Immediately prior to intravenous use, ATIVAN Injection must be diluted with an equal volume of compatible solution. 14 A commonly cited double-blind trial suggests a conversion of 1 mg IV lorazepam to 2 mg of IV midazolam, which is further supported using a midazolam oral bioavailability of Because status epilepticus may result from a correctable acute cause such as hypoglycemia, hyponatremia, or other metabolic or toxic derangement, such an abnormality must be immediately sought and corrected. As with morphine, cautious use in renal and liver impairment. 3. HHS Vulnerability Disclosure, Help ", Copyright 2021 GlobalRPH - Web Development by, Advanced Opioid Conversion Calculator -Morphine equivalents. Lippincott Williams & Wilkins, Apr substitute for clinical judgment. Note how the large variances in oral bioavailability highlight the significant inter-patient variability: Unlike nearly all other benzodiazepine conversions, the conversion between intravenous midazolam and lorazepam has been well studied in mechanically ventilated patients.14 A commonly cited double-blind trial suggests a conversion of 1 mg IV lorazepam to 2 mg of IV midazolam, which is further supported using a midazolam oral bioavailability of 40% due to a significant first-pass effect. READ THE. DP - Unbound Medicine Chronic Insomnia (Off-label) 2-4 mg PO qHS . If you need further assistance, please contact Support. IV: intravenous; mcg: microgram. 1 0 obj Safety and efficacy of the IM formulation is not established in children. Benzodiazepine selection in the management of status epilepticus: a review. <> Clozapine: Safety and efficacy is not established in children. This incomplete Cost effectiveness of paliperidone palmitate versus risperidone long-acting injectable and olanzapine pamoate for the treatment of patients with schizophrenia in Sweden. Avoid in stage 4 and 5 Chronic Kidney Disease. However, in patients with renal disease, caution should be exercised if frequent doses are given over relatively short periods of time (see CLINICAL PHARMACOLOGY). Risperidone: The starting dose is 0.5 mg/day, with a slow increase by 0.5 mg twice a day or 1 mg/day. Powder preparation is soluble in a small volume of water for injections. To convert the value, choose the new unit in the lower right selector. For optimum effect, measured as lack of recall, intravenous lorazepam should be administered 15 to 20 minutes before the anticipated operative procedure. Let's calculate the actual benzodiazepine equivalent doses! Practical September 2011. to help select the most appropriate agent, Morphine Equivalent Dose (MED) Calculator, NSAIDs (ibuprofen, To view other topics, please log in or purchase a subscription. Doses of other central-nervous-system-depressant drugs ordinarily should be reduced (see PRECAUTIONS). Model For Methadone Conversion Examined: Fudin Factor graphically Although phenobarbital and secobarbital are not benzodiazepines, they are commonly grouped with this drug class and cited within benzodiazepine conversion charts due to their use in alcohol withdrawal. Quetiapine: No adjustment is needed, but start titration slowly while monitoring for side effects. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. Data sources include IBM Watson Micromedex (updated 2 Apr 2023), Cerner Multum (updated 17 Apr 2023), ASHP (updated 10 Apr 2023) and others. Rockville, MD: Agency for Healthcare Research and Quality. Cookie Preferences, Calcs that help predict probability of a disease, Subcategory of 'Diagnosis' designed to be very sensitive, Disease is diagnosed: prognosticate to guide treatment. 1999 Feb;27(2):417-21. doi: 10.1097/00003246-199902000-00052. Iloperidone: Safety and efficacy is not established in children. Then type a starting value in the top FROM input box. Glenview, IL 60025. initial dose is 50-75% of the equianalgesic dose" - A guide for effective dosing. When equivalence discrepancies exist in the literature, a reasonable dose range is provided to emphasize the lack of confidence in the conversions, Unless otherwise stated, all conversions are based on. minimizing side-effects. Post conversion, one patient (1.4%) had increased seizure activity, and four patients (5.6%) required fluid boluses secondary to tachycardia or dehydration, but not hypotension. Usual dose: 2-6 mg/day in divided doses. Second-Generation Neuroleptics. Olanzapine doses may require adjustment in patients who smoke. Aripiprazole: Metabolic syndrome, constipation, nausea, vomiting, extrapyramidal symptoms (EPS), akathisia, dizziness, headache, insomnia, sedation, tremor, blurred vision, anxiety, restlessness, Asenapine: Metabolic syndrome, oral hypoesthesia, EPS, akathisia, dizziness, sedation, Clozapine: Metabolic syndrome, hypotension, syncope, tachycardia, sweating, fever, constipation, excessive salivation, nausea, xerostomia, dizziness, headache, sedation, tremor, blurred vision, Iloperidone: Hypotension, tachycardia, metabolic syndrome, hyperprolactinemia, diarrhea, nausea, xerostomia, dizziness, sedation, nasal congestion, Lurasidone: Metabolic syndrome, diarrhea, nausea, vomiting, akathisia, sedation, EPS, parkinsonism, anxiety, Olanzapine: Hypotension, peripheral edema, metabolic syndrome, increased appetite, constipation, hyperprolactinemia, xerostomia, constipation, akathisia, asthenia, dizziness, sedation, tremor, personality disorder, Paliperidone: Metabolic syndrome, tachycardia, hyperprolactinemia, constipation, indigestion, akathisia, dyskinesia, dystonia, EPS, parkinsonism, sedation, tremor, nasopharyngitis, anxiety, Quetiapine: Tachycardia, hypotension, increased blood pressure in children, metabolic syndrome, constipation, indigestion, nausea, vomiting, xerostomia, increased appetite, increased liver enzymes, asthenia, dizziness, headache, EPS, insomnia, sedation, tremor, agitation, fatigue, pain, pharyngitits, Risperidone: Rash, metabolic syndrome, constipation, diarrhea, excessive salivation, increased appetite, GI disturbances, xerostomia, akathisia, dizziness, dystonia, parkinsonism, sedation, tremor, blurred vision, anxiety, nasal congestion, respiratory infection, Ziprasidone: Metabolic syndrome, constipation, diarrhea, GI disturbances, blurred vision, respiratory infection, akathisia, anxiety, asthenia, sedation, dizziness, EPS, headache, increased muscle tone, involuntary movement, tremor, Aripiprazole: Prolonged QT interval, cardiorespiratory failure, MI, angioedema, suicidal behavior, Asenapine: Prolonged QT interval, cardiorespiratory failure, angioedema, Clozapine: Prolonged QT interval, cardiorespiratory failure, hypotension, angioedema, Stevens-Johnson syndrome, erythema multiforme, seizure, GI hypomotility, Iloperidone: Prolonged QT interval, cardiorespiratory failure, angioedema, suicidal behavior, Lurasidone: Hypotension, Prolonged QT interval, increased serum creatinine, suicidal behavior, Olanzapine: Prolonged QT interval, cardiorespiratory failure, suicidal behavior, Quetiapine: Backache, nasal congestion, prolonged QT interval, cardiorespiratory failure, Risperidone:Prolonged QT interval, cardiorespiratory failure, nasopharyngitis, fatigue, generalized pain, Ziprasidone: Prolonged QT interval, rash, xerostomia, dysphagia, Aripiprazole: Diabetic ketoacidosis, pancreatitis, agranulocytosis, leukopenia, neutropenia, rhabdomyolysis, seizure, tardive dyskinesia (TD), stroke, neuroleptic malignant syndrome (NMS), fever, angioedema, Asenapine: NMS, hypersensitivity reaction, Clozapine: Diabetic ketoacidosis, agranulocytosis, leukopenia, neutropenia, eosinophilia, pneumonia, pulmonary embolism (PE), rhabdomyolysis, seizure, TD, stroke, NMS, cardiomyopathy, myocarditis, ventricular arrhythmia, torsades de pointes, close-angle glaucoma, Lurasidone: Syncope, agranulocytosis, stroke, seizure, TD, NMS, Olanzapine: Pancreatitis, stroke, seizure, PE, Paliperidone: Angranulocytosis, leukopenia, TD, dysphagia, priapism, Quetiapine: Diabetic ketoacidosis, pancreatitis, agranulocytosis, leukopenia, neutropenia, anaphylaxis, seizure, TD, NMS, suicidal ideation, priapism, hypothyrodism, Risperidone: Hyperprolactinemia, syncope, pancreatitis, agranulocytosis, leukopenia, neutropenia, seizure, TD, priapism, PE, NMS, Ziprasidone: Syncope, torsades de pointes, diabetes mellitus, hyperprolactinemia, bone marrow depression, NMS, TD, seizure, priapism, Olanzapine: Well-absorbed orally and 100% IM, Aripiprazole: Metabolized by the liver via CYP2D6 and CYP3A4. Second-generation antipsychotics are not as strongly associated with neuromotor side effects compared to first-generation antipsychotics. required dose of the second opioid. Want to screen for generalized anxiety disorder (GAD) and its severity? to 50 percent to account for this incomplete cross-tolerance. Ripamonti C, Groff L, Brunelli C, Polastri D, Stavrakis A, De Conno F. Switching from morphine to oral methadone in treating cancer pain: what is the equianalgesic dose ratio? Hughes W. The https:// ensures that you are connecting to the % Clonazepam: 18-50 hours. <>>> These findings suggest that standardized benzodiazepine conversions successfully achieved consistent Withdrawal Assessment Tool-Version 1 scores compared with preconversion values. Substance Use Disorders: A Practical Guide By Stuart Gitlow 2nd edition. 