ADMINISTRATION ROUTES:
IV, IM, PO, PR
ALTERNATIVE NAMES:
Diazepam, Propam, Stesolid
ICU INDICATIONS:
- Agitation
- Alcohol and benzodiazepine withdrawal
- Seizures
PRESENTATION AND ADMINISTRATION:
PO:
Propam 2mg (white), 5mg (yellow), 10 mg (blue) Diazepam elixir 10 mg/10 mL
Stesolid (rectal tube) 5mg/2.5 mL and 10 mg/2.5 mL
IV:
10 mg/2 mL vial
Inject undiluted solution slowly at a rate not exceeding 5mg/min (avoid injecting into small veins)
In general, diazepam should not be mixed or diluted with other drugs or added to IV fluids. However, if IV infusion is required, diazepam in doses up to 20 mg can be added to at least 250 mL of 5% dextrose or Normal saline. Do not use any solution that is cloudy.
Store at room temperature and protect from light.
IM:
Injection 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.
DOSAGE:
IV, PO or PR:
2-20 mg 8-12 hrly
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
Dose in renal impairment
| GFR (ml/min) | DOSE |
|---|---|
| <10 | use small dose, titrate to response |
| 10-20 | use small dose, titrate to response |
| >20-50 | dose as in normal renal function |
Dose in renal replacement therapy
| MODALITY | DOSE |
|---|---|
| CAPD | use small dose, titrate to response |
| HD | use small dose, titrate to response |
| CVVHDF | use small dose, titrate to response |
DOSAGE IN PAEDIATRICS:
IV or PR:
0.1-0.4 mg/kg
PO:
0.04-0.2 mg/kg 8-12 hrly
Anaesthesia oral pre-med 0.2-0.4 mg/kg
CLINICAL PHARMACOLOGY:
Diazepam is a benzodiazepine. As with other benzodiazepines it has anticonvulsant, anxiolytic, sedative and muscle relaxant properties.
CONTRAINDICATIONS:
- Hypersensitivity to diazepam
WARNINGS:
Extreme care must be used in administering diazepam by the IV route to the elderly, to very ill patients and to those with limited pulmonary reserve because of the possibility that apnoea and/or cardiac arrest may occur. Concomitant use of barbiturates, alcohol or other central nervous system depressants increases depression with increased risk of apnoea.
Tonic status epilepticus has been precipitated in patients treated with IV diazepam for petit mal status or petit mal variant status.
PRECAUTIONS:
General:
Although seizures may be brought under control promptly, a significant proportion of patients experience a return to seizure activity, presumably due to the short-lived effect of diazepam after IV administration. Diazepam is not recommended for maintenance, and once seizures are brought under control, consideration should be given to the administration of agents useful in longer term control of seizures.
Withdrawal may precipitate seizures
Laboratory Tests:
No tests in addition to routine ICU tests are indicated
Drug/Laboratory Test Interactions:
None known
IMPORTANT DRUG INTERACTIONS IN ICU:
Increased CNS depression is seen when diazepam is combined with other CNS depressant drugs
ADVERSE REACTIONS:
Central Nervous System:
Confusion, drowsiness, ataxia, depression, dysarthria, headache, hypoactivity, slurred speech, syncope, tremor, vertigo. Paradoxical reactions such as acute hyperexcited states, anxiety, hallucinations, increased muscle spasticity, insomnia, rage, sleep disturbances and stimulation have been reported. Should these occur, use of the drug should be discontinued. Minor changes in EEG patterns, usually low-voltage fast activity, have been observed in patients during and after diazepam therapy and are of no known significance
Gastrointestinal System:
Constipation, nausea, jaundice
Genitourinary System:
Incontinence, urinary retention
Cardiovascular System:
Bradycardia, cardiovascular collapse, hypotension
Skin:
Urticaria, skin rash
Haematological System:
Neutropaenia