How is diazepam used for various conditions. What are the recommended dosages for adults and geriatric patients. How should diazepam be administered for different medical purposes.

Understanding Diazepam: Uses and Administration

Diazepam, commonly known by its brand name Valium, is a versatile medication used to treat a variety of conditions. This benzodiazepine drug acts on the central nervous system to produce calming effects. It’s crucial to understand the proper dosage and administration for different medical purposes to ensure safe and effective use.

What is diazepam used for?

Diazepam is primarily prescribed for:

• Anxiety disorders
• Alcohol withdrawal symptoms
• Muscle spasms
• Seizures
• Premedication for medical procedures
• Status epilepticus

The dosage and route of administration vary depending on the specific condition being treated and the patient’s individual characteristics.

Diazepam Dosage for Anxiety Disorders

For the management of anxiety disorders and short-term relief of anxiety symptoms, diazepam can be administered orally or parenterally.

What is the recommended oral dosage for anxiety?

The typical oral dosage for anxiety is 2 to 10 mg taken 2 to 4 times a day. The specific dose should be determined based on the severity of symptoms. It’s important to note that anxiety associated with everyday life stress usually does not require treatment with diazepam.

How is diazepam administered parenterally for anxiety?

For moderate anxiety disorders, 2 to 5 mg can be given intramuscularly (IM) or intravenously (IV), repeated in 3 to 4 hours if necessary. In cases of severe anxiety, the dose may be increased to 5 to 10 mg IM or IV, again repeatable after 3 to 4 hours if needed.

Treating Alcohol Withdrawal with Diazepam

Diazepam plays a crucial role in managing symptoms of acute alcohol withdrawal, including agitation, tremor, and hallucinations.

What is the dosage protocol for alcohol withdrawal?

For oral administration:

• Initial dose: 10 mg taken 3 to 4 times a day for the first 24 hours
• Maintenance dose: 5 mg taken 3 to 4 times a day as needed

For parenteral administration:

• 10 mg IM or IV once, followed by 5 to 10 mg IM or IV in 3 to 4 hours if necessary

Diazepam for Muscle Spasms

As an adjunctive treatment for various types of muscle spasms, diazepam can provide relief when used appropriately.

How should diazepam be dosed for muscle spasms?

Oral dosage: 2 to 10 mg taken 3 to 4 times a day

Parenteral dosage: 5 to 10 mg IM or IV, with the possibility of repeating the dose in 3 to 4 hours if needed. For patients with tetanus, larger parenteral doses may be necessary.

Managing Seizures with Diazepam

Diazepam is effective in managing various types of seizures, including refractory epilepsy and as an adjunctive treatment for convulsive disorders.

What are the dosage guidelines for seizure management?

Oral administration: 2 to 10 mg taken 2 to 4 times a day

Rectal administration:

• Initial dose: 0.2 mg/kg, rounded up to the next available dose
• A second dose of 0.2 mg/kg may be given 4 to 12 hours after the first dose if necessary
• Maximum frequency: Treatment for up to 1 seizure episode every 5 days, not exceeding 5 episodes per month

Diazepam in Medical Procedures

Diazepam is often used as a premedication for various medical procedures to reduce anxiety and provide sedation.

How is diazepam used in endoscopic procedures and cardioversion?

For cardioversion: 5 to 15 mg IV once, administered 5 to 10 minutes before the procedure

For endoscopic procedures:

• IV: Usually less than 10 mg, but some patients may require up to 20 mg, especially when narcotics are omitted
• IM: 5 to 10 mg once, 30 minutes prior to the procedure

The IV dose should be titrated to achieve the desired sedative response, such as slurred speech, with slow administration immediately before the procedure.

Diazepam in Status Epilepticus

In cases of status epilepticus, diazepam serves as an adjunct treatment to help control severe and recurrent seizures.

What is the recommended dosage for status epilepticus?

Parenteral administration:

• Initial dose: 5 to 10 mg IV once
• Can be repeated at 10 to 15 minute intervals to a maximum dose of 30 mg if necessary
• Treatment may be repeated every 2 to 4 hours, but caution is advised due to the persistence of active metabolites

The IV route is preferred, but IM administration can be used if IV access is impossible. Special caution should be exercised when administering diazepam to patients with chronic lung disease or unstable cardiovascular conditions.

Geriatric Considerations in Diazepam Dosing

Elderly patients often require adjusted dosages of diazepam due to changes in metabolism and increased sensitivity to the drug’s effects.

How should diazepam be dosed in geriatric patients?

For seizures in geriatric patients:

• Oral initial dose: 2 to 2.5 mg once to twice daily
• Rectal initial dose: 0.2 mg/kg, rounded to the nearest available dose

It’s crucial to start with lower doses in elderly patients and titrate slowly based on individual response and tolerability.

Are there special considerations for geriatric patients using diazepam?

Elderly patients may be more susceptible to the sedative effects of diazepam and have an increased risk of falls and cognitive impairment. Close monitoring is essential, and the lowest effective dose should be used for the shortest duration possible.

Safety Precautions and Dose Adjustments

While diazepam is a valuable medication for various conditions, its use requires careful consideration of individual patient factors and potential risks.

When might dose adjustments be necessary?

Dose adjustments may be required in the following situations:

• Patients with renal impairment
• Individuals with liver dysfunction
• Elderly patients
• Patients with respiratory conditions
• Those with a history of substance abuse

In these cases, starting with lower doses and carefully titrating based on response and tolerability is crucial.

What precautions should be taken when using diazepam?