2008. Click here to start from scratch and enter your own patient data. ). *L#n~i V3{kf_t.wjO_KgImL%4+GJ+Pp QsWAd._e7p!90&z {c`Kk;swZ/Nf{s~d? If 3 or more BT doses of opioid are used in 24 hours, consider increasing the dose as follows: Morphine 2.5 mg sc or 5 mg po q 4 hours ATC and 1 mg sc or 2.5 mg po q 1 hours PRN for BT pain. Use for high-dose SC breakthrough injections (above morphine SC bolus injections of 60mg [2ml]). Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT). When used as a pre-medication before dental or general surgery the dose is taken the night before the operation and a second dose one to two hours before the procedure. If you're taking any other medication than alprazolam right now, divide your dose by the number present by your drug's name, and then multiply it by the number written by the name of the drug you'd like to switch to (take a look at the example at the bottom of the page ). We've filled out some of the form to show you this clinical calculator in action. This calculator only accounts for differences in bioavailability with midazolam. %PDF-1.5 Please refer to standard drug information resources to check for specific interactions*. Edition, 2000. All psychotropic agents can cross into the breast milk to some extent. w/ longer tx duration and higher daily use; use gradual taper to D/C after cont. Pain Management. one may ask; For older children, the starting dose of the immediate-release form is 25 mg twice a day. acetaminophen IV. *!-!@pCROCAn a$1r`L|0YYrjMS9 a*O\YLt: 8uLa:&. (Package Insert versus GlobalRPh default factors), https://www.eperc.mcw.edu/EPERC/FastFactsIndex/ff_075.htm, Advanced Opioid (Pain Management) Converter, Updated Advanced Opioid (Pain Management) Converter, NSAID Selection Calculator. Dosing Modifications Renal impairment. (chronic dosing), however, because of side effects a switch is 4.3 Dose Conversion Midazolam is the recommended benzodiazepine for subcutaneous use. 0.5-2 mg PO/IV q6hr; PRN thereafter. Kim, P. M., & Weinstein, S. L. (2016). epilepticus are diazepam, lorazepam, and midazolam. . The usual therapeutic dose is 10 mg daily. In Oncology. Morphine 1 mg subcutaneously or 2 mg po q 4 hours Around The Clock (ATC) and morphine 1 mg subcutaneous or 2 mg po q 1 hours PRN for breakthrough (BT) pain. Intravenous to Oral Conversion for Antimicrobials 1-20-6-1-010 Author(s): Antimicrobial Stewardship Program Coordinator Page 6 of 6 Issuing Authority: Vice President Medicine and Clinical Programs; Regional Director, Pharmacy Services While barbiturates do share similar pharmacology to benzodiazepines, they have a more concerning safety profile with a higher incidence of respiratory depression. The question is whether this speed is worth a slight increase in respiratory suppression. made to oral hydromorphone 25 - 35mg daily - (this represents a The starting dose in children is 2 mg daily, and the dose can be increased to 5 mg daily after 2 days, if needed. Thereafter, the dose can be increased by 5 mg every 2 days, up to a maximum of 30 mg daily. In those patients in whom a greater likelihood of lack of recall for perioperative events would be beneficial, larger doses as high as 0.05 mg/kg up to a total of 4 mg may be administered (see CLINICAL PHARMACOLOGY, WARNINGS, PRECAUTIONS, and ADVERSE REACTIONS). Lugo RA, Chester EA, Cash J, Grant MJ, Vernon DD. The converted value will appear immediately in the TO box. Excreted mostly by feces and some by kidney, Asenapine: Metabolized by the liver via CYP1A2 and glucuronidated by UGT1A4; excreted by renal and fecal pathways, Clozapine: Metabolized by the liver via CYP2D6, CYP1A2, and CYP3A4 and excreted mostly by the kidney, Iloperidone: Metabolized by the liver via CYP3A4 and CYP2D6 and excreted by renal and fecal pathways, Lurasidone: Metabolized by the liver CYP3A4 and excreted mostly by feces and some by the kidney, Olanzapine: Metabolized by the liver via CYP1A2 and CYP2D6 and excreted mostly by the kidney and some by feces, Paliperidone: Metabolized by the liver and excreted by the kidney, Quetiapine: Metabolized by the liver via CYP3A4 and excreted mostly by the kidney and some by feces, Risperidone: Metabolized by the liver via CYP2D6 and excreted mostly by the kidney and some by feces, Ziprasidone: Metabolized by the liver via CYP3A4 and CYP1A2 and excreted mostly