Zyprexa and Ativan IM Compatibility - (Haldol Allergy)

[adnrnstudent, ASN, RN]

I've done quite a bit of looking into this, the research I've done leads me to believe not to admin Zyprexa and Ativan together in same syringe. I can't really find any good compatibility info in the resources I've looked at though.

It happens all the time though by nurses on my floor.

When patient has Haldol allergy, docs usually order Zyprexa.

So what can you experienced pros say on this subject?

Thanks in advance.

[Meriwhen, ASN, BSN, MSN, RN]

I've always kept them separate. Zyprexa needs to be reconstituted, so it's always been easier to just do that in one needle while drawing up the Ativan in another. Also, Ativan is very viscous and difficult to mix with other meds as it is.

[marshmallowstar, BSN, RN]

They're syringe compatible, but the Zyprexa should be reconstituted with water first.

http://pi.lilly.com/us/zyprexa-pi.pdf Page 6

ZYPREXA IntraMuscular should be reconstituted only with Sterile Water for Injection. ZYPREXA IntraMuscular should not be combined in a syringe with diazepam injection because precipitation occurs when

these products are mixed. Lorazepam injection should not be used to reconstitute ZYPREXA IntraMuscular as this combination

results in a delayed reconstitution time. ZYPREXA IntraMuscular should not be combined in a syringe with haloperidol injection

because the resulting low pH has been shown to degrade olanzapine over time.

[VivaLasViejas, ASN, RN]

When giving injectable Ativan at the hospital where I worked, we diluted it in a syringe with an equal amount of NS because it's so thick. We also didn't give it IM because it was still relatively viscous even diluted. I feel sorry for the patient who needs a hipful of Ativan and Zyprexa---yowch!

[TerpGal02, ASN]

Yeah I kind of feel sorry for pts getting IM Ativan. It's worse IMO than Haldol or Prolixin Dec. At work we give it with a 20 gauge because it is SO difficult to draw and inject in anything smaller. Although by the time we get to giving an IM the pt is so escalated that I doubt they even notice/remember it.

[MrsMig, BSN, RN]

I've always kept them separate. Zyprexa needs to be reconstituted so it's always been easier to just do that in one needle while drawing up the Ativan in another. Also, Ativan is very viscous and difficult to mix with other meds as it is.[/quote']

Ditto ... Always separate. How can u mix them? It must take forever...

[MrsMig, BSN, RN]

Yeah I kind of feel sorry for pts getting IM Ativan. It's worse IMO than Haldol or Prolixin Dec. At work we give it with a 20 gauge because it is SO difficult to draw and inject in anything smaller. Although by the time we get to giving an IM the pt is so escalated that I doubt they even notice/remember it.

Same gauge here too and yes, it's got to be painful. Highly doubtful they remember ...

[NurseJamie8]

The pharmacy at my hospital always tells us not to mix Zyprexa and Ativan. There aren't many things compatible with Ativan. But luckily haldol is!

[ClimberNurse05]

DO NOT ADMINISTER THESE TWO AT THE SAME TIME! They should not be mixed and not even given within an hour of each other. You could over sedate the patient and they bad interactions. Please call the physician FIRST! Then if they must get both, request one to be given IM and one oral with at least an hour between the two.

[stevefl]

The two should never be given IM at the same time just as the previous post stated. At the facility I am currently at, we have a full time Doc on board and he will order Zyprexa Zydis 10mg and Ativan 2mg PO and if an IM is needed his go to is Haldol 10mg, Ativan 2mg and Benadryl 50mg. He claims that the Zydis works faster because there are less binders in the tab so even if it's swallowed it's fast. As far as drawing Ativan when giving Haldol and Ativan, I draw the Haldol first, inject the Haldol into the Ativan, then draw both into one syringe. Pharmacy told me that as long as it was given within 15 minutes there wouldn't be a problem.

[B52, ADN, BSN, MSN, RN]

As others have posted, concomitant IM Ativan and Zyprexa are not safe. Here's info from MedScape Medscape: Medscape Access

[Fiddleback]

The state run facility where I work requires a 2 hour wait between Zyprexa and Ativan injections. For that reason The doctors usually order a shot of Benadryl at the same time time as the Zyprexa. Like others have said, most of the patients I give shots to are so agitated I seriously doubt they remember much about the event.