Important precautions include:

• Avoiding abrupt discontinuation to prevent withdrawal symptoms
• Monitoring for signs of dependence or addiction
• Being cautious when combining with other central nervous system depressants
• Avoiding use during pregnancy unless absolutely necessary
• Using with caution in patients with a history of depression or suicidal thoughts

Healthcare providers should carefully weigh the benefits and risks before prescribing diazepam and closely monitor patients during treatment.

Long-term Use and Discontinuation

While diazepam can be highly effective for short-term use, long-term administration requires careful consideration due to the potential for tolerance and dependence.

How should long-term use of diazepam be managed?

For patients requiring long-term diazepam therapy:

• Regular reassessment of the need for continued treatment
• Periodic attempts to reduce the dose or discontinue the medication
• Monitoring for signs of tolerance or loss of efficacy
• Implementing non-pharmacological strategies to complement treatment

What is the recommended approach for discontinuing diazepam?

Discontinuation of diazepam should be done gradually to minimize withdrawal symptoms. A typical tapering schedule might involve:

• Reducing the dose by 25% every 1-2 weeks
• Slowing the taper if withdrawal symptoms occur
• Considering switching to a longer-acting benzodiazepine for easier tapering in some cases
• Providing supportive care and counseling during the discontinuation process

The exact tapering schedule should be individualized based on the patient’s specific circumstances and response.

Diazepam in Special Populations

Certain populations require special consideration when it comes to diazepam use due to altered drug metabolism or increased sensitivity to its effects.

How should diazepam be used in patients with liver disease?

In patients with liver disease:

• Lower initial doses are typically recommended
• Closer monitoring of sedation and respiratory status is necessary
• Dosing intervals may need to be extended
• Alternative medications may be considered in severe liver dysfunction

What considerations are important for diazepam use in pregnancy and breastfeeding?

For pregnant and breastfeeding individuals:

• Diazepam should be avoided during pregnancy unless the potential benefit clearly outweighs the risk
• If used during pregnancy, the lowest effective dose for the shortest duration should be employed
• Breastfeeding mothers should be aware that diazepam is excreted in breast milk and may cause sedation in infants
• Alternative treatments should be considered when possible

Healthcare providers should discuss the risks and benefits thoroughly with patients in these special populations before initiating diazepam therapy.

Potential Side Effects and Monitoring

While diazepam is generally well-tolerated when used as directed, it can cause various side effects that require vigilant monitoring.

What are the common side effects of diazepam?

Common side effects include:

• Drowsiness and sedation
• Dizziness
• Confusion
• Ataxia (impaired coordination)
• Muscle weakness
• Blurred vision
• Changes in libido

How should patients be monitored during diazepam therapy?

Monitoring should include:

• Regular assessment of therapeutic efficacy
• Evaluation of cognitive function and motor skills
• Monitoring for signs of dependence or abuse
• Checking for paradoxical reactions, especially in elderly or debilitated patients
• Assessing respiratory function, particularly in patients with pre-existing respiratory conditions

Patients should be educated about potential side effects and instructed to report any concerning symptoms promptly.

Drug Interactions with Diazepam

Diazepam can interact with various medications, potentially altering its effectiveness or increasing the risk of side effects.

What are some important drug interactions to consider with diazepam?

Significant interactions include:

• Opioids: Increased risk of severe sedation, respiratory depression, and death
• Alcohol: Enhanced sedative effects
• Other CNS depressants: Additive sedative effects
• CYP3A4 inhibitors (e.g., ketoconazole): May increase diazepam levels
• CYP3A4 inducers (e.g., rifampin): May decrease diazepam effectiveness

How can healthcare providers manage potential drug interactions?

To manage interactions:

• Conduct a thorough medication review before prescribing diazepam
• Adjust dosages or consider alternative medications when necessary
• Educate patients about the risks of combining diazepam with other substances
• Monitor patients closely when initiating or discontinuing interacting medications

Patients should be instructed to inform all healthcare providers about their diazepam use to prevent potential interactions with newly prescribed medications.

Alternative Treatments and Complementary Approaches

While diazepam can be effective for various conditions, alternative treatments and complementary approaches may be considered in some cases.

What are some non-pharmacological alternatives to diazepam?

Alternative approaches include:

• Cognitive-behavioral therapy for anxiety disorders
• Relaxation techniques and mindfulness meditation
• Physical therapy and exercise for muscle spasms
• Lifestyle modifications for sleep disorders
• Dietary changes and stress management for general well-being

How can complementary approaches be integrated with diazepam therapy?

Integrating complementary approaches may involve:

• Combining diazepam with psychotherapy for anxiety disorders
• Incorporating relaxation techniques to enhance the effects of medication
• Using diazepam as a short-term solution while developing long-term coping strategies
• Gradually reducing diazepam dosage as non-pharmacological methods become more effective

Healthcare providers should discuss these options with patients to develop a comprehensive treatment plan that addresses individual needs and preferences.

Diazepam Dosage Guide + Max Dose, Adjustments

Medically reviewed by Drugs.com. Last updated on Oct 20, 2021.