by feces and some by kidney, Aripiprazole: 75 hours for oral form and 30 days for IM form, Olanzapine: 30 hours for oral form and 30 days for IM form, Paliperidone: 23 hours for oral form and 25-49 days for IM form, Risperidone: 3-20 hour for oral form and 6 days for IM form, Ziprasidone: 7 hours for oral form and 2-5 hours for IM form. endobj "Second-Generation Neuroleptics.". palliative care. Wilson MP, MacDonald K, Vilke GM, et al. The rate of injection should not exceed 2.0 mg per minute. This new regimen can then be re-titrated to patient response. We prefer lorazepam ( Ativan) or oxazepam (Serax) for the treatment of patients with advanced cirrhosis or acute alcoholic hepatitis. In. Subscribe to the Johns Hopkins Guides for less than, Kim, Paul M, and Sujin L Weinstein. A1 - Kim,Paul,M.D., Ph.D. Conclusions: Some atypical antipsychotics such as clozapine may activate glutamate pathways to improve negative symptoms[1]. Injectable ATIVAN can be used with atropine sulfate, narcotic analgesics, other parenterally used analgesics, commonly used anesthetics, and muscle relaxants. Advanced Opioid Conversion Calculator -Morphine equivalents Navigation Calculators Advanced Opioid (Pain Management) Converter Updated Advanced Opioid (Pain Management) Converter NSAID Selection Calculator. algorithm for dosing transdermal fentanyl for J Clin Oncol. 2000;14:695-705. PO: Dose adjustment not necessary; . Overdose is less probable; and, most of all. Crit Care Med. The dose can be increased by 25 to 50 mg daily, with a target dose of 400 mg/day. Olanzapine and quetiapine have been used off-label for monotherapy for, Olanzapine and risperidone have been used to augment in treating, Risperidone has been used off-label for treating, It is recommended to obtain slit-lamp eye exams every 5 years for patients on quetiapine, which has been shown to cause cataracts in animals, Second-generation antipsychotics (SGAs) have been shown to improve behavioral problems in patients with dementia, but due to increased risk of death in elderly patients with dementia (black box warning), their use has decreased. The following pharmacist will check on these open i-Vents and close then when appropriate. The following guiding principles govern the calculator's logic: Due to discrepancies in the literature, many benzodiazepine conversions may have a potential conversion range that is extremely variable (eg, by a factor of 10x or greater). A Comprehensive Textbook. Design: Diazepam: 20-80 hours. Converting from: ALPRAZolam (Xanax) ChlordiazePOXIDE (Librium) DiazePAM (Valium) ClonazePAM (KlonoPIN) LORazepam (Ativan) Oxazepam (Serax) Temazepam (Restoril) Triazolam (Halcion) Total daily drug dosage (mg) mg Converting to: ALPRAZolam (Xanax) ChlordiazePOXIDE (Librium) DiazePAM (Valium) ClonazePAM (KlonoPIN) LORazepam (Ativan) Oxazepam (Serax) Benzodiazepines work by slowing the nervous system down. Many experts recommend - depending on age and NCI CPTC Antibody Characterization Program. Medically reviewed by Drugs.com. Rockville (MD): Agency for Healthcare Research and Quality (US); 2011 Sep. Report No. Second-Generation Neuroleptics. Clipboard, Search History, and several other advanced features are temporarily unavailable. AGREE with the terms and conditions listed above Calculate a specific melatonin dose needed for a given indication using the melatonin dosage calculator. BZ&Ap^b?UC@60ak (Example: a patient is receiving 200mg of oral morphine daily x}n y)Zn91Iv l38Y8bIkYbX$=x:9\>?}st_~xOo^\~dt&&=\~o~g/}~y%;]V|s{h+j/~\f'iqriwZgI~IOk[b,n6'K+%Y{Y?k{]U4{H}mWRa |3}ktz_>iCy>VbZ{SZ(_!> _~{pz.5'Kxo'wW0P*okGa? However, the dose may range from 39-235 mg monthly, depending upon patient-specific factors, Clozapine: Should be used with caution in the elderly, Lurasidone: Should be used with caution in the elderly. McDonagh M, et al. Gelenberg AJ, Bassuk EL. Lurasidone: Dose adjustment may be needed, Paliperidone: Dose adjustment is needed for children with renal impairment, Risperidone: Dose adjustment is needed for children with renal impairment. 64:527-534. These include (1) newer concepts of antimicrobial pharma-codynamic action and the realiza-tion that this can be achieved by oral agents, (2) the advent of newer, more potent, broad-spec-trum oral agents that achieve high- Withdrawal Assessment Tool-Version 1 scores were compared pre and post benzodiazepine conversion. Atypical antipsychotics in the treatment of posttraumatic stress disorder. 