Diastat, Diazemuls , Valium
Classifications: benzodiazepine anticonvulsant; anxiolytic; Therapeutic: anticonvulsant; antianxiety
Pregnancy Category: D
Controlled Substance: Schedule IV
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
Long-acting benzodiazepine psychotherapeutic agent. Benzodiazepines act at the the limbic, thalamic, and hypothalamic regions
of the CNS and produce CNS depression resulting in sedation, hypnosis, skeletal muscle relaxation, and anticonvulsant activity
dependent on the dosage.
Has antianxiety, anticonvulsant, and skeletal muscle relaxation properties.
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.
Acute narrow-angle glaucoma, untreated open-angle glaucoma; during or within 14 d of MAOI therapy; pregnancy (category D),
lactation. Injectable form: Shock, coma, acute alcohol intoxication, depressed vital signs, obstetric patients, infants <30 d of age. Tablet form: Infants <6 mo of age.
Epilepsy, psychoses, mental depression; myasthenia gravis; impaired hepatic or renal function; neuromuscular disease; bipolar
disorder, dementia, Parkinson's disease; organic brain syndrome, psychosis, suicidal ideation; drug abuse, addiction-prone
individuals. Use injectable diazepam used with extreme caution in older adults, the very ill, and patients with COPD, or
Route & Dosage
Adult: IV/IM 510 mg, repeat if needed at 1015 min intervals up to 30 mg, then repeat if needed q24h
Child (≥5 y): IV 1 mg/kg q25min (max 10 mg) may repeat in 24 h
Child/Infant (1 mo5 y): IV 0.20.5 mg slowly q25min up to 5 mg
Neonate: IV 0.10.3 mg/kg q1530min (max total dose 2 mg)
Adult/Adolescent/Child (≥5 y): IV 510 mg q34h prn (larger dose for tetanus)
Child/Infant (1 mo5 y): IV 12 mg q34h prn
Adult/Adolescent: IV 210 mg, repeat if needed in 34 h
Child/Infant (≥6 mo): IV 0.040.3 mg q24h (max 0.6 mg/kg/8 h)
Adult: IV 10 mg then 510 mg in 34 h
Adult: IV 515 mg 510 min before procedure
- Ensure that sustained release form is not chewed or crushed. It MUST be swallowed whole. Give other tablets crushed with fluid or mixed with food if necessary.
- Supervise oral ingestion to ensure drug is swallowed.
- Avoid abrupt discontinuation of diazepam. Taper doses to termination.
- Give deep into large muscle mass. Inject slowly. Rotate injection sites.
- Do NOT give emulsion form (Dizac) as IM or SC. It is for IV use only.
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, dobutamine, doxorubicin, epinephrine, fluorouracil, furosemide, glycopyrrolate, nalbuphine, sodium bicarbonate. Emulsion also incompatible with morphine. Y-site: Amphotericin B cholesteryl complex, atracurium, bivalirudin, cefepime, dexmedetomidine, diltiazem, fenoldopam, fluconazole, foscarnet, furosemide, heparin, hetastarch, lansoprazole, linezolid, meropenem, oxaliplatin, pancuronium, potassium chloride, propofol, remifentanil, tirofiban, vecuronium, vitamin B complex with C. Do not mix emulsion with any other drugs. Do not administer through polyvinyl chloride (PVC) infusion sets.
- Store in tight, light-resistant containers at 15°30° C (59°86° F), unless otherwise specified
by manufacturer. Store Dizac emulsion at 2°8° C (36°46° F). Do not freeze.
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.
InteractionsDrug: Alcohol, cns depressants
increases diazepam plasma levels, increases toxicity; may decrease antiparkinson effects of levodopa;
may increase phenytoin
levels; smoking decreases sedative and antianxiety effects. Herbal: Kava, valerian
may potentiate sedation.
Readily from GI tract; erratic IM absorption. Onset:
3060 min PO; 1530 min IM; 15 min IV. Peak:
12 h PO. Duration:
15 min1 h IV; up to 3 h PO. Distribution:
Crosses bloodbrain barrier and placenta; distributed into breast milk. Metabolism:
In liver to active metabolites. Elimination:
Primarily in urine. Half-Life:
Assessment & Drug Effects
- Monitor for adverse reactions. Most are dose related. Physician will rely on accurate observation and reports of patient
response to the drug to determine lowest effective maintenance dose.
- Monitor for therapeutic effectiveness. Maximum effect may require 12 wk; patient tolerance to therapeutic effects may
develop after 4 wk of treatment.
- Observe necessary preventive precautions for suicidal tendencies that may be present in anxiety states accompanied by depression.
- Observe patient closely and monitor vital signs when diazepam is given parenterally; hypotension, muscular weakness, tachycardia,
and respiratory depression may occur.
- Lab tests: Periodic CBC and liver function tests during prolonged therapy.
- Supervise ambulation. Adverse reactions such as drowsiness and ataxia are more likely to occur in older adults and debilitated
or those receiving larger doses. Dosage adjustment may be necessary.
- Monitor I&O ratio, including urinary and bowel elimination.
- Note: Smoking increases metabolism of diazepam; lowering clinical effectiveness. Heavy smokers may need a higher dose than the
- Note: Psychic and physical dependence may occur in patients on long-term high dosage therapy, in those with histories of alcohol
or drug addiction, or in those who self-medicate.
Patient & Family Education
- Avoid alcohol and other CNS depressants during therapy unless otherwise advised by physician. Concomitant use of these agents
can cause severe drowsiness, respiratory depression, and apnea.
- Do not drive or engage in other potentially hazardous activities or those requiring mental precision until reaction to drug
- Tell physician if you become or intend to become pregnant during therapy; drug may need to be discontinued.
- Take drug as prescribed; do not change dose or dose intervals.
- Check with physician before taking any OTC drugs.