The injectable LORazepam shortage continues to worsen. As announced last week, we are reserving injectable LORazepam (and diazepam) for treatment of seizures. However, many power plans contain orders for pre-procedural doses of injectable LORazepam and are threatening our supply. Effective immediately, pharmacists will automatically convert injectable doses of LORazepam to PO LORazepam on a 1:1 basis when ordered pre-procedure.

 

Another issue that has arisen is the ordering of midazolam (Versed) in pre-procedural situations. Versed is only approved for use in ICUs and in situations where "comfort measures only" are appropriate. Procedural use is only allowed when the patient is constantly monitored by qualified personnel; as such, midazolam is not appropriate for pre-procedural use. An option in these situations is to convert midazolam IV to LORazepam PO on a 5:1 bases (5 mg midazolam IV ≈ 1 mg LORazepam PO). Another option is alprazolam (Xanax) 0.5 mg PO. Pharmacists will attempt to contact the prescriber for clarification when midazolam is ordered in this situation.

 

Thank you for your support as we work through this ongoing shortage. There is no definitive resolution date, but late January to late February have been mentioned. If you have any questions or concerns, please contact your unit-based pharmacist or David Collette.