Applies to the following strengths: 15 mg; 5 mg/mL; 2 mg; 5 mg; 10 mg; 5 mg/5 mL; 2.5 mg; 20 mg; 5 mg/dose; 10 mg/dose; 15 mg/dose; 20 mg/dose

Usual Adult Dose for:

• Anxiety
• Alcohol Withdrawal
• Muscle Spasm
• Seizures
• Endoscopy or Radiology Premedication
• Status Epilepticus
• Light Anesthesia

Usual Geriatric Dose for:

• Seizures
• Alcohol Withdrawal
• Anxiety
• Muscle Spasm

Usual Pediatric Dose for:

• Seizures
• Status Epilepticus
• Anxiety
• Muscle Spasm
• Seizure Prophylaxis
• Tetanus

Additional dosage information:

• Renal Dose Adjustments
• Liver Dose Adjustments
• Dose Adjustments
• Precautions
• Dialysis
• Other Comments

Usual Adult Dose for Anxiety

ORAL: 2 to 10 mg orally 2 to 4 times a day

PARENTERAL:
Moderate Anxiety Disorders and Symptoms: 2 to 5 mg IM or IV, repeated in 3 to 4 hours if necessary
Severe Anxiety Disorders and Symptoms: 5 to 10 mg IM or IV, repeated in 3 to 4 hours if necessary

Comments:

• Oral doses should be determined by the severity of symptoms.
• Anxiety associated with the stress of everyday life usually does not require treatment with this drug.

Use: Management of anxiety disorders and short-term relief of anxiety symptoms

Usual Adult Dose for Alcohol Withdrawal

ORAL:

• Initial dose: 10 mg orally 3 to 4 times a day for the first 24 hours
• Maintenance dose: 5 mg orally 3 to 4 times a day as needed

PARENTERAL: 10 mg IM or IV once, then 5 to 10 mg IM or IV in 3 to 4 hours if necessary

Use: Symptomatic relief of acute agitation, tremor, impending/acute delirium tremens, and hallucinations in acute alcohol withdrawal

Usual Adult Dose for Muscle Spasm

ORAL: 2 to 10 mg orally 3 to 4 times a day

PARENTERAL: 5 to 10 mg IM or IV, then 5 to 10 mg IM or IV in 3 to 4 hours if necessary

Comment: Larger parenteral doses may be necessary for patients with tetanus.

Use: Adjunctive treatment for the relief of skeletal muscle spasm due to reflex spasm to local pathology, spasticity caused by upper motor neuron disorders, athetosis, and stiff-man syndrome (e. g., inflammation of the muscles/joints secondary to trauma, cerebral palsy, paraplegia)

Usual Adult Dose for Seizures

ORAL: 2 to 10 mg orally 2 to 4 times a day

RECTAL:

• Initial dose: 0.2 mg/kg rectally, rounded upward to the next available dose. A 2.5 mg rectal dose may be given as a partial replacement if patients expel a portion of the initial dose
• If necessary, a second dose of 0.2 mg/kg may be given rectally 4 to 12 hours after the first dose.
• Maximum Frequency: May be used to treat up to 1 seizure episode every 5 days, and no more than 5 episodes/month

Uses:

• Management of selected, refractory patients with epilepsy on stable regimens of antiepileptic drugs who require intermittent use of this drug to control bouts of increased seizure activity
• Adjunctive treatment for convulsive disorders

Usual Adult Dose for Endoscopy or Radiology Premedication

PARENTERAL:
Cardioversion: 5 to 15 mg IV once 5 to 10 minutes before the procedure

Endoscopic Procedures:
IV: Usually less than 10 mg, but some patients require up to 20 mg IV, especially when narcotics are omitted

• IV titration: The IV dose should be titrated to desired sedative response (e. g., slurring of speech) with slow administration immediately before the procedure.

IM: 5 to 10 mg IM once 30 minutes prior to the procedure

Comments:

• Narcotic dosing should be reduced by approximately 33%, and may be omitted in some patients.
• The IV route is preferred, but IM administration may be used if IV administration is not possible.

Uses:

• Adjunct prior to endoscopic procedures if apprehension, anxiety, or acute stress reactions are present and to diminish recall of the procedures
• Prior to cardioversion for the relief of anxiety and tension and to diminish the patient’s recall of the procedure

Usual Adult Dose for Status Epilepticus

PARENTERAL:

• Initial dose: 5 to 10 mg IV once, repeated at 10 to 15 minute intervals to a maximum dose of 30 mg if necessary

Comments:

• The IV route is preferred; however, the IM route may be used if IV administration is impossible.
• Treatment may be repeated every 2 to 4 hours, but active metabolites may persist during readministration.
• Patients with chronic lung disease or unstable cardiovascular conditions should be given this drug with extreme caution.

Use: Adjunct to status epilepticus and severe recurrent convulsive seizures

Usual Adult Dose for Light Anesthesia

PARENTERAL:
Preoperative Medication: 10 mg IM once before surgery

Comments:

• The IM route is preferred when given as a preoperative medication.
• Atropine, scopolamine, and other premedications should be administered in separate syringes.

Use: Premedication for the relief of anxiety and tension in patients undergoing surgical procedures

Usual Geriatric Dose for Seizures

ORAL:

• Initial dose: 2 to 2.5 mg orally once to 2 times a day

RECTAL:

• Initial dose: 0.2 mg/kg rectally, rounded downward to the next available dose. A 2.5 mg rectal dose may be given as a partial replacement if patients expel a portion of the initial dose
• If necessary, a second dose of 0.2 mg/kg may be given rectally 4 to 12 hours after the first dose.
• Maximum Frequency: May be used to treat up to 1 seizure episode every 5 days, and no more than 5 episodes/month

Comment: Oral doses may be increased gradually as needed and tolerated, but should be limited to the smallest effective amount

Uses:

• Management of selected, refractory patients with epilepsy on stable regimens of antiepileptic drugs who require intermittent use of this drug to control bouts of increased seizure activity
• Adjunctive treatment in convulsive disorders

Usual Geriatric Dose for Alcohol Withdrawal

ORAL:

• Initial dose: 2 to 2.5 mg orally once to 2 times a day

PARENTERAL:

• Initial dose: 2 to 5 mg IM or IV, repeated in 3 to 4 hours if necessary

Comments:

• Doses may be increased gradually as needed and tolerated, but should be limited to the smallest effective amount.
• Maintenance doses should be determined by clinical need and patient tolerance.