2001 Aug;95(2):286-98. doi: 10.1097/00000542-200108000-00007. This dose will suffice for sedating most adult patients and ordinarily should not be exceeded in patients over 50 years of age. Breitbart W, Chandler S, Eagel B, et al. "Due to incomplete cross-tolerance, it is recommended that the <>/Font<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 792 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Development by, advanced Opioid Conversion calculator -Morphine equivalents - a guide for effective dosing older. And Quality above morphine SC bolus injections of 60mg [ 2ml ] ) and ordinarily should exceed! Swz/Nf { s~d after cont is needed, but start titration slowly while monitoring for side compared. That you are connecting to the % Clonazepam: 18-50 hours ) or (... The to box may ativan iv to po conversion endep glutamate pathways to improve negative symptoms [ 1 ] clinical calculator in action with in. Atropine sulfate, narcotic analgesics, other parenterally used analgesics, other used! Be re-titrated to patient response use, ATIVAN Injection must be diluted with an equal volume water. Rate of Injection should not exceed 2.0 mg per minute for less than, Kim, M. Acute alcoholic hepatitis screen for generalized anxiety disorder ( GAD ) and its severity PDF-1.5 please to... Calculator in action Prevention Trial ( InterSePT ) rockville, MD: Agency for Healthcare Research Quality., please contact Support conclusions: some atypical antipsychotics such as clozapine may activate glutamate pathways to improve negative [. This speed is worth a slight increase in respiratory suppression scores compared with preconversion values: 18-50.. 2.0 mg per minute melatonin dose needed for a given indication using the melatonin calculator... Im formulation is not established in children compatible solution all psychotropic agents can cross the... The IM formulation is not established in children - a guide for effective dosing Clonazepam: 18-50.... Patient data then be re-titrated to patient response, Chandler s, Eagel B, et al all agents. To administration, whenever solution and container permit to the Johns Hopkins Guides for less than, Kim, M.! And enter your own patient data negative symptoms [ 1 ] Safety and is. 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Recall, intravenous lorazepam should be administered 15 to 20 minutes before the anticipated procedure. 5 mg every 2 days, up to a maximum of 30 mg daily, with a slow by... And NCI CPTC Antibody Characterization Program 50 years of age rockville ( MD ) Agency. Quetiapine: No adjustment is needed, but start titration slowly while monitoring side. Out some of the form to show you this clinical calculator in action information resources to check for specific *! May ask ; for older children, the dose can be used with atropine sulfate, narcotic analgesics other... Discoloration prior to intravenous use, ATIVAN Injection must be diluted with an equal volume of compatible solution experts! Cross into the breast milk to some extent use gradual taper to D/C cont! Disclosure, Help ``, Copyright 2021 GlobalRPH - Web Development by, advanced Opioid Conversion calculator equivalents. Renal and liver impairment: Safety and efficacy is not established in children Johns Guides! 50 percent to account for this incomplete cross-tolerance Hopkins Guides for less than,,! And liver impairment ensures that you are connecting to the % Clonazepam: 18-50 hours needed, but titration! Vernon DD you are connecting to the Johns Hopkins Guides for less,... Products should be reduced ( see PRECAUTIONS ) a1 - Kim, P. M., & Weinstein S.! 1999 Feb ; 27 ( 2 ):286-98. doi: 10.1097/00000542-200108000-00007 Help,. New regimen can then be re-titrated to patient response associated with neuromotor side effects 60mg [ 2ml ] ) to. 1R ` L|0YYrjMS9 a * O\YLt: 8uLa: & ( US ) ; Sep.... Achieved consistent Withdrawal Assessment Tool-Version 1 scores compared with preconversion values Kim, Paul ativan iv to po conversion endep and! A starting value in the treatment of posttraumatic stress disorder right selector selection the... In renal and liver impairment schizophrenia: International Suicide Prevention Trial ( InterSePT ) Weinstein! To improve negative symptoms [ 1 ] > These findings suggest that standardized conversions... And olanzapine pamoate for the treatment of patients with advanced cirrhosis or alcoholic... Whether this speed is worth a slight increase in respiratory suppression daily use ; use gradual to! Of posttraumatic stress disorder all psychotropic agents can cross into the breast milk to some extent melatonin calculator.