Parenteral Manual

Diazepam emulsion (NON-FORMULARY)

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): 
DIAZEMULS®
Classification: 
Anxiolytic, sedative
Original Date: 
August 2005
Indications: 
  • Sedation/anxiolytic prior to procedures
  • Relief of muscle spasms in cerebral palsy
  • In place of diazepam IV solution to avoid local side effects (e.g. thrombophlebitis, local pain)
  • Not recommended for status epilepticus due to slow onset of action
Reconstitution and Stability: 
  • Available as 5 mg/mL ampoules. DO NOT further dilute
  • Stable at room temperature
  • Contains no preservative
  • When mixed with intralipid stable for 6 hours at room temperature

  • *DO NOT use PVC administration sets due to drug absorption

Compatibility: 

- Solutions Compatible: intralipid (own emulsion base)

- Additives/Above Cassette Compatible: no information

- Y-site Compatible: no information

Incompatible: morphine, glycopyrrolate, do not mix with other drugs or IV solutions

Administration: 

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

SC NO
IM YES, deep into muscle
IV Direct

YES, Note: Administration into tubing of a running IV is not recommended.  If necessary, it can be injected slowly through infusion tube as close as possible to the vein insertion

Usual dilution: undiluted (5 mg/mL)
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:  

  • Up to a maximum of 0.25 mg/kg/dose.  Can be cautiously repeated in 15-30 minutes PRN
  • Reassess treatment if 3 doses not effective to relieve symptoms.

Adult:      

  • 2-20 mg IV/IM Q 3-4 hours (dose may be repeated in 1 hour if needed)
Potential hazards of parenteral administration: 
  • Thrombophlebitis (administer slowly and into large veins where possible, e.g., antecubital vein)
  • Drowsiness, fatigue, ataxia
  • Confusion, hypotension, bradycardia, sedation, muscular weakness
  • Blurred vision, constipation, nausea
  • Laryngospasm
  • Neutropenia, jaundice
Notes: 
  • *Watch for egg and soybean oil allergies
  • Contraindications: patients with egg or soybean allergies, patients in shock or coma (possible apnea or cardiac arrest), or in neonates <30 days due to accumulation of metabolite.
  • Diazepam emulsion is different than the IV solution in its formulation and in its pharmacokinetics (the emulsion takes longer to take effect and to reach peak blood levels)
  • Onset: IM = 2 hours and IV = 15 minutes
  • Sedation and respiratory depression increased when used concomitantly with narcotic analgesics or other CNS depressants
  • Premedicate approximately 30 minutes prior to procedure

 

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