Drug General Information (ID: DDIJKO9GHZ)
Drug Name			Lorazepam		Drug Info		Olanzapine		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antianxiety Agents				Antipsychotic Agents
Structure

Mechanism of Lorazepam-Olanzapine Interaction (Severity Level: Major)
Additive cardiorespiratory depression effects Click to Show/Hide Mechanism Graph
Drug Name		Lorazepam				Olanzapine
Mechanism 1		Cardiorespiratory depression effects				Cardiorespiratory depression effects
Key Mechanism Factor 1
		Factor Name		Cardiorespiratory depression effects
		Factor Description		Cardiorespiratory depression is a reduction or inhibition of the normal function of the heart and lungs. The heart and lungs are the most important organs of the body's circulatory system, and when excessively depressed may result in decreased heart rate, decreased blood pressure, heart failure, slowed breathing (little to no visible chest movement), apnea, narrowed or pinpoint pupils, and seizures.
Mechanism Description		Additive cardiorespiratory depression effects by the combination of Lorazepam and Olanzapine
Additive CNS depression effects Click to Show/Hide Mechanism Graph
Drug Name		Lorazepam				Olanzapine
Mechanism 2		CNS depression effects				CNS depression effects
Key Mechanism Factor 2
		Factor Name		CNS depression effects
		Factor Description		CNS depressants are drugs that inhibit or suppress brain activity and can reduce mental and physical processes. Excessive CNS depression can lead to decreased heart rate, slow breathing (less than 10 breaths per minute), extreme confusion or loss of memory, nausea and vomiting, poor judgment, blue lips or fingertips, irritability and aggression, and clammy or cold skin.
Mechanism Description		Additive CNS depression effects by the combination of Lorazepam and Olanzapine

Recommended Action
Management		Caution is necessary when olanzapine is used in combination with benzodiazepines. Ambulatory patients should be made aware of the possibility of additive CNS effects and counseled to avoid activities requiring mental alertness until they know how these agents affect them. They should also be advised to avoid rising abruptly from a sitting or recumbent position and to contact their physician if they experience symptoms of hypotension such as dizziness, lightheadedness, or fainting. Concomitant administration of IM olanzapine and parenteral benzodiazepine has not been studied and is therefore not recommended. Patients given this combination when necessary should be closely monitored for excessive sedation and cardiorespiratory depression.

References
1	Product Information. Zyprexa (olanzapine). Lilly, Eli and Company, Indianapolis, IN.
2	Naso AR "Optimizing patient safety by preventing combined use of intramuscular olanzapine and parenteral benzodiazepines." Am J Health Syst Pharm 65 (2008): 1180-3.[PMID: 18541690]
3	Zacher JL, Roche-Desilets J "Hypotension secondary to the combination of intramuscular olanzapine and intramuscular lorazepam." J Clin Psychiatry 66 (2005): 1614-1615.[PMID: 16401168]