Uses:

• Management of anxiety disorders and short-term relief of anxiety symptoms
• Symptomatic relief of acute agitation, tremor, impending/acute delirium tremens, and hallucinations in acute alcohol withdrawal
• Adjunctive treatment for the relief of skeletal muscle spasm due to reflex spasm to local pathology, spasticity caused by upper motor neuron disorders, athetosis, and stiff-man syndrome (e.g., inflammation of the muscles/joints secondary to trauma, cerebral palsy, paraplegia)

Usual Geriatric Dose for Anxiety

ORAL:

• Initial dose: 2 to 2.5 mg orally once to 2 times a day

PARENTERAL:

• Initial dose: 2 to 5 mg IM or IV, repeated in 3 to 4 hours if necessary

Comments:

• Doses may be increased gradually as needed and tolerated, but should be limited to the smallest effective amount.
• Maintenance doses should be determined by clinical need and patient tolerance.

Uses:

• Management of anxiety disorders and short-term relief of anxiety symptoms
• Symptomatic relief of acute agitation, tremor, impending/acute delirium tremens, and hallucinations in acute alcohol withdrawal
• Adjunctive treatment for the relief of skeletal muscle spasm due to reflex spasm to local pathology, spasticity caused by upper motor neuron disorders, athetosis, and stiff-man syndrome (e.g., inflammation of the muscles/joints secondary to trauma, cerebral palsy, paraplegia)

Usual Geriatric Dose for Muscle Spasm

ORAL:

• Initial dose: 2 to 2.5 mg orally once to 2 times a day

PARENTERAL:

• Initial dose: 2 to 5 mg IM or IV, repeated in 3 to 4 hours if necessary

Comments:

• Doses may be increased gradually as needed and tolerated, but should be limited to the smallest effective amount.
• Maintenance doses should be determined by clinical need and patient tolerance.

Uses:

• Management of anxiety disorders and short-term relief of anxiety symptoms
• Symptomatic relief of acute agitation, tremor, impending/acute delirium tremens, and hallucinations in acute alcohol withdrawal
• Adjunctive treatment for the relief of skeletal muscle spasm due to reflex spasm to local pathology, spasticity caused by upper motor neuron disorders, athetosis, and stiff-man syndrome (e.g., inflammation of the muscles/joints secondary to trauma, cerebral palsy, paraplegia)

Usual Pediatric Dose for Seizures

ORAL:
6 months and older:

• Initial dose: 1 to 2.5 mg orally 3 to 4 times a day

RECTAL:
2 to 5 years:

• Initial dose: 0.5 mg/kg rectally, rounded upward to the next available dose. A 2.5 mg rectal dose may be given as a partial replacement if patients expel a portion of the initial dose
• If necessary, a second dose of 0. 5 mg/kg may be given rectally 4 to 12 hours after the first dose.
• Maximum Frequency: 1 episode every 5 days, and no more than 5 episodes/month

6 to 11 years:

• Initial dose: 0.3 mg/kg rectally, rounded upward to the next available dose. A 2.5 mg rectal dose may be given as a partial replacement if patients expel a portion of the initial dose
• If necessary, a second dose of 0.3 mg/kg may be given rectally 4 to 12 hours after the first dose.
• Maximum Frequency: 1 episode every 5 days, and no more than 5 episodes/month

12 years and older:

• Initial dose: 0.2 mg/kg rectally, rounded upward to the next available dose. A 2.5 mg rectal dose may be given as a partial replacement if patients expel a portion of the initial dose
• If necessary, a second dose of 0.2 mg/kg may be given rectally 4 to 12 hours after the first dose.
• Maximum Frequency: May be used to treat up to 1 seizure episode every 5 days, and no more than 5 episodes/month

Comment: Oral doses may be increased gradually as needed and tolerated, but should be limited to the smallest effective amount.

Uses:

• Management of selected, refractory patients with epilepsy on stable regimens of antiepileptic drugs who require intermittent use of this drug to control bouts of increased seizure activity
• Adjunctive treatment in convulsive disorders

Usual Pediatric Dose for Status Epilepticus

PARENTERAL:
IV Injection:
30 days to less than 5 years: 0.2 to 0.5 mg slow IV injection every 2 to 5 minutes, up to a maximum dose of 5 mg. Repeat in 2 to 4 hours if needed.

5 years and older: 1 mg slow IV injection every 2 to 5 minutes, up to a maximum dose of 10 mg. Repeat in 2 to 4 hours if needed.

Comment: EEG monitoring may be helpful to monitor seizure activity.

Use: Adjunct in status epilepticus and severe recurrent convulsive seizures

Usual Pediatric Dose for Anxiety

ORAL:
6 months and older:

• Initial dose: 1 to 2.5 mg orally 3 to 4 times a day

Comments:

• Doses may be increased gradually as needed and tolerated, but should be limited to the smallest effective amount.
• Maintenance doses should be determined by clinical need and patient tolerance.

