SCCM Resource Library-Drug Shortage Alert: Parenteral Benzodiazepines

Pdf Summary

The Drug Shortage Alert addresses the shortage of IV lorazepam, a benzodiazepine commonly used in intensive care settings for seizures, sedation, anxiety, and substance withdrawal. The shortage results from increased demand and manufacturing delays, necessitating alternative strategies. This alert outlines recommendations based on current evidence and expert advice while emphasizing the importance of consulting institutional policies.<br /><br />To manage the shortage, practitioners are advised to use oral lorazepam whenever possible and to reserve IV lorazepam for critical scenarios, such as uncontrolled seizures, third-line IV antiemetic treatments, and when enteral benzodiazepines are not tolerated. Alternative benzodiazepines like diazepam and midazolam may be considered based on specific indications and availability.<br /><br />For acute seizures, both diazepam and midazolam can be used via various administration routes, including intramuscular, intranasal, and buccal. The guidelines suggest using diazepam for rectal administration and midazolam for intramuscular injections. Alternatives for catatonia and anticipatory nausea include drugs like diazepam, oxazepam, alprazolam, and even non-pharmacological interventions like behavioral therapy.<br /><br />In the context of alcohol withdrawal syndrome, alternative benzodiazepines like diazepam and chlordiazepoxide are recommended. Phenobarbital and ketamine may be considered in the intensive care setting, given their potential in managing withdrawal symptoms.<br /><br />The alert highlights safety considerations, stressing the importance for clinicians to be familiar with benzodiazepines they may not commonly use, as differences in onset, duration of action, and metabolite effects can impact patient safety. Education and interdisciplinary collaboration among clinical staff are essential to develop effective mitigation strategies during the shortage.<br /><br />This document, developed by experts like Christina J. Smith and Shan Wang, underscores the need for clear communication and continuous staff education to maintain effective and safe patient care amidst drug shortages.

Asset Subtitle

Pharmacology, Crisis Management, 2022, 0:08:10

Asset Caption

IV lorazepam is frequently on shortage due to increased demand and manufacturing delays, which may result in the need for alternative benzodiazepines (BZDs). IV lorazepam is commonly used in the ICU for seizures, sedation, anxiety, catatonia, intoxication, and substance withdrawal. In this alert, we will discuss commonly used BZDs (lorazepam, midazolam, diazepam) that may be used as alternatives to lorazepam. The recommendations provided in this document are based on both current evidence, including a review of available literature by the SCCM Drug Shortages and Medication Safety Committee, and the need for conservation during this shortage.

Meta Tag

Content Type Article

Knowledge Area Pharmacology

Knowledge Area Crisis Management

Knowledge Level Foundational

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Nonmember

Membership Level Associate

Membership Level Professional

Membership Level Select

Tag Resource Allocation

Tag Analgesia and Sedation

Year 2022

Keywords

IV lorazepam shortage

benzodiazepines

intensive care

seizures

alternative strategies

diazepam

midazolam

alcohol withdrawal

patient safety

staff education

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