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diazepam
Antenex‡, Apo-Diazepam†, Diastat, Diazemuls†‡, Diazepam Intensol,
Ducene‡, Novo-Dipam†, PMS-Diazepam†, Valium, Vivol†

Controlled Substance Schedule IV

Pregnancy Risk Category D

How supplied
Tablets:
2 mg, 5 mg, 10 mg
Capsules (extended-release):
15 mg
Oral solution:
5 mg/5 ml, 5 mg/ml
Injection: 5 mg/ml
Sterile emulsion for injection:
5 mg/ml
Rectal gel twin packs
: 2.5 mg, 5 mg, 10 mg, 15 mg, 20 mg

Action
Unknown. A benzodiazepine that may exert its anxiolytic effects by facilitating the action of the inhibitory neurotransmitter gamma-aminobutyric acid. Drug depresses the CNS at the limbic and subcortical levels of the brain and suppresses the spread of seizure activity produced by epileptogenic foci in the cortex, thalamus, and limbic structures.

Indications & dosage
Anxiety--

Adults:
depending on severity, 2 to 10 mg P.O. b.i.d. to q.i.d. or 15 to 30 mg extended-release capsules P.O. once daily. Or, 2 to 10 mg I.M. or I.V. q 3 to 4 hours, p.r.n.
Children age 6 months and older:
1 to 2.5 mg P.O. t.i.d. or q.i.d., increased gradually, as needed and tolerated.
Elderly:
initially, 2 to 2.5 mg once or twice daily; increased gradually.
Acute alcohol withdrawal--

Adults:
10 mg P.O. t.i.d. or q.i.d. first 24 hours; reduced to 5 mg P.O. t.i.d. or q.i.d., p.r.n. Or, initially, 10 mg I.M. or I.V.; then 5 to 10 mg I.M. or I.V. q 3 to 4 hours, p.r.n.
Before endoscopic procedures--

Adults:
I.V. dose titrated to desired sedative response (up to 20 mg). Or, 5 to 10 mg I.M. 30 minutes before procedure.
Muscle spasm--

Adults:
2 to 10 mg P.O. b.i.d. to q.i.d., or 15 to 30 mg extended-release capsules once daily. Or, 5 to 10 mg I.M. or I.V. initially; then 5 to 10 mg I.M. or I.V. q 3 to 4 hours, p.r.n. For tetanus, larger doses may be needed.
Children over age 30 days to 5 years:
1 to 2 mg I.M. or I.V. slowly, repeated q 3 to 4 hours, p.r.n.
Children ages 5 and older:
5 to 10 mg I.M. or I.V. q 3 to 4 hours, p.r.n.
Preoperative sedation--

Adults:
10 mg I.M. (preferred) or I.V. before surgery.
Cardioversion--

Adults:
5 to 15 mg I.V. within 5 to 10 minutes before procedure.
Adjunct in seizure disorders--

Adults:
2 to 10 mg P.O. b.i.d. to q.i.d.
Children ages 6 months and older:
1 to 2.5 mg P.O. t.i.d. or q.i.d. initially; increased as needed and tolerated.
Status epilepticus, severe recurrent seizures--

Adults:
5 to 10 mg I.V. (preferred) or I.M. initially. I.M. route should only be used if I.V. access is unavailable. Repeated q 10 to 15 minutes, p.r.n., up to maximum dose of 30 mg. Repeated q 2 to 4 hours, if needed.
Children over age 30 days to 5 years:
0.2 to 0.5 mg I.V. slowly q 2 to 5 minutes up to maximum of 5 mg. Repeated q 2 to 4 hours, if needed.
Children ages 5 and older:
1 mg I.V. q 2 to 5 minutes up to maximum of 10 mg. Repeated q 2 to 4 hours, if needed.
Patients on stable regimens of antiepileptic drugs who need intermittent use of diazepam to control bouts of increased seizure activity--

Adults and children ages 12 and older:
0.2 mg/kg P.R. A second dose may be given 4 to 12 hours after first.
Children ages 6 to 11:
0.3 mg/kg P.R.. A second dose may be given 4 to 12 hours after first.
Children ages 2 to 5:
0.5 mg/kg P.R.. A second dose may be given 4 to 12 hours after first.
Adjust-a-dose:
For elderly and debilitated patients, reduce dosage to decrease the likelihood of ataxia and oversedation.
  Note:
Use Diastat rectal gel to treat no more than five episodes per month and no more than one episode every 5 days.

Adverse reactions
CNS:
drowsiness, dysarthria, slurred speech, tremor, transient amnesia, fatigue, ataxia, headache, insomnia, paradoxical anxiety, hallucinations, minor changes in EEG patterns.
CV:
hypotension, CV collapse, bradycardia.
EENT:
diplopia, blurred vision, nystagmus.
GI:
nausea, constipation.
GU:
incontinence, urine retention, altered libido.
Hematologic: neutropenia.
Hepatic:
elevated liver function test results, jaundice.
Respiratory:
respiratory depression.
Skin:
rash.
Other:
physical or psychological dependence, acute withdrawal syndrome (after sudden discontinuation in physically dependent persons), pain, phlebitis at injection site.

Interactions
Drug-drug.
Cimetidine: decreased clearance of diazepam, with increased potential for adverse effects. Monitor patient carefully.
CNS depressants:
increased CNS depression. Avoid concomitant use.
Digoxin:
may increase serum digoxin levels and risk of toxicity. Monitor patient closely.
Phenobarbital:
increased effects of both drugs. Use together cautiously.
Drug-lifestyle.
Alcohol use: increased CNS depression. Avoid concomitant use.
Smoking:
decreased effectiveness of benzodiazepines. Monitor patient closely.

Effects on diagnostic tests
None reported.

Contraindications
Contraindicated in patients with hypersensitivity to drug or soy protein; in patients experiencing shock, coma, or acute alcohol intoxication (parenteral form); and in children under age 6 months (oral form). Diastat rectal gel is contraindicated in patients with acute narrow-angle glaucoma.

Nursing considerations

I.V. administration

Patient teaching

*Liquid contains alcohol. **May contain tartrazine.  †Canada  ‡Australia  §U.K.  OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING

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