Uses:

• Management of anxiety disorders and short-term relief of anxiety symptoms
• Symptomatic relief of acute agitation, tremor, impending/acute delirium tremens, and hallucinations in acute alcohol withdrawal
• Adjunctive treatment for the relief of skeletal muscle spasm due to reflex spasm to local pathology, spasticity caused by upper motor neuron disorders, athetosis, and stiff-man syndrome (e.g., inflammation of the muscles/joints secondary to trauma, cerebral palsy, paraplegia)

Usual Pediatric Dose for Muscle Spasm

ORAL:
6 months and older:

• Initial dose: 1 to 2.5 mg orally 3 to 4 times a day

Comments:

• Doses may be increased gradually as needed and tolerated, but should be limited to the smallest effective amount.
• Maintenance doses should be determined by clinical need and patient tolerance.

Uses:

• Management of anxiety disorders and short-term relief of anxiety symptoms
• Symptomatic relief of acute agitation, tremor, impending/acute delirium tremens, and hallucinations in acute alcohol withdrawal
• Adjunctive treatment for the relief of skeletal muscle spasm due to reflex spasm to local pathology, spasticity caused by upper motor neuron disorders, athetosis, and stiff-man syndrome (e.g., inflammation of the muscles/joints secondary to trauma, cerebral palsy, paraplegia)

Usual Pediatric Dose for Seizure Prophylaxis

ORAL:
6 months and older:

• Initial dose: 1 to 2.5 mg orally 3 to 4 times a day

Comments:

• Doses may be increased gradually as needed and tolerated, but should be limited to the smallest effective amount.
• Maintenance doses should be determined by clinical need and patient tolerance.

Uses:

• Management of anxiety disorders and short-term relief of anxiety symptoms
• Symptomatic relief of acute agitation, tremor, impending/acute delirium tremens, and hallucinations in acute alcohol withdrawal
• Adjunctive treatment for the relief of skeletal muscle spasm due to reflex spasm to local pathology, spasticity caused by upper motor neuron disorders, athetosis, and stiff-man syndrome (e. g., inflammation of the muscles/joints secondary to trauma, cerebral palsy, paraplegia)

Usual Pediatric Dose for Tetanus

PARENTERAL:
30 days to 5 years: 1 to 2 mg IM or slow IV injection, repeated every 3 to 4 hours as necessary

5 years and older: 5 to 10 mg IM or slow IV injection, repeated every 3 to 4 hours as necessary to control spasms

Comment: Respiratory assistance should be available for patients.

Use: Tetanus

Renal Dose Adjustments

Renal dysfunction:

• Oral formulations: Data not available
• Parenteral and rectal formulations: Use with caution

Liver Dose Adjustments

Patients with liver disease: Use with caution (parenteral and rectal formulations)
Mild to moderate hepatic insufficiency: Dose adjustment(s) may be required; however, no specific guidelines have been suggested. Caution recommended. (oral formulations)
Severe hepatic insufficiency: Contraindicated (oral formulations)

Dose Adjustments

Debilitated patients:
Oral:

• Initial dose: 2 to 2. 5 mg orally once or 2 times a day

Parenteral:

• Initial dose: 2 to 5 mg once a day

Rectal:

• Initial dose: 0.2 mg/kg rectally, rounded downward to the next available dose. A 2.5 mg rectal dose may be given as a partial replacement if patients expel a portion of the initial dose
• If necessary, a second dose of 0.2 mg/kg may be given rectally 4 to 12 hours after the first dose.
• Maximum Frequency: May be used to treat up to 1 seizure episode every 5 days, and no more than 5 episodes/month

Precautions

US BOXED WARNINGS:
RISKS FROM CONCOMITANT USE WITH OPIOIDS:

• Concomitant use of benzodiazepines and opioids may result in profound sedation, respiratory depression, coma, and death.
• Because of these risks, reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate.
• Limit dosages and durations to the minimum required.
• Follow patients for signs and symptoms of respiratory depression and sedation.
• Advise both patients and caregivers about the risks of respiratory depression and sedation when this drug is used with opioids.

Safety and efficacy have not been established in patients younger than 30 days (parenteral formulations), 6 months (oral formulations), and 2 years (rectal formulations).

Consult WARNINGS section for additional precautions.

US Controlled Substance: Schedule IV

Dialysis

Data not available

Other Comments

Administration advice:

• IV administration: This drug should be injected slowly (at a rate of at least 1 minute for every 5 mg OR 1 mL/min), avoiding small veins. If direct IV injection is not possible, treatment should be injected slowly through infusion tubing as close as possible to vein insertion.
• Pediatric IV administration: The IV should be given slowly, over a 3-minute period at a rate of 0. 25 mg/kg or slower. After 15 to 30 minutes, the initial dosage may be repeated. The use of emulsion for injection formulations should be carefully considered in pediatric patient populations.
• IM administration: This drug should be injected deeply into the muscle.
• Rectal formulations: Patients and caregivers should review administration steps included in the manufacturer product information.

Storage requirements:

• Emulsion for injection: When used as a continuous infusion, the mixed product should be used within 6 hours. When used as an injection, the dose should be drawn into a syringe immediately before administration.
• Oral concentrated solution: Once mixed into food/liquid, the solution should not be stored for future use.

Reconstitution/preparation techniques:

• Emulsion for injection: When used for continuous infusion, the emulsion may be added to dextrose 5% or 10% to make a solution with a concentration of 0. 1 to 0.4 mg/mL.
• Oral concentrated solution: The concentrated solution should be dosed with the included calibrated dropper and mixed into liquids or semi-soft foods. Once the solution is added to the liquid/food, it should be mixed for a few seconds; patients should immediately consume the entire dose.
• Solution for injection: When used for continuous infusion, the solution should be used immediately after mixing with infusion fluid.

