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DIAZEPAM

(dye-az'e-pam)
Apo-Diazepam , Diastat, Diazemuls , E-Pam , Meval , Novodipam ,
Valium, Valrelease, Vivol
DIAZEPAM EMULSIFIED
Dizac
Classifications: CENTRAL NERVOUS SYSTEM AGENT; BENZODIAZEPINE
ANTICONVULSANT; ANXIOLYTIC
Pregnancy Category: D
Controlled Substance: Schedule IV

Availability
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

Actions
Psychotherapeutic agent related to chlordiazepoxide; reportedly superior in antianxiety
and anticonvulsant activity, with somewhat shorter duration of action. Like
chlordiazepoxide, it appears to act at both limbic and subcortical levels of CNS.

Therapeutic Effects
Shortens REM and stage 4 sleep but increases total sleep time. Antianxiety and
anticonvulsant agent.

Uses
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.

Contraindications
Injectable form: Shock, coma, acute alcohol intoxication, depressed vital signs,
obstetrical patients, infants <30 d of age. Tablet form: Infants <6 mo of age, acute
narrow-angle glaucoma, untreated open-angle glaucoma; during or within 14 d of MAO
inhibitor therapy. Safe use during pregnancy (category D) and lactation is not established.

Cautious Use
Epilepsy, psychoses, mental depression; myasthenia gravis; impaired hepatic or renal
function; drug abuse, addiction-prone individuals. Injectable diazepam used with extreme
caution in older adults, the very ill, and patients with COPD.

Route & Dosage

Status Epilepticus
Adult: IV/IM 5–10 mg, repeat if needed at 10–15 min intervals up to 30 mg, then repeat if
needed q2–4h
Child: IV/IM <5 y, 0.2–0.5 mg slowly q2–5min up to 5 mg; >5 y, 1 mg slowly q2–5min up
to 10 mg, repeat if needed q2–4 h

Anxiety, Muscle Spasm, Convulsions, Alcohol Withdrawal


Adult: PO 2–10 mg b.i.d. to q.i.d. or 15–30 mg/d sustained release IV/IM 2–10 mg, repeat
if needed in 3–4 h
Geriatric: PO 1–2 mg 1–2 times/d (max: 10 mg/d)
Child: PO >6 mo, 1–2.5 mg b.i.d. or t.i.d.

Administration
Note: Dizac emulsion is administered by IV only.

Oral

• 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.

Intramuscular

• 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.

Intravenous

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, benzquinamide, dobutamine,


doxapram, doxorubicin, fluorouracil, glycopyrrolate, heparin, nalbuphone,
sufentanil. Emulsion also incompatible with morphine. Y-site: Furosemide, heparin,
potassium chloride, vitamin B complex with C. Emulsion also incompatible with
morphine. 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.

Interactions
Drug: Alcohol, CNS DEPRESSANTS, ANTICONVULSANTS potentiate CNS depression;
cimetidine increases diazepam plasma levels, increases toxicity; may decrease
antiparkinson effects of levodopa; may increase phenytoin levels; smoking decreases
sedative and antianxiety effects. Herbal: Kava kava, valerian may potentiate sedation.

Pharmacokinetics
Absorption: Readily absorbed from GI tract; erratic IM absorption. Onset: 30–60 min
PO; 15–30 min IM; 1–5 min IV. Peak: 1–2 h PO. Duration: 15 min–1 h IV; up to 3 h
PO. Distribution: Crosses blood–brain barrier and placenta; distributed into breast milk.
Metabolism: Metabolized in liver to active metabolites. Elimination: Excreted primarily
in urine. Half-Life: 20–50 h.

NURSING IMPLICATIONS
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 1–2 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 nonsmoker.
• 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 is known.
• 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.
• Do not breast feed while taking this drug without consulting physician.

Common adverse effects in italic, life-threatening effects underlined: generic names in bold; classifications
in SMALL CAPS; Canadian drug name; Prototype drug

Copyright © 2006 Pearson Education, Inc. All Rights Reserved