Diazepam

Diazepam

[1 ampoule $1.84; 1 tablet 4 cents]

ADMINISTRATION ROUTES:

  • IV, IM, PO, PR

ALTERNATIVE NAMES:

  • Diazepam, Propam, Stesolid

ICU INDICATIONS:

  1. agitation
  2. alcohol and benzodiazepine withdrawal
  3. seizures

PRESENTATION AND ADMINISTRATION:

  • PO:
    Propam 2mg (white), 5mg (yellow), 10mg (blue) Diazepam elixir 10mg/10ml Stesolid (rectal tube) 5mg/2.5ml and 10mg/2.5ml
  • IV:
    10mg/2ml ampoule
    Inject undiluted solution slowly at a rate not exceeding 5mg/min (avoid injecting into small veins) In general, diazepam should not be mixed or diluted with other drugs or added to IV fluids. However, if IV infusion is required, diazepam in doses up to 20mg can be added to at least 250ml of 5% dextrose or normal saline.
    Do not use any solution that is cloudy.
    Store at room temperature and protect from light.
  • IM:
    Injection by this route is painful and absorption is slow and erratic. This route should be avoided where possible. If the IM route is used, inject undiluted.

DOSAGE:

  • IV, PO or PR: Usual dose 2-20mg 8-12 hourly

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

  • Dose in renal impairment [GFR (ml/min)]
    <10: use small doses and titrate to response
    10-20: use small doses and titrate to response
    >20-50: use small doses and titrate to response
  • Dose in renal replacement therapy
    CAPD: use small doses and titrate to response
    HD: use small doses and titrate to response
    CVVHDF: dose as in normal renal function

DOSAGE IN PAEDIATRICS:

  • IV or PR:
    0.1-0.4mg/kg
  • PO:
    0.04-0.2mg/kg 8-12 hourly; pre-med 0.2-0.4mg/kg oral

CLINICAL PHARMACOLOGY:

  • Diazepam is a benzodiazepine. As with other benzodiazepines it has anticonvulsant, anxiolytic, sedative and muscle relaxant properties.

CONTRAINDICATIONS:

  1. hyper sensitivity to diazepam

WARNINGS

  • Extreme care must be used in administering diazepam by the IV route to the elderly, to very ill patients and to those with limited pulmonary reserve because of the possibility that apnoea and/or cardiac arrest may occur. Concomitant use of barbiturates, alcohol or other central nervous system depressants increases depression with increased risk of apnoea. Tonic status epilepticus has been precipitated in patients treated with IV diazepam for petit mal status or petit mal variant status.

PRECAUTIONS

  • General:
    Although seizures may be brought under control promptly, a significant proportion of patients experience a return to seizure activity, presumably due to the short-lived effect of diazepam after IV administration. Diazepam is not recommended for maintenance, and once seizures are brought under control, consideration should be given to the administration of agents useful in longer term control of seizures.
    Withdrawal may precipitate seizures.
  • Laboratory Tests:
    No tests in addition to routine ICU tests are indicated
  • Drug/Laboratory Test Interactions:
    None known.

IMPORTANT DRUG INTERACTIONS FOR THE ICU

  • Increased CNS depression is seen when diazepam is combined with other CNS depressant drugs

ADVERSE REACTIONS

  • Central Nervous System:
    Confusion, drowsiness, ataxia, depression, dysarthria, headache, hypoactivity, slurred speech, syncope, tremor, vertigo. Paradoxical reactions such as acute hyperexcited states, anxiety, hallucinations, increased muscle spasticity, insomnia, rage, sleep disturbances and stimulation have been reported; should these occur, use of the drug should be discontinued. Minor changes in EEG patterns, usually low-voltage fast activity, have been observed in patients during and after diazepam therapy and are of no known significance.
  • Gastrointestinal System:
    Constipation, nausea, jaundice.
  • Genitourinary System:
    Incontinence, urinary retention.
  • Cardiovascular System:
    Bradycardia, cardiovascular collapse, hypotension
  • Skin:
    Urticaria, skin rash.
  • Haematological System:
    Neutropenia

Critical Care Drug Manual

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