Lorazepam Injection Shortage

As of December 28, 2023

LCMC Health is experiencing a shortage of lorazepam injection and our supply is decreasing by the day. Stocks will be depleted in less than 2 weeks.

Mitigation strategy for decreasing the use of lorazepam injection effective immediately.

Indications for IV lorazepam or diazepam:

  1. Seizure abortion- lorazepam first line until stock runs outs.
  2. EtOH withdrawal in the ED/ICU
To steward use: Encourage IV phenobarbital in ED/ICU, PO BZD prn or scheduled PO BZD tapers for ED/floor and non-BZD adjunctive agents like gabapentin scheduled for floor/ICU
 
Indications for IV midazolam:

  1. Seizure abortion- once lorazepam runs short; will need to address the issue with midazolam restrictions on the floor
  2. Status epilepticus (infusion)
  3. Procedural sedation (once PRN)
  4. ICP management (infusion)
  5. Last line agents for adult ICU sedation (must try propofol, dexmedetomidine, and ketamine first – this excludes pediatric patients who should be able to use IV midazolam infusion 1st line)
  6. Comfort care if PO lorazepam contraindicated
Indications for the following can use PO BZD or IV/PO antipsychotics – restrict IV BZD in these situations:

  1. EtOH withdrawal on the floor => use PO BZD prn or taper with adjunctive gabapentin (may consider 1x IV dose if CIWA 10-18 and then must order PO BZD)
  2. Agitation/Anxiety => IV/PO antipsychotic or PO BZD
  3. Muscle spasm => PO diazepam, methocarbamol, cyclobenzaprine, tizanidine
  4. Comfort Care => PO lorazepam AND IV haloperidol – this is already built into the adult comfort care order set
If you have any questions or concerns with these alternatives, please reach out to me or any of the clinical staff on the floors. Thank you.

Ethan Austin, PharmD, BCCCP
Clinical Pharmacy Manager
Clinical Pharmacy Specialist- Medical ICU
PGY-1 Residency Program Director

University Medical Center New Orleans
2000 Canal St.
New Orleans, LA 70112
O 504.702.2111
F 504.702.5380