Adult Dosing
Anxiety
- 2-10 mg IM/IV q3-4 hrs PRN
Alcohol withdrawal
- Start 10 mg IM/IV x 1; then 5 mg IM/IV q3-4 hrs PRN
Sedation, preoperative
- 10 mg IM x 1 given 1 hr before surgery
Sedation, endoscopic procedures
- 10-20 mg IV 30 mins before procedure; alt: 5-10 mg IM 30 mins before procedure
Sedation; cardioversion
- 5-15 mg IV 5-10 mins before procedure
Muscle spasm
- 5-10 mg IM/IV q3-4 hrs PRN
Status epilepticus
- 5-10 mg IV x1, then 5-10 mg IV q10-15 mins. [Max total dose: 30 mg]
Tetanus [Non-FDA Approved]
Neuroleptic malignant syndrome [Non-FDA approved]
- 5 mg IV q5min; dose limited by level of consciousness
Vertigo [Non-FDA Approved]
Pediatric Dosing
Anxiety
- Child (6 mo-12 yrs): 0.04-0.2 mg/kg IM/IV q3-4 hrs PRN
- Child (> 12 yrs): 2-10 mg IM/IV q3-4 hrs PRN
Status epilepticus
- Child (1 mo to 5 yrs): 0.2-0.5 mg IV q2-5 mins. [Max total dose: 5 mg]
- Child (> 5 yrs): 1 mg IV q2-5 mins. [Max total dose: 10 mg]
Tetanus [Non-FDA Approved]
- 0.04 to 0.2 mg/kg/dose IV/IM q2-4h; Max 10 mg/dose
Acute treatment of seizures [Non-FDA Approved]
- Neonate: 0.3-0.75 mg/kg/dose IV q15-30 min × 2-3 doses; Max total dose: 2 mg
- Child >1 mo: 0.2-0.5 mg/kg/dose IV q15-30 min; Max total dose: <5 yr: 5 mg; 5 yr: 10 mg
[Outline]
- To reduce the possibility of venous thrombosis, phlebitis, local irritation, swelling, vascular; inject slowly, taking at least one minute for each 5 mg (1 mL) given. Do not use small veins, such as those on the dorsum of the hand or wrist. Extreme care should be taken to avoid intra-arterial administration or extravasation
- Parentral administration should be reserved primarily for acute states. Not recommended for maintenance therapy
- Parenteral form not recommended in infants younger than 30 days of age
- It is not intended for use in patients with primary depressive disorder, psychosis, or disorders in which anxiety is not prominent
- Usage of tranquilizers (diazepam, meprobamate and chlordiazepoxide) during the first trimester of pregnancy is associated with an increased risk of congenital malformations in the neonates. Avoid use during this period
- Taper dose gradually to discontinue (abrupt cessation may cause a withdrawal syndrome)
- Monitor CBC, LFTs if prolonged therapy
Cautions: Use cautiously in
- Renal impairment
- Hepatic impairment
- CNS depressant use
- Impaired pulmonary function
- Psychosis
- Suicidal ideation
- Alcohol abuse
- Substance abuse
- Geriatric patients
Pregnancy Category:D
Breastfeeding: Safety unknown. Due to long half-life of diazepam and nordiazepam, timing breastfeeding with respect to the dose would be of little benefit in reducing infant exposure. Other agents should be preferred, especially while nursing a newborn or preterm infant. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 3 November 2009).
