II. Indications
- Insomnia
- Anxiety Disorder
- Alcohol Withdrawal
- Seizure Disorder (esp. Status Epilepticus)
- Musculoskeletal spasm
- Tetanus
III. Contraindications
- Acute Narrow Angle Glaucoma
- Untreated Open Angle Glaucoma
- Children under age 6 years
IV. Pharmacokinetics
- Half Life: 20-90 hours
- High lipid solubility
- Rapid onset of action (1-3 minutes)
V. Precautions
- Avoid when requiring optimal mental status
- Driving
- Operating machinery
- Use caution if risk of cardiopulmonary depression
- Elderly
- Very ill patients
- Limited pulmonary reserve (e.g. COPD)
- Do not use with other cardiopulmonary depressants
- Intravenous Injection
- Inject intravenously slowly (1 ml per minute)
- Reduce dose to 70% when administering with Narcotic
VI. Adverse Reactions
- Common General affects
- Drowsiness
- Fatigue
- Ataxia
- Benzodiazepine Dependence with withdrawal symptoms
- Local injection side affects (inject slowly)
- Venous thrombosis
- Phlebitis
- Less common, but serious reactions
- Hypotension
- Respiratory depression
VII. Dosing
-
Anxiety Disorder
- Dose: 2 to 10 mg PO bid to qid
- Maximum Daily Dose: 40 mg
- Acute Alcohol Withdrawal
- First day: 10 mg PO tid to qid
- Next days: 5 mg PO tid to qid
- Musculoskeletal spasm
- Dose: 2 to 10 mg PO tid to qid
-
Seizure Disorder
- See Status Epilepticus
- IV or IM: 0.1 to 0.3 mg/kg IV up to 8-10 mg/dose maximum (may repeat once in 5 minutes)
- Rectal: 0.5 mg/kg per Rectum up to maximum of 20 mg
- Instill via lubricated Feeding Tube inserted 4-5 cm into the Rectum OR
- Via tuberculin syringe (without needle) intra-rectally
- Hold buttocks closed after instilling medication
- Diazepam is as effective as Lorazepam in Status Epilepticus
- Chamberlain (2014) JAMA 311(16): 1652-60
- Diazepam IM dosing is as effective as IV dosing
- Silbergleit (2012) N Engl J Med 366:591-600
- Antiepileptic activity is short (5 to 15 minutes)
- Must be immediately followed with longer acting anticonvulsant (e.g. Fosphenytoin) due to short duration
- Older patients or with comorbid condition
- Dose: 2 to 2.5 mg PO qd to bid
VIII. Preparations
- Equivalents to 10 mg Diazepam (for withdrawal protocol)
- Alprazolam (Xanax) 1 mg
- Chlordiazepoxide (Librium) 25 mg
- Clonazepam (Klonopin) 4 mg
- Flurazepam (Dalmane) 15 mg
- Halazepam (Paxipam) 40 mg
- Lorazepam (Ativan) 2 mg
- Oxazepam (Serax) 10 mg
- Temazepam (Restoril) 10 mg
- Equivalents to 60 mg Diazepam (for withdrawal protocol)
- Alprazolam (Xanax) 6 mg
- Chlordiazepoxide (Librium) 150 mg
- Clonazepam (Klonopin) 24 mg
- Flurazepam (Dalmane) 90 mg
- Halazepam (Paxipam) 240 mg
- Lorazepam (Ativan) 12 mg
- Oxazepam (Serax) 60 mg
- Temazepam (Restoril) 60 mg
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Related Studies
| diazepam (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| DIAZEPAM 10 MG RECTAL GEL SYST | Generic | $252.48 each |
| DIAZEPAM 10 MG TABLET | Generic | $0.03 each |
| DIAZEPAM 2 MG TABLET | Generic | $0.02 each |
| DIAZEPAM 20 MG RECTAL GEL SYST | Generic | $249.66 each |
| DIAZEPAM 5 MG TABLET | Generic | $0.03 each |