Diazepam
Diazepam (Valium)
Diazepam
(dye- AYZ-eh-pam)
Pregnancy Category: D Apo-Diazepam Diastat Diazemuls Diazepam Intensol E Pam Novo-Dipam PMS-Diazepam Valium Valium Roche Vivol (C-IV) (Rx)

Classification: Antianxiety agent, anticonvulsant, skeletal muscle relaxant

See Also: See also Tranquilizers .

Action/Kinetics: The skeletal muscle relaxant effect of diazepam may be due to enhancement of GABA-mediated presynaptic inhibition at the spinal level as well as in the brain stem reticular formation. Onset: PO, 30-60 min; IM, 15-30 min; IV, more rapid. Peak plasma levels: PO, 0.5-2 hr; IM, 0.5-1.5; IV, 0.25 hr. Duration: 3 hr. t 1/2: 20-50 hr. Metabolized in the liver to the active metabolites desmethyldiazepam, oxazepam, and temazepam. Diazepam and metabolites are excreted through the urine. Diazepam is 97%-99% bound to plasma protein.

Uses: Anxiety, tension (more effective than chlordiazepoxide), alcohol withdrawal, muscle relaxant, adjunct to treat seizure disorders, antipanic drug. Used prior to gastroscopy and esophagoscopy, preoperatively and prior to cardioversion. In dentistry to induce sedation. Treatment of status epilepticus. Relief of skeletal muscle spasm due to inflammation of muscles or joints or trauma; spasticity caused by upper motor neuron disorders such as cerebral palsy and paraplegia; athetosis; and stiff-man syndrome. Relieve spasms of facial muscles in occlusion and temporomandibular joint disorders. IV: Status epilepticus, severe recurrent seizures, and tetanus. Rectal gel: Treat epilepsy in those with stable regimens of anticonvulsant drugs who require intermittent diazepam to control increased seizure activity. To interrupt clusters of repetitive seizures in epilepsy clients.

Additional Contraindications: Narrow-angle glaucoma, children under 6 months, lactation, and parenterally in children under 12 years.

Special Concerns: When used as an adjunct for seizure disorders, diazepam may increase the frequency or severity of clonic-tonic seizures, for which an increase in the dose of anticonvulsant medication is necessary. Safety and efficacy of parenteral diazepam have not been determined in neonates less than 30 days of age. Prolonged CNS depression has been observed in neonates, probably due to inability to biotransform diazepam into inactive metabolites.

Additional Drug Interactions: Diazepam potentiates antihypertensive effects of thiazides and other diuretics. Diazepam potentiates muscle relaxant effects of d-tubocurarine and gallamine. Fluoxetine / half-life of diazepam. Isoniazid / half-life of diazepam. Ranitidine / GI absorption of diazepam.

How Supplied: Concentrate: 5 mg/mL; Injection: 5 mg/mL; Rectal Gel: 2.5 mg, 5 mg, 10 mg, 15 mg, 20 mg; Solution: 5 mg/5 mL; Tablet 2 mg, 5 mg, 10 mg

Dosage
?Tablets, Oral Solution Antianxiety, anticonvulsant, adjunct to skeletal muscle relaxants.
Adults: 2-10 mg b.i.d.-q.i.d. Elderly, debilitated clients: 2-2.5 mg 1-2 times/day. May be gradually increased to adult level. Pediatric, over 6 months, initial: 1-2.5 mg (0.04-0.2 mg/kg or 1.17-6 mg/m ²) b.i.d.-t.i.d.
Alcohol withdrawal.
Adults: 10 mg t.i.d.-q.i.d. during the first 24 hr; then, decrease to 5 mg t.i.d.-q.i.d. as required.
Anticonvulsant.
Adults: 15-30 mg once daily.
?Rectal Gel Anticonvulsant.
Over 12 years: 0.2 mg/kg. Children, 6-11 years: 0.3 mg/kg; 2-5 years: 0.5 mg/kg. If required, a second dose can be given 4 to 12 hr after the first dose. Do not treat more than five episodes per month or more than one episode every 5 days. Adjust dose downward in elderly or debilitated clients to reduce ataxia or oversedation.
?IM, IV Preoperative or diagnostic use.
Adults: 10 mg IM 5-30 min before procedure.
Adjunct to treat skeletal muscle spasm.
Adults, initial: 5-10 mg IM or IV; then, repeat in 3-4 hr if needed (larger doses may be required for tetanus).
Moderate anxiety.
Adults: 2-5 mg IM or IV q 3-4 hr if necessary.
Severe anxiety, muscle spasm.
Adults: 5-10 mg IM or IV q 3-4 hr, if necessary.
Acute alcohol withdrawal.
Initial: 10 mg IM or IV; then, 5-10 mg q 3-4 hr.
Preoperatively.
Adults: 10 mg IM prior to surgery.
Endoscopy.
IV: 10 mg or less although doses up to 20 mg can be used; IM: 5-10 mg 30 min prior to procedure.
Cardioversion.
IV: 5-15 mg 5-10 min prior to procedure.
Tetanus in children.
IM, IV, over 1 month: 1-2 mg, repeated q 3-4 hr as necessary; 5 years and over: 5-10 mg q 3-4 hr.
?IV Status epilepticus.
Adults, initial: 5-10 mg; then, dose may be repeated at 10-15-min intervals up to a maximum dose of 30 mg. Dosage may be repeated after 2-4 hr. Children, 1 month-5 years: 0.2-0.5 mg q 2-5 min, up to maximum of 5 mg. Can be repeated in 2-4 hr. 5 years and older: 1 mg q 2-5 min up to a maximum of 10 mg; dose can be repeated in 2-4 hr, if needed.
NOTE: Elderly or debilitated clients should not receive more than 5 mg parenterally at any one time.