Diazepam

Tranquilizer, Sedative/Hypnotic · Benzodiazepine

Indications

Short-term treatment of anxiety that is severe or disabling occurring alone or with insomnia. Acute alcohol withdrawal. Night terrors and somnambulism in children. Muscle spasm, cerebral spasticity. Sedative cover in medical and surgical procedures. Status epilepticus. Febrile convulsions.

Dosage

Adults: ORAL: Anxiety, insomnia, night terrors and somnambulism: 1-5 mg daily; others, 6-30 mg daily. Muscle spasm, cerebral spasticity: Adults, Elderly, 1-30 mg daily; others, 2-60 mg daily. Both in divided doses. Sedative cover in medical and surgical procedures: Usually 0.2 mg/kg. INJECTION: Status epilepticus. Febrile convulsions: 10-20 mg by IV or IM inj repeated after 30-60 min if necessary. If indicated up to 3 mg/kg by IV infusion over 24 hr. SUPPOSITORIES: Anxiety: 10-30 mg (higher dose divided); dose form not appropriate for less than 10 mg. Anxiety, insomnia, night terrors and somnambulism: Elderly, 5 mg; others, 10 mg. Both by IM or IV inj four hourly. Muscle spasm, cerebral spasticity: Elderly, 5 mg; others, 10 mg. Both four hourly IM or IV. Children: Status epilepticus, febrile convulsions, convulsions caused by poisoning: INJECTION: The following dose given by IV…

Administration

IV: Continuous infusion is not recommended because of precipitation in IV fluids and absorption of drug into infusion bags and tubing. In children, do not exceed 1-2 mg/min IVP; in adults 5 mg/min. By IV injection, 10 mg at a rate of 1 mL (5 mg) per min, repeated once after 10 min if necessary. Children under 12 years, 300-400 mcg/kg (maximum 10 mg). IM: Administration by this route is painful and absorption is slow and erratic. This route should be avoided where possible. If the IM route is used, inject undiluted. Reconstitution: Most stable at pH 4-8, hydrolysis occurs at pH <3. Compatibility: Do not mix IV product with other medications. Y-site administration: Drug to Drug IV Incompatibility: Amphotericin B cholesteryl sulphate complex, atracurium, cefepime. Diltiazem, fluconazole, gatifloxacin, heparin, heparin with hydrocortisone sodium succinate, hydromorphone, potassium chloride.…

Adverse Effects

Drowsiness and light headedness, which may continue into the following day. Muscle weakness, ataxia, confusion, dizziness, tremor, fatigue, vertigo, GI upset, hypotension, visual disturbance, rash, impaired alertness and dexterity, headache, urinary retention, changes in libido, Rarely blood disorder, jaundice, respiratory depression, abnormal psychological reactions. Paradoxical reactions, anterograde amnesia. Dependence. Injection: rarely, thrombophlebitis.

Risk Factor (Pregnancy/Lactation)

Pregnancy: Positive evidence of risk: Use only when no safer alternative exists for a serious problem. Lactation: Caution advised or effect undetermined. Contraindications: Acute pulmonary insufficiency, respiratory depression, sleep apnoea, phobic or obsessional state, hyperkinesia, chronic psychosis, unstable Myasthaenia gravis, acute porphyria. Severe hepatic impairment. As monotherapy to treat depression or anxiety associated with depression. Precautions: Chronic pulmonary insufficiency, Myasthaenia gravis, renal impairment, mild to moderate hepatic impairment, chronic hepatic disease, history of drugs or alcohol abuse, personality disorders, closed angle glaucoma, porphyria, coma, atherosclerosis. Elderly, avoid long-term use. Withdraw gradually

Interactions

Alcohol, CNS depressants, anticonvulsants, CYP3A4 inhibitors or inducers (e.g. cimetidine, rifampicin, phenytoin, phenobarbital, carbamazepine, St John's wort), sodium oxybate, protease inhibitors. CYP2C19 inhibitors, azole antifungals, oral contraceptives, corticosteroids, antihypertensives, vasodilators, diuretics, dopaminergics, fluoxetine, fluvoxamine, clozapine, omeprazole, esomeprazole, isoniazid, theophylline, digoxin, lofexidine, disulfiram, levodopa, ketamine, caffeine, grapefruit juice.

Advice to Patient

Take with or without meals. Do not take prescription medications or OTC medications especially pain medications, sedatives, antihistamines, hypnotics during therapy without consulting prescriber. Contact prescriber if there is headache, difficulty in breathing, change in urinary pattern, change in memory, change in sexual ability, muscle cramps, change in vision, increased sweating, constant abdominal cramps, constipation, vomiting, loss of appetite, depression, confusion, increased sleepiness, excitation, agitation, lack of sleep, fatigue, dizziness, worsening of seizures or loss of control on seizure. Avoid alcohol during therapy. Take sufficient amount of fluids (2-3 litres per day) to maintain hydration, unless restricted by the prescriber. If you take this medication to control seizures, carry an identification card mentioning name of your antiepileptic medications. On start of…

Pharmacokinetics

Onset of action: Sedation: Paediatric patients: IV: 4-5 mins. Status epilepticus: IV: 1-3 mins; Rectal: 2-10 mins. Duration of action: Sedation: Paediatric patients: 60-120 mins. Status epilepticus: 15-30 mins. Absorption: Oral: Well absorbed (>90%); delayed and decreased when administered with a moderate fat meal. Rectal: Well absorbed. Metabolism: Hepatic. Bioavailability: IM: >90%. Oral: >90%. Rectal: 90%. Half-life elimination: Note: Diazepam accumulates upon multiple dosing and the terminal elimination half-life is slightly prolonged. IM: Premature neonates (GA: 28-34 wks): 54 hrs. Infants: Approx. 30 hrs. Children 3-8 yrs: 18 hrs. Adults: Parent: Approx. 60-72 hrs; Desmethyldiazepam: Approx. 152-174 hrs. IV: Parent: 33-45 hrs; Desmethyldiazepam: 87 hrs. Oral: Parent: 44-48 hrs; Desmethyldiazepam: 100 hrs. Rectal: Parent: 45-46 hrs; Desmethyldiazepam: 71-99 hrs. Time to peak: IM:…

Brands with this active ingredient

Compiled by Healify Pharmacy from published drug references. How we compile it →

Always consult a pharmacist or doctor.