Lorazepam clozapine

Although clozapine has been considered an alternate agent, as mentioned earlier there is also a risk with this agent ( 494, 495 and 496). An unusual adverse effect of clozapine, apparently unrelated to NMS, is hyperthermia in 10% to 15% of patients (usually 0.5°C to 1°C, but virtually never above 40°C [104°F]). This symptom usually occurs between the fifth and the fifteenth days of treatment, after which, temperature returns to normal. Benzodiazepines (e.g., lorazepam) have also been recommended to either avoid or at least minimize the dose of antipsychotic. 

Klimke A, Kleiser E. Sudden death after intravenous application of lorazepam in a patient treated with clozapine. Am J Psychiatry 1994 151 780. 

Cobb CD, Anderson CB, Seidel DR. Possible interaction between clozapine and lorazepam [Letter]. Am J Psychiatry 1991 148 1606-1607. 

Phenothiazines and related drugs, e.g., chlorpromazine (Largactil/ Thorazine). Some tricyclic antidepressants, e.g., amitriptyline Dibenzodiazepine derivatives and thienobenzodiazepines, e.g., clozapine, olanzapine Benzodiazepines, e.g., diazepam (Valium), nitrezepam (Librium) and lorazepam Barbiturates Opiates... 

Caution has been recommended when starting clozapine in patients taking benzodiazepines (SEDA-19,55). Three cases of delirium associated with clozapine and benzodiazepines (244) have been reported. There have been several reports of synergistic reactions, resulting in increased sedation and ataxia, when lorazepam was begun in patients already taking clozapine (245). 

Biperiden Zolpidem Oomipramine Trihexyphenidyl Amoxapine Hydroxyzine HCl Lorazepam Nortriptyline Diphenhydramine BusfJirone Clonidine Prazepam Clozapine Benztropine Pemoline Flurazepam Valproic acid Valproic acid Trazodone Dextroamphetamine... 

Chlorpromazine Flaloperidol Thioridazine Atypical Antipsychotics Clozapine Risperidone Benzodiazepines Lorazepam Oxazepam Triazolam... 

Potentially clinically significant interactions include the tendency for fluvoxamine to increase circulating concentrations of oxidatively metabolized benzodiazepines, clozapine, theophylline, and warfarin. Sertraline and fluoxetine can increase levels of benzodiazepines, clozapine, and warfarin. Paroxetine increases levels of clozapine, theophylline, and warfarin. Fluoxetine also potentiates tricyclic antidepressants and some class 1C antiarrhythmics with a narrow therapeutic index (including encainide, flecainide, and propafenone). Nefazodone potentiates benzodiazepines other than lorazepam and oxazepam. 

Also analyzed acebutolol, acepromazine, acetaminophen, acetazolamide, acetophenazine, albuterol, amitriptyline, amobarbital, amoxapine, antipsrrine, atenolol, atropine, azata-dine, baclofen, benzocaine, bromocriptine, brompheniramine, brotizolam, bupivacaine, buspirone, butabarbital, butalbital, caffeine, carbamazepine, cetirizine, chlorqyclizine, chlordiazepoxide, chlormezanone, chloroquine, chlorpheniramine, chlorpromazine, chlorpropamide, chlorprothixene, chlorthalidone, chlorzoxazone, cimetidine, cisapride, clomipramine, clonazepam, clonidine, clozapine, cocaine, codeine, colchicine, qyclizine, (yclo-benzaprine, dantrolene, desipramine, diazepam, diclofenac, diflunisal, diltiazem, diphenhydramine, diphenidol, dipheno late, dipyridamole, disopyramide, dobutamine, doxapram, doxepin, droperidol, encainide, ethidium bromide, ethopropazine, fenoprofen, fentanyl, flavoxate, fluoxetine, fluphenazine, flurazepam, flurbiprofen, fluvoxamine, fii-rosemide, glutethimide, glyburide, guaifenesin, haloperidol, homatropine, hydralazine, hydrochlorothiazide, hydrocodone, hydromorphone, hydro g chloroquine, hydroxyzine, ibuprofen, imipramine, indomethacin, ketoconazole, ketoprofen, ketorolac, labetalol, le-vorphanol, lidocaine, loratadine, lorazepam, lovastatin, loxapine, mazindol, mefenamic acid, meperidine, mephenytoin, mepivacaine, mesoridazine, metaproterenol, methadone, methdilazine, methocarbamol, methotrexate, methotrimeprazine, methoxamine, methyl-dopa, methylphenidate, metoclopramide, metolazone, metoprolol, metronidazole, midazolam, moclobemide, morphine, nadolol, nalbuphine, naloxone, naphazoline, naproxen, nifedipine, nizatidine, norepinephrine, nortriptyline, oxazepam, oxycodone, oxymetazo-line, paroxetine, pemoline, pentazocine, pentobarbital, pentoxifylline, perphenazine, pheniramine, phenobarbital, phenol, phenolphthalein, phentolamine, phenylbutazone, phenyltoloxamine, phenytoin, pimozide, pindolol, piroxicam, pramoxine, prazepam, prazosin, probenecid, procainamide, procaine, prochlorperazine, procyclidine, promazine, promethazine, propafenone, propantheline, propiomazine, propofol, propranolol, protriptyline, quazepam, quinidine, quinine, racemethorphan, ranitidine, remoxipride, risperidone, salicylic acid, scopolamine, secobarbital, sertraline, sotalol, spironolactone, sulfinpyrazone, sulindac, temazepam, terbutaline, terfenadine, tetracaine, theophylline, thiethyl-perazine, thiopental, thioridazine, thiothixene, timolol, tocainide, tolbutamide, tolmetin, trazodone, triamterene, triazolam, trifluoperazine, triflupromazine, trimeprazine, trimethoprim, trimipramine, verapamil, warfarin, xylometazoline, yohimbine, zopiclone... 

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