IV compatibility:

• Emulsion for Injection: When used as a continuous infusion, the emulsion may be mixed with intralipid 10% or 20%, but mixture with saline solutions should be avoided. Adsorption into plastic infusion equipment may occur, but may be less than with other formulations.
• Solution for Injection: When used as a continuous infusion, this formulation should be mixed with at least 200 mL of sodium chloride or dextrose in glass bottles. Adsorption into plastic bags may occur.

General:

• Rectal solution formulations are recommended in patients who require rapid treatment, but cannot receive IV formulations.
• Efficacy of long-term use (e.g., longer than 4 months) of the oral solution has not been established. Patients should be regularly reassessed for continued need of treatment, especially when they are symptom-free.
• Patients should receive the lowest effective dose for the shortest amount of time.
• If a third IV dose does not relieve symptoms in pediatric patients, adjunctive therapy appropriate to the condition should be used.

Monitoring:

• Renal function, especially in elderly patients with decreased renal function
• Periodic blood counts, especially in patients on long-term therapy
• Periodic liver function tests, especially in patients on long-term therapy
• Sedation, especially within 1 hour of administration AND when given a parenteral formulation

Patient advice:

• Advise patients to speak to their healthcare provider if they become pregnant, intend to become pregnant, or are breastfeeding.
• Inform patients that this drug may cause drowsiness, and they should avoid driving or operating machinery until the full effects of the drug are seen.
• Patients and their caregivers should be told to report any signs/symptoms of respiratory depression or profound sedation.

More about diazepam

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• Compare alternatives
• Pricing & coupons
• Reviews (822)
• Drug images
• Latest FDA alerts (2)
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• Patient tips
• During pregnancy
• Support group
• Drug class: benzodiazepine anticonvulsants
• Breastfeeding

Patient resources

• Drug Information
• Diazepam injection
• Diazepam nasal
• Diazepam rectal
• Diazepam (Injection) (Advanced Reading)

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Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

How and when to take diazepam

Dosage

Your doctor will decide the right dose of diazepam for you. It’s important to take diazepam exactly as your doctor tells you to.

Dosage for tablets and liquid

The usual dose is:

• anxiety – 2mg, taken 3 times a day, this can be increased to 5mg to 10mg, taken 3 times a day
• sleep problems (related to anxiety) – 5mg to 15mg, taken once a day at bedtime
• muscle spasms in adults – 2mg to 15 mg a day. This can be taken as 1mg twice a day and can go up to 5mg taken 3 times a day. The dose can be increased to up to 20mg, taken 3 times a day if needed
• muscle spasms in children (aged 1 month to 17 years) – the dose varies depending on age. It’s usually taken twice a day, with 10 to 12 hours between each dose

Your dose might be lower if you’re over 65 or have kidney or liver problems or severe breathing problems.

Dosage for rectal tubes

Your doctor will decide the right dose of diazepam rectal tubes for you or your child according to your weight, age and general health.

How to take or use it

How to take tablets and liquid

Take diazepam tablets or liquid with a drink of water. You can take them with or without food.

If you’re taking diazepam as a liquid, the medicine will come with a plastic syringe or spoon to help you measure out the right dose. If you do not have a syringe or spoon, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not measure the right amount.

How to use rectal tubes

Diazepam rectal tubes (or rectal diazepam) can be used if you or your child is having a seizure or fit.

If you have been prescribed rectal tubes, it’s important that a family member, friend or carer knows how to give you this medicine. This may vary between different brands. Read the instructions that come with the medicine carefully.

If you’re having a seizure, they also need to know how long to wait before giving you rectal diazepam. This depends on the type of seizure and how long it lasts.

Before prescribing diazepam rectal tubes your doctor will talk to you and your family member or carer about how to recognise the type of seizure that should be treated with this medicine. They will also teach your family member or carer how to give the medicine.

How long to take it for

How long you’ll need to take diazepam for depends on why you’re taking it. It is usually only recommended for a short period of time of up to 4 weeks.

If you’re prescribed diazepam for more than 4 weeks, your dose may be reduced gradually to prevent withdrawal symptoms.

If you forget to take it

If you’re taking diazepam regularly and forget to take a dose, take the missed dose as soon as you remember, unless it’s nearly time for your next dose. In this case, just leave out the missed dose and take your next dose at the usual time.

Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to remember to take your medicine.

If you take too much

If you take more than your prescribed dose of diazepam you may get symptoms including:

• poor co-ordination or trouble speaking
• feeling sleepy
• a slow or irregular heartbeat
• uncontrolled eye movements
• muscle weakness
• feeling overexcited

The amount of diazepam that can lead to an overdose varies from person to person.

Urgent advice: Contact 111 for advice now if:

• you take more than your prescribed dose of diazepam

Go to 111.nhs.uk or call 111

If you need to go to A&E, do not drive yourself. Get someone else to drive you or call for an ambulance.

Take the diazepam packet, or the leaflet inside it, plus any remaining medicine with you.

Page last reviewed: 3 February 2022

Next review due: 3 February 2025

Benzodiazepines in anesthesiology

Benzodiazepines are mainly used for premedication, anxiolysis, amnesia and sedation. Currently, in most European countries and the USA, three benzodiazepine receptor agonists are used in anesthesiology: midazolam, diazepam and lorazepam .

Diazepam 0005 ) was synthesized by Sternbach in 1959 in the search for a new and better drug in anesthesiology. It was first described for use as an intravenous anesthetic for induction in 1965.

