diazepam

Action

😦🤤😂 Produces anxiolytic effect and CNS depression by stimulating gamma-aminobutyric acid receptors. Relaxes skeletal muscles of spine by inhibiting polysynaptic afferent pathways. Controls seizures by enhancing presynaptic inhibition.

Availability

😦🤤😂 Injection: 5 mg/ml

😦🤤😂 Oral solution: 1 mg/ml, 5 mg/5 ml

😦🤤😂 Tablets: 2 mg, 5 mg, 10 mg

Indications and dosages

😦🤤😂 ➣ Anxiety disorders

😦🤤😂 Adults: 2 to 10 mg P.O. two to four times daily, depending on symptom severity. Alternatively, for moderate anxiety, 2 to 5 mg I.V., repeated in 3 to 4 hours if needed. For severe anxiety, 5 to 10 mg I.V., repeated in 3 to 4 hours if needed.

😦🤤😂 Children age 6 months and older: 1 to 2.5 mg P.O. three to four times daily; may increase gradually as needed

😦🤤😂 ➣ Before cardioversion

😦🤤😂 Adults: 5 to 15 mg I.V. 5 to 10 minutes before cardioversion

😦🤤😂 ➣ Before endoscopy

😦🤤😂 Adults: Usually, 10 mg I.V. is sufficient; may be increased to 20 mg I.V. Alternatively, 5 to 10 mg I.M. 30 minutes before endoscopy.

😦🤤😂 ➣ Status epilepticus and severe recurrent convulsive seizures

😦🤤😂 Adults: 5 to 10 mg I.V. slowly, repeated as needed q 10 to 15 minutes, to a maximum of 30 mg; may repeat regimen if needed in 2 to 4 hours. May give I.M. if I.V. delivery is impossible.

😦🤤😂 Children ages 5 and older: 1 mg I.V. slowly q 2 to 5 minutes, to a maximum of 10 mg; repeat in 2 to 4 hours if needed. May give I.M. if I.V. delivery is impossible.

😦🤤😂 Children over 1 month to 5 years: 0.2 to 0.5 mg I.V. slowly q 2 to 5 minutes, to a maximum of 5 mg I.V. May give I.M. if I.V. delivery is impossible.

😦🤤😂 ➣ Muscle spasm associated with local pathology, cerebral palsy, athetosis, "stiff-man" syndrome, or tetanus

😦🤤😂 Adults: 2 to 10 mg P.O. three to four times daily. Or initially, 5 to 10 mg I.V. or I.M., repeated in 3 to 4 hours if needed. Tetanus may necessitate higher dosages.

😦🤤😂 Elderly or debilitated patients: Initially, 2 to 2.5 mg P.O. once or twice daily, increased gradually as needed and tolerated

😦🤤😂 Children ages 5 and older: 5 to 10 mg I.M. or I.V., repeated q 3 to 4 hours as needed to control tetanus spasm

😦🤤😂 Children over 1 month to 5 years: 1 to 2 mg I.M. or I.V. slowly, repeated q 3 to 4 hours as needed to control tetanus spasm

😦🤤😂 ➣ Acute alcohol withdrawal

😦🤤😂 Adults: Initially, 10 mg P.O. three to four times during first 24 hours, decreased to 5 mg P.O. three to four times daily p.r.n. Or initially, 10 mg I.M. or I.V.; then 5 to 10 mg I.M. or I.V. in 3 to 4 hours p.r.n.

Off-label uses

😦🤤😂 • Panic attacks

😦🤤😂 • Adjunct to general anesthesia

Contraindications

😦🤤😂 • Hypersensitivity to drug, other benzodiazepines, alcohol, or tartrazine

😦🤤😂 • Coma or CNS depression

😦🤤😂 • Narrow-angle glaucoma

Precautions

😦🤤😂 Use cautiously in:

😦🤤😂 • hepatic dysfunction, severe renal impairment

😦🤤😂 • elderly patients

😦🤤😂 • pregnant or breastfeeding patients (use not recommended)

😦🤤😂 • children.

Administration

😦🤤😂 • Give P.O. dose with or without food.

