Indicated for management of anxiety disorders or for short-term relief of the symptoms of anxiety
2-10 mg PO q6-12hr, OR
2-5 mg IV/IM q3-4hr if necessary, for moderate anxiety disorders; 5-10 mg IV/IM q3-4hr for severe anxiety disorders
Alcohol Withdrawal
Aid in symptomatic relief of acute agitation, tremor, impending or acute delirium tremens, hallucinations
10 mg PO q6-8hr during first 24hr; reduce to 5 mg PO q6-8hr PRN OR
10 mg IV/IM, initially may give additional doses of 5-10 mg IV q6-8hr as needed
Endoscopic Precedures
Adjunct use, if apprehension, anxiety or acute stress reactions present prior to endoscopic procedures
≤10 mg adequate; may give up to 20 mg IV, particularly when concomitant narcotics omitted; if IV cannot be used, 5-10 mg IM approximately 30 min prior to procedure
Titrate IV dosage to desired sedative response, such as slurring of speech, with slow administration immediately prior to procedure
Dosage of narcotics should be reduced by at least a third and in some cases may be omitted
Preoperative Sedation
If atropine, scopolamine or other premedications desired, they must be administered in separate syringes
10 mg (IM preferred) before surgery
Sedation in the ICU
5-10 mg IV 1-2 hours before surgery; 0.03-0.1 mg/kg q30min to 6hr
Muscle Spasm
May be used adjunctively for relief of skeletal muscle spasm due to reflex spasm to local pathology (eg, inflammation of the muscles or joints, secondary to trauma); spasm associated with local pathology, cerebral palsy, athetosis, stiff-man syndrome, or tetanus
2-10 mg PO q6-8hr PRN, OR
5-10 mg, IV/IM initially, THEN 5-10 mg q3-3hr, if necessary; administer larger doses for tetanus
Seizure Disorder
Indicated for acute treatment of intermittent, stereotypic episodes of frequent seizure activity (ie, seizure clusters, acute repetitive seizures) distinct from a patient’s usual seizure pattern
Used adjunctively in convulsive disorders, although it has not proved useful as the sole therapy
51-75 kg: 15 mg (two 7.5-mg devices); 1 spray in each nostril
≥76 kg: 20 mg (two 10-mg devices); 1 spray in each nostril
Second dose and maximum dose
Second dose: When required, may be administered after at least 4 hr after initial dose; if the second dose is administered, use a new blister pack of diazepam intranasal
Maximum dosage: Not to exceed 2 doses to treat a single episode
Treatment frequency: Do not use for more than 1 episode q5days and no more than 5 episodes/month
Diazepam gel (rectal)
0.2 mg/kg PR or 10-20 mg as single dose
Rectal gel is measured in 2.5-mg increments from 2.5-20 mg/dose; calculate dose and round upward to next measurable dose
May prescribe second dose of diazepam rectal gel; when required, may be given 4-12 hr after first dose
Adolescent or adult weight-based dosing
14-25 kg: 5 mg
26-37 kg: 7.5 mg
38-50 kg: 10 mg
51-62 kg: 12.5 mg
63-75 kg: 15 mg
76-87 kg: 17.5 mg
88-111 kg: 20 mg
Status Epilepticus
5-10 mg initially (IV preferred); injection may be repeated if necessary, at 10-15 minute intervals up to 30 mg maximum; may repeat in 2 to 4 hours if necessary; however, consider that residual active metabolites may persist
Use extreme caution in individuals with chronic lung disease or unstable cardiovascular status
Administer IV slowly; administer IM if IV administration impossible
OR
0.2-0.5 mg/kg PR; round up dose to nearest 2.5 mg increment; not to exceed 20 mg as single dose
Cardioversion
5-15 mg IV within 5-10 min prior to procedure to relieve anxiety and tension and to reduce recall of procedure
Dosage Modifications
Renal impairment:
Oral: Data not available
No dose adjustment recommended unless administered for prolonged period; decrease dose in prolonged periods
Rectal gel: Not studied; use caution
Intranasal spray: Not studied
Hepatic impairment
Rectal gel: Not studied; use caution
Intranasal spray: Not studied
Prescribing information describes literature review showing diazepam 0.1-0.15 mg/kg IV had prolonged half-life by 2- to 5-fold in patients with alcoholic cirrhosis
Oral administration
Mild to moderate: Use with caution and consider dose adjustment; average half-life is increased in mild and moderate cirrhosis; average increase has been variously reported from 2-fold to 5-fold, with individual half-lives over 500 hr reported
Severe: Contraindicated
Dosing Considerations
Adjust dose periodically to reflect changes in patient’s age or weight
May use 2.5-mg dose as a partial replacement dose for patients who may expel a portion of first dose
Long-term (>4 months) effectiveness of diazepam has not been assessed by systematic clinical studies
Periodically reassess the efficacy for each patient
Once acute symptomatology has been properly controlled with diazepam injection, the patient may be placed on oral therapy if further treatment required
Discontinuation or dosage reduction
Use a gradual taper to discontinue diazepam tablets or reduce dosage to avoid withdrawal reactions
If any withdrawal reaction develops, consider pausing taper or increasing dose to previous tapered dosage level; subsequently decrease dose more slowly
Seizures (Orphan)
Intermittent use to control bouts of increased seizure activity or Dravet syndrome by various administrative routes
