 and 23, October 28, 2013; January 10 and 27, February 24, March 10 and 24, April 28, May 12, June 9, August 8, 2014, September 9 and 21, October 29, November 10, December 1 and 22, 2014; and February 2, March 4 and 18, April 8, May 8, June 8, and July 14, 2015. 
  6. Ativan injection product information. Deerfield, IL: Baxter Healthcare Corp., November 2006.
  7. McEvoy, G. K., E. K. Snow, et al., Eds. (2011). AHFS DI (Lexi-Comp Online). Bethesda, MD, American Society of Health-System Pharmacists.
  8. Wickersham, R. M., K. K. Novak, et al., Eds. (2010). Drug Facts and Comparisons (eFacts). St. Louis, MO, Wolters Kluwer Health, Inc.
  9. Aminoff MJ, Greenberg DA, Simon RP, eds. Clinical Neurology. 6th ed. New York, NY: Lange Medical BooksMcGraw-Hill; 2005.
  10. Meierkord H, Boon P, Engelsen B, et al. EFNS guideline on the management of status epilepticus in adults. Eur J Neurol. Mar 2010;17(3):348-355.
  11. Millikan D, Rice B, Silbergleit R. Emergency treatment of status epilepticus: current thinking. Emerg Med Clin North Am. Feb 2009;27(1):101-113, ix.

Updated

Updated August 26, 2015 by Leslie Jensen, PharmD, Drug Information Specialist. Created April 8, 2011, by Jane Chandramouli, PharmD, Drug Information Specialist. Copyright 2015, Drug Information Service, University of Utah, Salt Lake City, UT.

Disclaimer

This information is provided through the support of Novation to ASHP solely as a service to its members, which shall not use this information for their further commercial use. The content was prepared by the Drug Information Center of University of Utah. Novation, ASHP, and the University of Utah 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, which respect to such information, and specifically disclaim all such warranties. Users of this information are advised that decisions regarding the use of drugs and drug therapies are complex medical decisions and that in using this information, each user must exercise his or her own independent professional judgment. Neither Novation, ASHP nor the University of Utah assumes any liability for persons administering or receiving drugs or other medical care in reliance upon this information, or otherwise in connection with this bulletin. Neither Novation, ASHP nor University of Utah endorses or recommends the use of any drug.

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