Quetiapine Lorazepam

First, optimize current mood stabilizer or initiate mood-stabilizing medication lithium,0 valproate,0 or carba-mazepine0 Consider adding a benzodiazepine (lorazepam or clonazepam) for short-term adjunctive treatment of agitation or insomnia if needed Alternative medication treatment options carbam-azepine0 if patient does not respond or tolerate, consider atypical antipsychotic (e.g., olanzapine, quetiapine, risperidone) or oxcarbazepine. 

Agitation (acute, severe) Lorazepam Ziprasidone Risperidone Trazodone Olanzapine Quetiapine Haloperidol... 

Brief Severe Agitation. Acute management of severe agitation with physical aggression requires more definitive treatment. The first choice is haloperidol given in low doses (0.25-1 mg) as needed. Lorazepam can also be helpful if used briefly. Risperidone, olanzapine, quetiapine, or trazodone can also be used but are not available in injectable forms. 

Antipsychotic drugs are also indicated for schizoaffective disorders, which share characteristics of both schizophrenia and affective disorders. No fundamental difference between these two diagnoses has been reliably demonstrated. They are part of a continuum with bipolar psychotic disorder. The psychotic aspects of the illness require treatment with antipsychotic drugs, which may be used with other drugs such as antidepressants, lithium, or valproic acid. The manic phase in bipolar affective disorder often requires treatment with antipsychotic agents, although lithium or valproic acid supplemented with high-potency benzodiazepines (eg, lorazepam or clonazepam) may suffice in milder cases. Recent controlled trials support the efficacy of monotherapy with atypical antipsychotics in the acute phase (up to 4 weeks) of mania, and olanzapine and quetiapine has been approved for this indication. 

Quetiapine dose not appear to interact to a clinically relevant extent with cimetidine, fluoxetine, imipramine or lorazepam. Isolated cases of adverse outcomes have been reported with diphenhydramine, iovastatin and mirtazapine. 

The pharmacokinetics and pharmacodynamic effects of a single 2-mg dose of lorazepam were studied in 10 men taking quetiapine 250 mg three times daily. It was found that the maximum serum lorazepam levels were not significantly changed by quetiapine, and the alterations in the performance of a number of psychometric tests were small and considered not to be clinically relevant. ... 

Thieme, D. Sachs, H. Improved screening capabilities in forensic toxicology by application of liquid chromatography-tandem mass spectrometry, Anal.ChimActa, 2003, 492, 171-186. [hair LC-MS alprazolam dothiepin piritramide cocaine lorazepam lormetazepam clonazepam flimitrazepam bromazepam midazolam flurazepam nitrazepam temazepam medazepam nordazepam diazepam methylclonazepam triazolam oxazepam haloperidol benperidol sulpiride amisulpride mirtazapine citalopram olanzapine paroxetine fluoxetine sertraline zopiclone zolpidem risperidone quetiapine fentanyl pipamperone meperidine buprenorphine propoxyphene pentazocine phenazocine EDDP ... 

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