October 13, 2023

Welcome back to UH EMS-I’s Pharmacy Phriday.  In past episodes, we have discussed drug shortages throughout the nation and how they might affect the provider in the pre-hospital setting.  There have been isolated shortages reported of Versed within the UH system and the need to place Ativan in the drug boxes instead. Due to these reports, we felt it may be a good opportunity to review our backup benzo, Ativan.

Ativan had been used for many years as the first-line medication in controlling seizures and providing sedation and now stands as the backup to the preferred Versed.  Although similar in its actions and use, Ativan does have some differences from Versed.  Ativan’s onset time and half-life are both longer when compared to Versed. Another disadvantage of Ativan is that it degrades with heat, creating storage issues.  Without refrigeration, Ativan’s shelf life is only 60-90 days before needing to be replaced. 

Some of the uses of Ativan and the dosing within the UH protocols are as follows:

As with other benzos, Ativan should be administered slowly when administered IV. Contraindications, precautions, and side effects are also like those of other benzos (i.e., hypotension, altered mental status, and respiratory depression).

One concern with treatment using the next drug up or backup drug is medication errors.  The use of secondary, unfamiliar medications greatly increases the risk of errors. The EMS Institute, your Medical Directors, and the supplying pharmacies strive to provide prior notice to field personnel when shortages occur and replacement medications are placed in the boxes, as well as provide just-in-time training. When in doubt, be sure to use resources available to you through your partners, protocols, and online medical direction. Also, be sure to review various markings, stickers, etc. on your drug boxes when they are issued to you and point out changes to the rest of your crew and department.

Finally, we want to take this time to thank all of our Pharmacy staff for their hard work. October 15–21, 2023 is “Pharmacy Week”, a time to recognize the powerful impact our pharmacies and their staff make on our patients.

Till next week, stay safe!

Sincerely,



The UH EMS-I Team

University Hospitals