Pharm
Diazepam
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Diazepam
, Valium
See Also
Benzodiazepine
Indications
Insomnia
Anxiety Disorder
Alcohol Withdrawal
Seizure Disorder
(esp.
Status Epilepticus
)
Musculoskeletal spasm
Tetanus
Contraindications
Acute
Narrow Angle Glaucoma
Untreated
Open Angle Glaucoma
Children under age 6 years
Pharmacokinetics
Half Life: 20-90 hours
High lipid solubility
Rapid onset of action (1-3 minutes)
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
Alcohol
Barbiturate
s
Intravenous Injection
Inject intravenously slowly (1 ml per minute)
Reduce dose to 70% when administering with
Narcotic
Adverse Reactions
Common
Gene
ral 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
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
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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