Potentiation of the effect of gamma-amino butyrate (GABA). Example: diazepam,

Specific Dosages

Dosing: Adult

Note: Oral absorption is more reliable than I.M.

Acute ethanol withdrawal: Oral: 10 mg 3-4 times during first 24 hours, then decrease to 5 mg 3-4 times/day as needed

Anticonvulsant (acute treatment): Rectal gel: 0.2 mg/kg. Note: Dosage should be rounded upward to the next available dose, 2.5, 5, 7.5, 10, 12.5, 15, 17.5, and 20 mg/dose; dose may be repeated in 4-12 hours if needed; do not use for more than 5 episodes per month or more than one episode every 5 days.

Anxiety (symptoms/disorders):

Oral: 2-10 mg 2-4 times/day

I.M., I.V.: 2-10 mg, may repeat in 3-4 hours if needed

Muscle spasm: I.V., I.M.: Initial: 5-10 mg; then 5-10 mg in 3-4 hours, if necessary. Larger doses may be required if associated with tetanus.

Sedation in the ICU patient: I.V.: 0.03-0.1 mg/kg every 30 minutes to 6 hours

Skeletal muscle relaxant (adjunct therapy): Oral: 2-10 mg 3-4 times/day

Status epilepticus:

I.V.: 5-10 mg every 5-10 minutes given over ≤5 mg/minute (maximum dose: 30 mg)

Rectal gel: Premonitory/out-of-hospital treatment: 10 mg once; may repeat once if necessary

Rapid tranquilization of agitated patient (administer every 30-60 minutes): Oral: 5-10 mg; average total dose for tranquilization: 20-60 mg

Dosing: Pediatric

(For additional information see "Diazepam: Pediatric drug information")

Anticonvulsant (acute treatment): Rectal gel:

Children <2 years: Safety and efficacy have not been studied

Children 2-5 years: 0.5 mg/kg

Children 6-11 years: 0.3 mg/kg

Children ≥12 years: Refer to adult dosing.

Note: Dosage should be rounded upward to the next available dose, 2.5, 5, 7.5, 10, 12.5, 15, 17.5, and 20 mg/dose; dose may be repeated in 4-12 hours if needed; do not use for more than 5 episodes per month or more than one episode every 5 days.

Conscious sedation for procedures:

Oral:

Children: 0.2-0.3 mg/kg (maximum dose: 10 mg) 45-60 minutes prior to procedure

Adolescents: 10 mg

I.V.: Adolescents: 5 mg; may repeat with 2.5 mg if needed

Febrile seizure prophylaxis: Oral: Children: 1 mg/kg/day divided every 8 hours; initiate therapy at first sign of fever and continue for 24 hours after fever is gone

Muscle spasm associated with tetanus: I.V., I.M.:

Infants >30 days: 1-2 mg/dose every 3-4 hours as needed

Children ≥5 years: 5-10 mg/dose every 3-4 hours as needed

Sedation or muscle relaxation or anxiety:

Oral: Children: 0.12-0.8 mg/kg/day in divided doses every 6-8 hours

I.M., I.V.: Children: 0.04-0.3 mg/kg/dose every 2-4 hours to a maximum of 0.6 mg/kg within an 8-hour period if needed

Spasticity in cerebral palsy (unlabeled use): Oral: Dose should be individualized:

Children ≤5 years: <8.5 kg: 0.5-1 mg at bedtime; 8.5-15 kg: 1-2 mg at bedtime (Mathew, 2005)

Children 5-16 years: 1.25 mg 3 times daily to 5 mg 4 times daily (Engle, 1966)

Status epilepticus:

I.V.: Infants >30 days and Children: 0.1-0.3 mg/kg given over ≤5 mg/minute; may repeat dose after 5-10 minutes; maximum: 10 mg/dose (Hegenbarth, 2008)

Rectal: 0.5 mg/kg/dose then 0.25 mg/kg/dose in 10 minutes if needed (prepare dose using parenteral formulation)

Dosing: Geriatric

Oral absorption is more reliable than I.M.. Elderly and/or debilitated patients:

Oral: 2-2.5 mg 1-2 times/day initially; increase gradually as needed and tolerated.

Rectal gel: Due to the increased half-life in elderly and debilitated patients, consider reducing dose.

Dosing: Renal Impairment

No dose adjustment recommended; decrease dose if administered for prolonged periods.

I.V.: Risk of propylene glycol toxicity; monitor closely if using for prolonged periods or at high doses.

Hemodialysis: Not dialyzable (0% to 5%); supplemental dose is not necessary.

Dosing: Hepatic Impairment

Use caution.

Dosage Forms: U.S.

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Gel, rectal [adult rectal tip (6 cm)]: 20 mg (4 mL) [delivers set doses of 12.5 mg, 15 mg, 17.5 mg, 20 mg]

Diastat® AcuDial™: 20 mg (4 mL) [contains benzoic acid, benzyl alcohol, ethanol 10%, propylene glycol, sodium benzoate; 5 mg/mL (delivers set doses of 12.5 mg, 15 mg, 17.5 mg, and 20 mg)]

Gel, rectal [pediatric rectal tip (4.4 cm)]: 5 mg/mL (0.5 mL)

Diastat®: 5 mg/mL (0.5 mL) [contains benzoic acid, benzyl alcohol, ethanol 10%, propylene glycol, sodium benzoate]

Gel, rectal [pediatric/adult rectal tip (4.4 cm)]: 10 mg (2 mL) [delivers set doses of 5 mg, 7.5 mg, 10 mg]

Diastat® AcuDial™: 10 mg (2 mL) [contains benzoic acid, benzyl alcohol, ethanol 10%, propylene glycol, sodium benzoate; 5 mg/mL (delivers set doses of 5 mg, 7.5 mg, and 10 mg)]

Injection, solution: 5 mg/mL (2 mL, 10 mL)

Solution, oral: 5 mg/5 mL (5 mL, 500 mL)

Solution, oral [concentrate]:

Diazepam Intensol™: 5 mg/mL (30 mL) [contains ethanol 19%, propylene glycol]

Tablet, oral: 2 mg, 5 mg, 10 mg

Valium®: 5 mg, 10 mg [scored]

Valium®: 2 mg [scored; dye free]

Generic Equivalent Available: U.S.

Yes

Administration

Intensol™ should be diluted before use.

Continuous infusion is not recommended because of precipitation in I.V. fluids and absorption of drug into infusion bags and tubing. In children, do not exceed 1-2 mg/minute IVP; adults 5 mg/minute.

Rectal gel: Prior to administration, confirm that prescribed dose is visible and correct, and that the green “ready” band is visible. Patient should be positioned on side (facing person responsible for monitoring), with top leg bent forward. Insert rectal tip (lubricated) into rectum and push in plunger gently over 3 seconds. Remove tip of rectal syringe after 3 additional seconds. Buttocks should be held together for 3 seconds after removal. Dispose of syringe appropriately