Generic Name

Diazepam

Precaution

Impaired renal and hepatic function, respiratory disease, organic cerebral changes, elderly, psychotic patients, epileptics, history of alcohol or drug addiction, impaired gag reflux, obese patients. May cause CNS depression. Discontinue treatment if patient develops psychiatric and paradoxical reactions. Caution when used in patients with depression or anxiety associated with depression, especially if patient has suicidal risk. May increase risk of falls. Safety and efficacy of the inj have not been established in children <1 mth of age. Safety and efficacy of oral use have not been established in children <6 mth of age. Safety and efficacy of rectal gel have not been established in children <2 yr of age. Abrupt withdrawal or large dose reduction may cause rebound or withdrawal symptoms. Lactation: Enters breast milk; not recommended

Indication

Agitation, Anxiety, Anaesthesia, Seizures, Insomnia, Muscle spasms, Alcohol withdrawal syndrome

Contra Indication

Hypersensitivity; myasthenia gravis, preexisting CNS depression or coma, respiratory depression; acute pulmonary insufficiency or sleep apnoea syndrome; severe hepatic impairment; acute narrow angle glaucoma; children <6 mth (oral); pregnancy and lactation.

Dose

N/A

Side Effect

1-10% Atax (3%),Euphoria (3%, rectal gel),Incoordination (3%, rectal gel),Somnolence (>1%),Rash (3%, rectal gel),Diarrhea (4%, rectal gel) Frequency Not Defined Common,Hypotension,Fatigue,Muscle weakness,Respiratory depression,Urinary retention,Depression,Incontinence,Blurred vision,Dysarthria,Headache,Skin rash,Changes in salivation,Serious,Neutropenia,Jaundice Local effects: Pain, swelling, thrombophlebitis, carpal tunnel syndrome, tissue necrosis,Phlebitis if too rapid IV push Potentially Fatal: Respiratory and CNS depression, coma.

Pregnancy Category

Mode of Action

Diazepam is a long-acting benzodiazepine w/ anticonvulsant, anxiolytic, sedative, muscle relaxant and amnestic properties. It increases neuronal membrane permeability to Cl ions by binding to stereospecific benzodiazepine receptors on the postsynaptic GABA neuron w/in the CNS and enhancing the GABA inhibitory effects resulting in hyperpolarisation and stabilisation.

Interaction

May significantly enhance CNS depressant effect w/ antivirals (e.g. amprenavir, ritonavir). May enhance CNS depressant effect w/ anaesth, narcotic analgesics, antidepressants, antipsychotics, anxiolytics, antiepileptics, antihistamines, antihypertensives, muscle relaxants (e.g. tizanidine, baclofen), nabilone. May decrease clearance w/ antibacterials that interfere w/ metabolism by hepatic enzymes (e.g. isoniazid and erythromycin), OC, cimetidine, omeprazole. May increase clearance w/ antibacterials which are known inducers of hepatic enzymes (e.g. rifampicin). May increase serum level w/ disulfiram. May reduce clearance of digoxin. May reduce therapeutic effect w/ theophylline. Reversible deterioration of parkinsonism w/ levodopa.

Pregnancy Category Note

Pregnancy category: D Lactation: Enters breast milk; not recommended Minor tranquilizers should be avoided in first trimester of pregnancy due to increased risk of congenital malformations Maternal use shortly before delivery is associated with floppy infant syndrome (good and consistent evidence) Prenatal benzodiazepine exposure slightly increased oral cleft risk (limited or inconsistent evidence)

Adult Dose

Anxiety 2-10 mg PO q6-12hr, OR 2-10 mg IV/IM q6-12hr; no more than 30 mg/8 hours Alcohol Withdrawal 10 mg PO q6-8hr during first 24hr; reduce to 5 mg PO q6-8hr PRN Initial: 10 mg IV/IM, may give additional doses of 5-10 mg IV q6-8hr as needed Endoscopy IV: Titrate dose to 10 mg or less immediately before procedure, not to exceed cumulative dose of 20 mg; reduce dose of narcotic by one third or omit, OR IM: 5-10 mg 30 minutes before procedure Preoperative Sedation 10 mg IM before surgery Sedation in the ICU 5-10 mg IV 1-2 hours before surgery; 0.03-0.1 mg/kg q30min to 6hr Muscle Spasm 2-10 mg PO q6-8hr PRN, OR 5-10 mg IV/IM initially; THEN q3-4hr if necessary Seizure Disorder 2-10 mg PO q6-12hr as adjunct, OR 0.2 mg/kg PR, repeat after 4-12 hours PRN Status Epilepticus 5-10 mg IV/IM q5-10min; not to exceed 30 mg, OR 0.5 mg/kg PR (using parenteral solution), THEN 0.25 mg/kg in 10 minutes PRN Elderly: Should not exceed half the adult dose. Hepatic impairment: Dose reduction may be required.

Child Dose

Sedative/Muscle Relaxant Potentially toxic dose in patients <6 years: >0.5 mg/kg <6 months: Not recommended >12 years 0.12-0.8 mg/kg/day PO divided q6-8hr, OR 0.04-0.2 mg/kg IV/IM q2-4hr; no more than 0.6 mg/kg within 8 hours Status Epilepticus Potentially toxic dose in patients <6 years: >0.5 mg/kg PR 2-6 years: 0.5 mg/kg; may repeat in 4-12 hours PRN 6-12 years: 0.3 mg/kg; may repeat in 4-12 hours PRN >12 years: 0.2 mg/kg; may repeat in 4-12 hours PRN IV 6 months-5 years: 0.2-0.5 mg IV initially, repeat every 2-5 minutes; do not exceed 5 mg; may repeat 2-4 hours later PRN >5 years: 1 mg IV given slowly every 2-5 min; not to exceed 10 mg total dose; may repeat in 2-4 hours if necessary

Renal Dose

Renal impairment: Dose reduction may be required.

Administration

May be taken with or without food. IV Preparation Compatibility with D5W, NS, and Ringer's controversial. If infusion is selected, adding the infusion solution to the diazepam injection (and not the other way around) may prevent precipitate formation IV Administration Administer over 3 min; no more than 5 mg/min Monitor respiration q5-15min and before each IV dose Have airway support ready until effects of IV administration are known Rectal Administration Place patient on side facing you with upper leg bent forward, lubricate rectal applicator tip, gently insert syringe tip in rectum and slowly push plunger