Medications That Cannot Be Given with Lorazepam IM

Critical Drug Interactions with Lorazepam IM

High-dose olanzapine should not be combined with lorazepam IM due to risk of fatal outcomes, including oversedation and respiratory depression 1, 2
Olanzapine (high-dose): Fatalities have been reported with concurrent use of benzodiazepines and high-dose olanzapine, specifically due to oversedation and respiratory depression 1, 2, 3

When combining lorazepam with antipsychotics in agitated patients, use lower doses (0.25-0.5 mg) in elderly, frail patients, or those with COPD, as recommended by the ESMO guidelines 1, 3
The ESMO guidelines note that while combination therapy may be used for severe agitation, the risk of respiratory compromise necessitates readiness to support ventilation 3, 4
For acute agitation management, if rapid sedation is required and combination therapy is deemed necessary, the evidence supports using lorazepam with haloperidol may produce more rapid sedation than monotherapy 5

Be prepared to support ventilation whenever combining lorazepam with any CNS depressant, particularly in elderly patients or those with respiratory compromise, as recommended by the ESMO guidelines 3, 4