DIAZEPAM
(dye-az'e-pam)
Apo-Diazepam , Diastat, Diazemuls , E-Pam , Meval , Novodipam , Valium, Valrelease, Vivol 
DIAZEPAM EMULSIFIED
Dizac
Classifications: central nervous system agent; benzodiazepine anticonvulsant; anxiolytic
Pregnancy Category: D
Controlled Substance: Schedule IV

Availability

2 mg, 5 mg, 10 mg tablets; 1 mg/mL, 5 mg/mL, 5 mg/5 mL oral solution; 5 mg/mL injection; 2.5 mg, 5 mg, 10 mg, 15 mg, 20 mg rectal gel

Actions

Psychotherapeutic agent related to chlordiazepoxide; reportedly superior in antianxiety and anticonvulsant activity, with somewhat shorter duration of action. Like chlordiazepoxide, it appears to act at both limbic and subcortical levels of CNS.

Therapeutic Effects

Shortens REM and stage 4 sleep but increases total sleep time. Antianxiety and anticonvulsant agent.

Uses

Drug of choice for status epilepticus. Management of anxiety disorders, for short-term relief of anxiety symptoms, to allay anxiety and tension prior to surgery, cardioversion and endoscopic procedures, as an amnesic, and treatment for restless legs. Also used to alleviate acute withdrawal symptoms of alcoholism, voiding problems in older adults, and adjunctively for relief of skeletal muscle spasm associated with cerebral palsy, paraplegia, athetosis, stiff-man syndrome, tetanus.

Contraindications

Injectable form: Shock, coma, acute alcohol intoxication, depressed vital signs, obstetrical patients, infants <30 d of age. Tablet form: Infants <6 mo of age, acute narrow-angle glaucoma, untreated open-angle glaucoma; during or within 14 d of MAO inhibitor therapy. Safe use during pregnancy (category D) and lactation is not established.

Cautious Use

Epilepsy, psychoses, mental depression; myasthenia gravis; impaired hepatic or renal function; drug abuse, addiction-prone individuals. Injectable diazepam used with extreme caution in older adults, the very ill, and patients with COPD.

Route & Dosage

Status Epilepticus
Adult: IV/IM 5–10 mg, repeat if needed at 10–15 min intervals up to 30 mg, then repeat if needed q2–4h
Child: IV/IM <5 y, 0.2–0.5 mg slowly q2–5min up to 5 mg; >5 y, 1 mg slowly q2–5min up to 10 mg, repeat if needed q2–4 h

Anxiety, Muscle Spasm, Convulsions, Alcohol Withdrawal
Adult: PO 2–10 mg b.i.d. to q.i.d. or 15–30 mg/d sustained release IV/IM 2–10 mg, repeat if needed in 3–4 h
Geriatric: PO 1–2 mg 1–2 times/d (max: 10 mg/d)
Child: PO >6 mo, 1–2.5 mg b.i.d. or t.i.d.

Administration

Note: Dizac emulsion is administered by IV only.

Oral
Intramuscular
Intravenous

PREPARE: Direct: Do not dilute or mix with any other drug.  

ADMINISTER: Direct: Give direct IV by injecting drug slowly, taking at least 1 min for each 5 mg (1 mL) given to adults and taking at least 3 min to inject 0.25 mg/kg body weight of children.  

  • If injection cannot be made directly into vein, inject slowly through infusion tubing as close as possible to vein insertion.
  • The emulsion form is incompatible with PVC infusion sets.
  • Avoid small veins and take extreme care to avoid intraarterial administration or extravasation.

INCOMPATIBILITIES Solution/additive: Bleomycin, benzquinamide, dobutamine, doxapram, doxorubicin, fluorouracil, glycopyrrolate, heparin, nalbuphone, sufentanil. Emulsion also incompatible with morphine. Y-site: Furosemide, heparin, potassium chloride, tirofiban, vitamin B complex with C. Emulsion also incompatible with morphine. Do not mix emulsion with any other drugs. Do not administer through polyvinyl chloride (PVC) infusion sets.

Adverse Effects (1%)

Body as a Whole: Throat and chest pain. CNS: Drowsiness, fatigue, ataxia, confusion, paradoxic rage, dizziness, vertigo, amnesia, vivid dreams, headache, slurred speech, tremor; EEG changes, tardive dyskinesia. CV: Hypotension, tachycardia, edema, cardiovascular collapse. Special Senses: Blurred vision, diplopia, nystagmus. GI: Xerostomia, nausea, constipation, hepatic dysfunction. Urogenital: Incontinence, urinary retention, gynecomastia (prolonged use), menstrual irregularities, ovulation failure. Respiratory: Hiccups, coughing, laryngospasm. Other: Pain, venous thrombosis, phlebitis at injection site.

Interactions

Drug: Alcohol, cns depressants, anticonvulsants potentiate CNS depression; cimetidine increases diazepam plasma levels, increases toxicity; may decrease antiparkinson effects of levodopa; may increase phenytoin levels; smoking decreases sedative and antianxiety effects. Herbal: Kava kava, valerian may potentiate sedation.

Pharmacokinetics

Absorption: Readily absorbed from GI tract; erratic IM absorption. Onset: 30–60 min PO; 15–30 min IM; 1–5 min IV. Peak: 1–2 h PO. Duration: 15 min–1 h IV; up to 3 h PO. Distribution: Crosses blood–brain barrier and placenta; distributed into breast milk. Metabolism: Metabolized in liver to active metabolites. Elimination: Excreted primarily in urine. Half-Life: 20–50 h.

Nursing Implications

Assessment & Drug Effects

Patient & Family Education


Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug