Diazepam (Valium)

Category:

  • Sedative

  • Muscle relaxant

Description:

  • Benzodiazapine

  Indications:

  • Antianxiety

  • Sedative

  • Acute alcohol withdrawal

  • Anticonvulsant

  • Skeletal muscle relaxant

  • Pre-surgery/procedure relaxation

  Contraindications:

  • Psychoses

  • Acute narrow-angle glaucoma

  • Lactation

  • Co-administration with ketoconazole or itraconazole (P450 enzyme inhibition)

  Precautions:

  • Pregnancy category D

  • Controlled Substance: Schedule IV

  • Closely monitor patients with suicidal tendencies.

  • Use with caution in psychiatric patients due to paradoxical reactions of excitement, over stimulation and acute rage.

  • Use with caution in seizure disorder patients due to an increase in occurance of grand mal seizures.

  • Will impair higher order motor function, therefore use caution when operating machinery or automobiles.

  • Do not drink alcohol and use with caution when administering with other CNS depressive medications.

  • When administering IV or IM to children, have respiratory assistance available.  Give slowly over 3 minutes in a dosage not to exceed 0.25mg/kg. After 15-30 minutes, if children is stable, may repeat initial dosage.  If no relief after three doses, commence adjunctive therapy.

  • May take with food if gastrointestinal upset occurs.

  Adverse Reactions (Side Effects):

  • Central nervous system: drowsiness, dizziness, fatigue, blurred vision, headache, nervousness

  • Cardiovascular: bradycardia, tachycardia, hypertension, hypotension

  • GI: constipation, diarrhea, dry mouth

Dosage:

Administered orally, rectally, intravenously

  • Adult:

    • Anxiety/convulsive disorders: 

      • PO 2-10mg 3-4 times daily

    • Sedative-hypnotic, alcohol withdrawal: 

      • PO 10mg 3-4 times daily, tapered as needed

    • Skeletal muscle relaxant: 

      • PO 2-10mg 3-4 times daily

    • Status epilepticus: 

      • IV bolus 5-20mg infused at a rate of 2 mg/minute

      • may repeat every 5-10 minutes, not to exceed 60mg

      • may repeat in 30 minutes if seizures reappear

    • Adjunct for epilepsy: 

      • PR 0.2 mg/kg as needed

  • Geriatric:  
    • 2-2.5mg 1-4 times daily
    • titrated as needed
  • Child: 

    • IV bolus 0.1-0.3 mg/kg (over 3 minutes)

    • may repeat every 15 minutes for 2 doses

  • Tetanic muscle spasms: 

    • Infants >30 days to <5years IM/IV 1-2mg to 5-10mg every 3-4 hours as needed

  • Anxiety/convulsive disorders: 

    • > 6 months PO 1-2.5mg 3-4 times daily (0.04-0.2 mg/kg 3-4 times daily as needed)

  • Adjunct for epilepsy: 

    • PR: age 2-5 years 0.5 mg/kg as needed

    • age 6-11 years 0.3 mg/kg as needed

    • age > 12 years 0.2 mg/kg as needed

 
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