Water-soluble benzodiazepine midazolam ( dormicum ) is the most frequently administered intravenous drug in anesthesiology due to its rapid onset and end of action and lack of active metabolites compared to other benzodiazes pinami (for example, diazepam). The onset of the effect of midazolam (dormicum) is slower than that of propofol and barbiturates, and the recovery of consciousness, especially when used in large doses or with prolonged infusion, is much slower than that of propofol or thiopental. Benzodiazepines act through GABA receptors. Flumazenil is a specific benzodiazepine antagonist. It can be used to reverse the sedative effect of benzodiazepines. Benzodiazepines usually slightly reduce blood pressure and moderately depress breathing. Intravenous dose of midazolam ( dormicum ) for anxiolysis and mild sedation is 0.015–0.03 mg/kg with repeated injection after 30–60 min .

Three drugs of the benzodiazepine group used for anesthesia are classified as short-acting drugs ( midazolam) , 9000 3 medium duration ( lorazepam ) and long-acting ( diazepam ), according to their metabolism and plasma clearance. All benzodiazepines have hypnotic, sedative, anxiolytic, amnestic, anticonvulsant and central muscle relaxant effects . Drugs differ in their potency and efficacy for each of the pharmacodynamic actions.

The mechanism of action of benzodiazepine o to is fairly well understood. Sedation, anterograde amnesia and anticonvulsant properties mediated α1 receptors , anxiolysis and muscle relaxation mediated s α2-GABA _A receptors. Benzodiazepine receptors are found in high density in the olfactory bulb, cerebral cortex, cerebellum, hippocampus, substantia nigra and inferior tubercles, and in lower density in the striatum, brain stem and spinal cord.

Long-term use of benzodiazepines leads to the development of resistance, which is defined as a decrease in the effectiveness of the drug over time. Although the mechanism of chronic tolerance is not fully understood , it is likely that long-term exposure to benzodiazepines causes a decrease in receptor function and binding (ie, suppression of the _A GABA receptor-benzodiazepine complex).

Start and duration after bolus intravenous administration of benzodiazepines depends on the lipid solubility of the drug, which probably explains the differences in the onset and duration of action of midazolam, diazepam and lorazepam. Midazolam and diazepam are characterized by a faster onset of action (usually within 30-60 seconds) than lorazepam (from 60 to 120 seconds).

Effect of benzodiazepines on the respiratory system

Benzodiazepines, like most intravenous anesthetics, cause dose-dependent respiratory depression . Apnea with benzodiazepines is dose dependent. The frequency of apnea after the use of an induction dose of thiopental or midazolam is the same. In clinical trials of midazolam, apnea occurred in 20% of 1130 patients treated with midazolam for induction and in 27% of 580 patients treated with thiopental. Apnea is more likely to develop when combined with opioids. Older age, cachexia, and the use of respiratory depressants also increase the likelihood of developing sleep apnea.

Action of benzodiazepines on the central nervous system

Benzodiazepines reduce cerebral blood flow in a dose dependent manner. In healthy volunteers, midazolam at a dose of 0.15 mg/kg induces sleep and reduces cerebral blood flow by 34%, despite a slight increase in PaCO ₂ from 34 to 39 mm Hg. Art. Antiemetic effects of benzodiazepines have not been identified.

Cardiovascular effects of benzodiazepines

Benzodiazepines used in anesthesiology have little effect on hemodynamics. The predominant hemodynamic effect is a slight decrease in blood pressure as a result of a decrease in systemic vascular resistance. The mechanism by which maintenance benzodiazepines provide hemodynamic stability involves the maintenance of homeostatic reflex mechanisms, but there is evidence that baroreflexes are impaired by midazolam and diazepam. Midazolam causes a slightly greater decrease in blood pressure compared to other benzodiazepines, but the hypotensive effect is minimal and approximately similar to thiopental. Despite hypotension, midazolam, even at doses of 0.2 mg/kg, is safe and effective in inducing anesthesia even in patients with severe aortic stenosis.

Sedation with benzodiazepines

Benzodiazepines are used for sedative purposes as part of preoperative sedation, intraoperatively during regional and local anesthesia in the postoperative period. Sedation, amnesia, and increased seizure threshold for local anesthetic are desirable effects of benzodiazepines.

Longer periods of sedation eg in the intensive care unit are also administered with benzodiazepines. Prolonged infusion leads to accumulation of the drug, and in the case of midazolam, to significant concentrations of the active metabolite. The main advantages are amnesia and hemodynamic stability, and the disadvantage compared to propofol is a slightly longer cessation of the effect after the end of the infusion.

Use and dosage of intravenous benzodiazepines

Benzodiazepines are weak analgesics and should be used with other anesthetics to provide adequate analgesia, however, during general anesthesia, benzodiazepines provide sedation and amnesia. Midazolam is the benzodiazepine drug of choice for induction into anesthesia. When midazolam is used at the recommended dosages, induction is slower than with thiopental, but amnesia is more reliable. Numerous factors affect the rapidity of action of midazolam and other benzodiazepines when used to induce general anesthesia, including dose, rate of administration, level of premedication, age, physical condition according to ASA classification, as well as the simultaneous use of other anesthetics.

	Midozalam	Diazepam	Lorazepam
Premedication	5 mg IM	10 mg IM
Induction	0. 05-0.15 mg/kg	0.3-0.5 mg/kg	0.1 mg/kg
Maintenance anesthesia	0.05 mg/kg	0.1 mg/kg	0.02 mg/kg
Sedation	0.5-1 mg repeated 0.07 mg/kg IM	2 mg re	0.25 mg re

Side effects of benzodiazepines

Benzodiazepines are not allergenic and do not suppress adrenal function. The main problem with the use of midazolam is respiratory depression. The main side effects of lorazepam and diazepam, in addition to respiratory depression, are venous irritation and thrombophlebitis, problems associated with insolubility in water and the need for a solvent.