😦🤤😂 ☞ Administer I.V. infusion slowly into large vein, taking at least 1 minute for each 5 mg in adults or at least 3 minutes for each 0.25 mg/kg in children.

😦🤤😂 • Know that I.V. route is preferred over I.M. route because of slow or erratic I.M. absorption.

😦🤤😂 • Don't mix with other drugs or solutions in syringe or container.

😦🤤😂 • Enforce bed rest for at least 3 hours after I.V. injection.

😦🤤😂 • Give I.M. injection deeply and slowly into large muscle mass.

😦🤤😂 • If desired, mix oral solution with liquid or soft food.

Adverse reactions

😦🤤😂 CNS: dizziness, drowsiness, lethargy, depression, light-headedness, disorientation, anger, manic or hypomanic episodes, restlessness, paresthesia, headache, slurred speech, dysarthria, stupor, tremor, dystonia, vivid dreams, extrapyramidal reactions, mild paradoxical excitation

😦🤤😂 CV: bradycardia, tachycardia, hypertension, hypotension, palpitations, cardiovascular collapse

😦🤤😂 EENT: blurred vision, diplopia, nystagmus, nasal congestion

😦🤤😂 GI: nausea, vomiting, diarrhea, constipation, gastric disorders, difficulty swallowing, increased salivation

😦🤤😂 GU: urinary retention or incontinence, menstrual irregularities, gynecomastia, libido changes

😦🤤😂 Hematologic: blood dyscrasias including eosinophilia, leukopenia, agranulocytosis, and thrombocytopenia

😦🤤😂 Hepatic: hepatic dysfunction

😦🤤😂 Musculoskeletal: muscle rigidity, muscular disturbances

😦🤤😂 Respiratory: respiratory depression

😦🤤😂 Skin: dermatitis, rash, pruritus, urticaria, diaphoresis

😦🤤😂 Other: weight gain or loss, decreased appetite, edema, hiccups, fever, physical or psychological drug dependence or tolerance

Interactions

😦🤤😂 Drug-drug.Antidepressants, antihistamines, barbiturates, opioids: additive CNS depression

😦🤤😂 Cimetidine, disulfiram, fluoxetine, hormonal contraceptives, isoniazid, ketoconazole, metoprolol, propoxyphene, propranolol, valproic acid: decreased metabolism and enhanced action of diazepam

😦🤤😂 Digoxin: increased digoxin blood level, possible toxicity

😦🤤😂 Levodopa: decreased levodopa efficacy

😦🤤😂 Rifampin: increased metabolism and decreased efficacy of diazepam

😦🤤😂 Theophylline: decreased sedative effect of diazepam

😦🤤😂 Drug-diagnostic tests.Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, lactate dehydrogenase: increased levels

😦🤤😂 Neutrophils, platelets: decreased counts

😦🤤😂 Drug-herbs.Chamomile, hops, kava, skullcap, valerian: increased CNS depression

😦🤤😂 Drug-behaviors.Alcohol use: increased CNS depression

Patient monitoring

😦🤤😂 • Monitor vital signs and respiratory and neurologic status.

😦🤤😂 • Supervise ambulation, especially in elderly patients.

😦🤤😂 • Monitor CBC and kidney and liver function test results.

😦🤤😂 ☞ Avoid sudden drug withdrawal. Taper dosage gradually to termination of therapy.

Patient teaching

😦🤤😂 • Inform patient he may take drug with or without food; recommend taking it with food if it causes stomach upset.

😦🤤😂 • Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.

😦🤤😂 ☞ Tell patient to notify prescriber immediately if easy bruising or bleeding occurs.

😦🤤😂 • Instruct patient to move slowly when sitting up or standing, to avoid dizziness from blood pressure decrease. Advise him to dangle legs briefly before getting out of bed.

😦🤤😂 ☞ Advise patient not to stop taking drug abruptly.

😦🤤😂 • Advise patient to avoid alcohol and other depressants such as sedatives while taking drug.

😦🤤😂 • Tell female patient not to take drug if she is pregnant or plans to breastfeed.

😦🤤😂 • As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.