On April 22 we had a pipe elbow failure in our Emergency Department (ED) causing a significant water leak. Crews are assessing the impact and we are in the process of water abatement. Our ED is open, but several rooms are currently offline which could increase wait times. Some surgeries are also being rescheduled.
Pharmacy Update: Lorazepam - Critical Shortage
We are unfortunately once again facing a critical shortage of IV/IM lorazepam (2mL vials) and down to a limited supply (~2 weeks). We will be implementing an EPIC alert but wanted to also notify you directly due to the far reaching nature of this shortage.
For clinical scenarios that require IV/IM lorazepam critically (e.g. status epilepticus): please proceed with order. Otherwise, some options for managing this shortage include:
- Utilize PO lorazepam whenever possible (dosing conversion is 1:1)
- For ED/CCU/procedural areas – consider utilizing midazolam if able.
- For med/surg areas, consider IV diazepam (avoid IM due to erratic absorption) if able.
NOTE: 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. Below are conservative recommendations and information regarding the onset and duration.
|
Agent |
Onset of Action (min) – Intravenous |
Duration of Action (hours) – Intravenous |
Onset of Action (min) – Intramuscular |
Duration of Action (hours) - Intramuscular |
Half Life (hours) |
Conservative estimate on equivalent dose1 |
|
Lorazepam |
5 to 20 |
6 to 8 |
15 to 30 |
6 to 8 |
8 to 15 |
1mg |
|
Diazepam |
1 to 5 |
0.3 to 0.5 |
Erratic/slow |
Erratic/slow |
20 to 120 |
5mg |
|
Midazolam |
1 to 5 |
< 2 |
5 to 15 |
< 2 |
3 to 11 |
2mg |