5 drugs that changed the world – but not as expected

• Health

Dr. problems.

August 31, 2022

Source:

IStockphoto

Anesthetics

English chemist (part-time priest) Joseph Priestley in 1772 received nitrous oxide – N₂O. The English chemist Humphry Davy thought that it could be used for pain relief in surgery, but it turned out that the gas has a very interesting effect – at low concentrations it causes a slight intoxication. Nitrous oxide is listed as recreational drug (not for medical reasons).

Later, in 1834, the French chemist Jean-Baptiste Dumas determined the empirical formula of the gas synthesized by several scientists at once and called it chloroform . Already 14 years later, the Scottish doctor James Young Simpson used his for pain relief during childbirth .

Anesthesia soon became more widely used during surgery, which markedly reduced mortality from shock and pain during surgery. But at the same time, everyone is well aware of the side effects of anesthesia, including modern anesthetics.

– If it is possible not to do anesthesia, it is better not to do it, – said anesthetist Andrei Meleshko. – Of course, if an urgent or elective operation is indicated, and a person without it can become disabled or die, then, of course, anesthesia cannot be avoided and it is not considered “harmful”. Here, anesthesia is a way to make a person feel better.

Approximately 10% of patients in the postoperative period after general anesthesia have cognitive impairment of varying degrees. This is a recognized clinical phenomenon.

Anesthesiologist Irina Golub

Penicillin

For the first time, the antimicrobial properties of the mold Penicillium ( penicillin) were told by the Scottish doctor Alexander Fleming. Later, Australian pathologist Howard Flory and his team stabilized penicillin and conducted the first human experiments.0322 . With American funding, penicillin was mass-produced – during World War II, 90,321 thousand 90,322 wounded were successfully treated with it.

Penicillin and its “descendants” are extremely successful drugs for the treatment of diseases that once claimed the lives of millions of people. But there is also the other side of the coin.

The widespread use of antibiotics has led to the emergence of drug-resistant strains of bacteria . And is a much more serious problem than it seems at first glance. 9 people die each year due to antimicrobial resistance0004 approximately 700 thousand people, and by 2050 the number of victims risks equaling the death rate from cancer – 10 million people.

– For the first time, the problem of resistance of microorganisms became significant for world medicine after the start of the widespread use of penicillin, when, after a short period of euphoria, strains of Staphylococcus aureus resistant to penicillin were isolated. This is one of the most pressing problems in modern healthcare . It is regarded by many states as a threat to national security,” says Professor Sergei Shlyapnikov. — The COVID-19 pandemic partly aggravated the situation. There has been a trend towards an increase in the unnecessary use of antibiotics, as it was believed that these drugs help in the protection and treatment of viral infections, including coronavirus. This is not true: antibiotics are only used for a bacterial infection—caused by a bacterium, not a virus.

See also

Nitroglycerin

This organic compound was discovered in 1847 by chemists and found to cause severe headaches. The practical application of nitroglycerin at first, however, was completely different – Alfred Nobel found out that it was the most powerful explosive in the world and patented his method of making explosives.

Years later, nitroglycerin was registered as a drug for high blood pressure, and a little later – after experiments by the London doctor William Murrell, the drug began to be used to treat angina pectoris – chest pain associated with heart disease. By the way, , the publication on the results of the study of nitroglycerin was included in the golden fund of medicine.

Nitroglycerin is believed to have enabled millions of people with angina to live longer and relatively normal lives, and has been the impetus for the development of blood pressure drugs, beta-blockers and statins, which prolong the lives of patients with terminal illnesses.

But as life expectancy increases, so does the death rate from cancer and other noncommunicable diseases. Thus, nitroglycerin suddenly changed the world.

– The biggest risk factor for most cancers is aging, according to a 2015 study. – This is due to the fact that over time, errors accumulate in our DNA code that can push the cell to become cancerous. Therefore, the longer we live, the more time we have for the accumulation of errors . Thus, over time, the risk of getting cancer increases as more and more of these defects accumulate in our genes.

More people than ever are living to an age when they are at increased risk of developing cancer.

British scientist Greg Jones

Contraceptives

Researcher Gregory Pincus is considered the father of the magic pill that prevents pregnancy. He received money to develop an effective hormonal contraceptive from philanthropist and feminist Katherine McCormick.

Pincus discovered that progesterone helps stop ovulation and used this to develop a trial pill. During clinical trials in women from Puerto Rico , there were concerns about the side effects of birth control. But despite this, the first pill was released in the early 60s of the last century: the risk of pregnancy was considered greater than the risk of side effects – blood clots and strokes.

By the way, there are no hormonal drugs for men yet, but scientists are actively working in this direction.

The first birth control pills contained very high amounts of synthetic estrogen, which often caused side effects such as nausea or weight gain. This has led to many publications and even investigations. It wasn’t until 1970 that hormone levels in pills dropped dramatically.

The invention of the hormonal contraceptive pill caused major global demographic changes – families became smaller and their incomes increased as women began to work again. So the usual “pill” was able to change the world and dramatically affect the role of women in it.

Read also

Diazepam

The first benzodiazepine tranquilizer, diazepam (Valium), went on sale in the 1960s and was the top-selling pharmaceutical in the United States between 1962 and 1982. It has been used to manage stress and anxiety.

But now there is more and more evidence that dependence on such drugs (Xanax and Phenazepam are also included in the benzodiazepine class) is increasing, and the number of side effects is so high that alternative methods of treatment should be sought.

Studies show that benzodiazepines are highly addictive and difficult to stop.