Parenteral Manual

Diazepam

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
VALIUM®, VIVOL®
Classification: 
Anxiolytic, anticonvulsant, muscle relaxant
Original Date: 
August 2005
Revised Date: 
October 2009
Indications: 
  • Acute anxiety or tension states                                                                                   
  • Alleviation of symptoms of acute alcohol withdrawal
  • Temporary control of prolonged and severe recurrent seizures
  • Premedication for relief of anxiety before surgery
Reconstitution and Stability: 
  • Stable at room temperature. Protect from light.
  • Available as a 5 mg/mL ampoule. DO NOT DILUTE
Compatibility: 

- Solutions Compatible: no information

- Additives/Above Cassette Compatible: no information

- Y-site Compatible: no information

- Incompatible: do not mix with any other drug or IV fluid

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM YES, deep into the muscle (absorption is delayed and unpredictable)
IV Direct

YES

Administration into tubing of a running IV is not recommended.  If necessary, it should be administered as close to the vein as possible

Usual dilution: undiluted into a large vessel (i.e: antecubital vein)
Infusion time: 3-5 minutes
Infusion rate: 1-2 mg/minute in children and 5 mg/minute in adults
IV Intermittent Infusion NO
IV Continuous Infusion NO
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Pediatric:   

  • Sedative/muscle relaxant: 0.04-0.3 mg/kg/dose IM/IV; may repeat in 2-4 hours prn.  
                                              Maximum:  0.6 mg/kg/8 hour period          
  • Status epilepticus: 0.05-0.3 mg/kg/dose IV Q 15-30 minutes to a maximum total dose of: 
      < 5 yrs: 5 mg
      > 5 yrs: 10 mg

Adolescent/Adult:  

  • Sedative/muscle relaxant: 2-10 mg/dose IM/IV Q 3-4 hours prn
  • Status epilepticus:  5-10 mg IV Q 10-15 minutes; may repeat in 2-4 hours   
                                  Maximum: 30 mg/8 hour period    
Potential hazards of parenteral administration: 
  • Thrombophlebitis; DO NOT administer into small veins, avoid intra-arterial administration or extravasation
  • Local irritation, pain with IM injection                                
  • Hypotension (antidote - norepinephrine or dopamine), bradycardia, cardiovascular collapse
  • Respiratory depression
  • Drowsiness, ataxia, dizziness
  • Laryngospasm
  • Paradoxical reactions (rare)
  • CNS depression
Notes: 
  • Use with caution in severe hepatic failure                                                           
  • May be potentiated if given concomitantly with other psychotropic agents, CNS depressants                           
  • Even though it is given in status epilepticus, it may induce or aggravate seizures in some patients with convulsive disorders (rare)
  • As a premedicant, diazepam should be given 45-60 minutes prior to procedure            
  • Monitor HR, RR, BP
  • Contraindicated in hyperbilirubinemic infants due to sodium benzoate preservative in injectable vehicle
  • Oral absorption is more predictable than IM absorption.

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