Zyprexa and Ativan IM Compatibility - (Haldol Allergy)

[adnrnstudent]

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.

[NurseNinja1990]

From my own experience, we typically do Zyprexa and Benadryl, and in 2 separate syringes at that.

[nursejessica722]

I know its been said already but Ativan and Zyprexa IM should not be given together due to the inceased chance in respiratory depression. Haldol is the only antipsychotic that is syringe compatable as far as I've ever been able to find after discussing it with multiple pharmacists and psychiatrists and reading all the drug info.

[Kenj24]

Hi guys,

I work in an Adult Psych facility in New Mexico. I'm a fairly new nurse, I've been here for a year and 3 months. I was told by our Pharmacists and Doctors that you should not give Zyprexa IM and Ativan IM together because it can cause QTC prolongation. They need to be given atleast 2 hours apart. However, they can be given together orally but IM is a no no.?‍♀️

[TCASII, ADN]

There have been some fatalities with IM olanzapine, and I believe it has occurred without the combo as well. I know the depot olanzapine has caused some deaths too. It's generally recommended that IM olanzapine not be given with an IM benzodiazepine (e.g., lorazepam). I have given lorazepam and olanzapine IM as a combo before and nothing happened. In fact, the patient was not affected at all. It has nothing to do with QTc prolongation, such that QTc prolongation is less than haloperidol. It is simply d/t the increased prevalence of respiratory depression/CNS depression when used together. I know of a particular patient who died after receiving a Geodon IM during a bout of agitation. He also had an underlying heart condition no one was informed about.

I am sure part of the reluctance and recommendation against using olanzapine and a BZD IM is hysteria over the deaths. I'm sure if we had actual numbers of deaths from other similar drugs, it wouldn't be much different. A lot of FDA warnings have caused similar responses in the past that born out to be dispelled. Time will tell. As of now, most doctors and institutions have avoided using IM olanzapine, but a lot of that also has to with the efficacy compared to other rapid tranquilizations and worry of litigation. There isn't a perfect RT, they're all essentially the same. And if you've worked long enough in the field you will find that Thorazine, Haldol/Avitan, Geodon, or similar RT meds are hit or miss.

I wanna say that I had read somewhere that the olanzapine/lorazepam IM combo thing was considered overblow, but I do not recall where atm.