Lorazepam Injection Shortage 12.5.18

To:            Physicians, Nursing, Pharmacy

From:     Alan Mader, Pharmacy Clinical Coordinator

Date:      12/5/2018

Re:   Lorazepam Injection Shortage

Situation Lorazepam 2mg/mL 1 mL vials are on manufacturer on backorder.   The estimated re-supply date of November 2018 has already been exceeded.  Other projections for release include December 2018 to January 2019, with others extending to January 2020.
Background Lorazepam 2 mg/mL 10 mL vials have been on backorder since November 2017.
Assessment The addition of the 1 mL vials to backorder status severely limits availability of lorazepam injection.  While the pharmacy maintains some supply of lorazepam injection, the probability of depletion of stock before repletion is high.  Use of other benzodiazepines may become necessary.
Recommendation For patients who currently require lorazepam, please consider use of the PO route whenever possible.

While there are no direct dose conversions between benzodiazepines, please consider the following information on pharmacokinetics to aid in selection of an alternative:

Medication Onset

IV (minutes)

Onset

IM (minutes)

Duration

IV

(hours)

Duration

IM

(hours)

T ½

(Hours)

Active metabolites
Diazepam

(currently available in MDV’s only)

1 to 5 Slow and erratic absorption 0.3 to 0.5 Slow and erratic absorption 20 to120 Yes
Lorazepam 5 to 20 15 to 30 6 to 8 6 to 8 8 to15 No
Midazolam

5 mg/1 mL

5 mg/5 mL

2 mg/2mL

1 to 5 5 to 15 ≤2 2* 3 to 11 Yes

Pharmacologic effect of Midazolam may last up to 6 hours in some patients