Lorazepam Injection Shortage 12.5.18

To:            Physicians, Nursing, Pharmacy

From:     Alan Mader, Pharmacy Clinical Coordinator

Date:      12/5/2018

Re:   Lorazepam Injection Shortage

SituationLorazepam 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.
BackgroundLorazepam 2 mg/mL 10 mL vials have been on backorder since November 2017.
AssessmentThe 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.
RecommendationFor 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:

MedicationOnset

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 5Slow and erratic absorption0.3 to 0.5Slow and erratic absorption20 to120Yes
Lorazepam5 to 2015 to 306 to 86 to 88 to15No
Midazolam

5 mg/1 mL

5 mg/5 mL

2 mg/2mL

1 to 55 to 15≤22*3 to 11Yes

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