Diazepam(dye az’ e pam)
Apo-Diazepam (CAN), Diastat, AcuDial, Diazemuls (CAN), Diazepam Intensol, Valium
PREGNANCY CATEGORY D
CONTROLLED SUBSTANCE C-IV
Drug Classes
Antiepileptic
Anxiolytic
Benzodiazepine
Skeletal muscle relaxant (centrally acting)
Therapeutic Actions
Exact mechanisms of action not understood; acts mainly at the limbic system and reticular formation; may act in spinal cord and at supraspinal sites to produce skeletal muscle relaxation; potentiates the effects of GABA, an inhibitory neurotransmitter; anxiolytic effects occur at doses well below those necessary to cause sedation, ataxia; has little effect on cortical function.
Indications
Management of anxiety disorders or for short-term relief of symptoms of anxiety
Acute alcohol withdrawal; may be useful in symptomatic relief of acute agitation, tremor, delirium tremens, hallucinosis
Muscle relaxant: Adjunct for relief of reflex skeletal muscle spasm due to local pathology (inflammation of muscles or joints) or secondary to trauma; spasticity caused by upper motoneuron disorders (cerebral palsy and paraplegia); athetosis, stiff-man syndrome
Parenteral: Treatment of tetanus
Antiepileptic: Adjunct in status epilepticus and severe recurrent convulsive seizures (parenteral); adjunct in seizure disorders (oral)
Preoperative (parenteral): Relief of anxiety and tension and to lessen recall in patients prior to surgical procedures, cardioversion, and endoscopic procedures
Rectal: Management of selected, refractory patients with epilepsy who require intermittent use to control bouts of increased seizure activity
Unlabeled use: Treatment of night terrors
Contraindications and Cautions
Contraindicated with hypersensitivity to benzodiazepines; psychoses, acute narrow-angle glaucoma, shock, coma, acute alcoholic intoxication; pregnancy (cleft lip or palate, inguinal hernia, cardiac defects, microcephaly, pyloric stenosis when used in first trimester; neonatal withdrawal syndrome reported in newborns); lactation.
Use cautiously with elderly or debilitated patients; impaired liver or renal function; and in patients with history of substance abuse.
Available Forms
Tablets—2, 5, 10 mg; oral solution—1 mg/mL; oral concentrate solution—5 mg/mL; rectal gel—2.5, 5, 10, 20 mg; injection—5 mg/mL
Dosages
Individualize dosage; increase dosage cautiously to avoid adverse effects.
Adults
Oral
Anxiety disorders, skeletal muscle spasm, seizure disorders: 2–10 mg PO bid–qid.
Alcohol withdrawal: 10 mg PO tid–qid first 24 hr; reduce to 5 mg tid–qid, as needed.
Rectal
0.2 mg/kg; treat no more than one episode every 5 days. May give a second dose in 4–12 hr.
Parenteral
Usual dose is 2–20 mg IM or IV. Larger doses may be required for some indications (tetanus). Injection may be repeated in 1 hr.
Anxiety: 2–10 mg IM or IV; repeat in 3–4 hr if necessary.
Alcohol withdrawal: 10 mg IM or IV initially, then 5–10 mg in 3–4 hr if necessary.
Endoscopic procedures: 10 mg or less, up to 20 mg IV just before procedure or 5–10 mg IM 30 min prior to procedure. Reduce or omit dosage of opioids.
Muscle spasm: 5–10 mg IM or IV initially, then 5–10 mg in 3–4 hr if necessary.
Status epilepticus: 5–10 mg, preferably by slow IV. May repeat every 5–10 min up to total dose of 30 mg. If necessary, repeat therapy in 2–4 hr; other drugs are preferable for long-term control.
Preoperative: 10 mg IM.
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