Brand Name:

Generic Name:

Classification: BENZODIAZEPINES

Recommended Dosage, Route, and Frequency:

Antianxiety
Adult: PO 2–6 mg/d in divided doses (max: 10 mg/d)
Geriatric: PO 0.5–1 mg/d (max: 2 mg/d)
Child: PO/IV 0.05 mg/kg q4–8h (max: 2 mg/dose)
Insomnia
Adult: PO 2–4 mg at bedtime
Geriatric: PO 0.5–1 mg h.s.
Premedication
Adult: IM 2–4 mg (0.05 mg/kg) at least 2 h before surgery IV 0.044 mg/kg up to 2 mg 15–20 min before
surgery
Child: PO/IV/IM 0.05 mg/kg (range: 0.02–0.09 mg/kg)
Status Epilepticus
Adult: IV 4 mg injected slowly at 2 mg/min, may repeat dose once if inadequate response after 10 min
Child: IV 0.1 mg/kg slow IV over 2–5 min (max: 4 mg/dose), may repeat with 0.05 mg in 10–15 min if
needed
Neonate: IV 0.05 mg/kg over 2–5 min, may repeat in 10–15 min repeat q 2– 4 hr.
Drug Action: ADME, Onset, Peak, Duration

Depresses the CNS, probably by potentiating GABA, an inhibitory neurotransmitter. Produces skeletal
muscle relaxation by inhibiting spinal polysynaptic afferent pathways. Has anticonvulsant properties due
to enhanced presynaptic inhibition.Therapeutic Effects: Relief of anxiety. Sedation. Amnesia. Skeletal
muscle relaxation. Decreased seizure activity.
Absorption: Rapidly absorbed from the GI tract. Absorption from IM sites may be slow and
unpredictable. Well absorbed (90%) from rectal mucosa.
Distribution: Widely distributed. Crosses the blood-brain barrier. Crosses the placenta; enters breast
milk.
Metabolism and Excretion: Highly metabolized by the hepatic P450 enzymes (CYP2C19 and CYP3A4); the
CYP2C19 enzyme system exhibits genetic polymorphism;

Drug-Drug and Drug-Food Interactions:

Drug-Drug: Alcohol, antidepressants, antihistamines, and opioid analgesics— concurrent use results in
additive CNS depression

Indications:

Adjunct in the management of: Anxiety Disorder, Athetosis, Anxiety relief prior to cardioversion
(injection), Stiffman Syndrome, Preoperative sedation, Conscious sedation (provides light anesthesia and
anterograde amnesia). Treatment of status epilepticus/uncontrolled seizures (injection). Skeletal muscle
relaxant. Management of the symptoms of alcohol withdrawal. Unlabeled Use: Anxiety associated with
acute myocardial infarction, insomnia.
Contraindications:

Contraindicated in: Hypersensitivity; Cross-sensitivity with other benzodiazepines may occur; Comatose
patients; Myasthenia gravis; Severe pulmonary impairment; Sleep apnea; Severe hepatic dysfunction;
Pre-existing CNS depression; Uncontrolled severe pain; Angle-closure glaucoma; Some products contain
alcohol, propylene glycol, or tartrazine and should be avoided in patients with known hypersensitivity or
intolerance;OB:qrisk of congenital malformations; Pedi: Children 6 mo

Side Effects: By system

CNS: dizziness, drowsiness, headache EENT: blurred vision GI: constipation, diarrhea, nausea, vomiting
Derm: rashes

Adverse Reaction: By system

CNS: dizziness, drowsiness, lethargy, depression, hangover, ataxia, slurred speech, headache,
paradoxical excitation. EENT: blurred vision. Resp: RESPIRATORY DEPRESSION. CV: hypotension (IV only).
GI: constipation, diarrhea (may be caused by propylene glycol content in oral solution), nausea,
vomiting, weight gain. Derm: rashes. Local: pain (IM), phlebitis (IV), venous thrombosis.Misc: physical
dependence, psychological dependence, tolerance.

Nursing Responsibilities: (ADPIE Format)

Assessment
● Geri: Assess risk of falls and institute fall prevention strategies. ● Anxiety: Assess mental status
(orientation, mood, behavior) and degree of anxiety ● Muscle Spasms: Assess muscle spasm, associated
pain, and limitation of movement prior to and during therapy. ● Alcohol Withdrawal
Potential Nursing Diagnoses
Anxiety (Indications) Impaired physical mobility (Indications)
Risk for injury (Side Effects)
Implementation
● Patient should be kept on bedrest and observed for at least 3 hr following parenteral administration. ●
PO: Tablets may be crushed and taken with food or water if patient has difficulty swallowing.
Patient/Family Teaching
● Seizures: Patients on anticonvulsant therapy should carry identification describing disease process and
medication regimen at all times.
Evaluation/Desired Outcomes
● Decrease in anxiety level. Full therapeutic antianxiety effects occur after 1– 2 wk of therapy. ●
Decreased recall of surgical or diagnostic procedures. ● Control of seizures. ● Decrease in muscle
spasms. ● Decreased tremulousness and more rational ideation when used for alcohol withdrawal.