| Name: |
DIAZEPAM (ValiumR) |
| Classification: |
Anxiolytic agent; sedative; anticonvulsant:
- Used in the initial control of seizures or in the treatment of status epilepticus
- Has no long-term anticonvulsant activity
- Useful in the management of alcohol withdrawal and delirium tremens
- Muscle relaxant - useful in patient with tetanus
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| Dose: |
- Dose must be individualized
- Anxiolytic, sedative: 2-5 mg IV (moderate anxiety)
- 5-10 mg IV (severe anxiety)
- Alcohol withdrawal: 5-20 mg IV repeated as needed (intervals from 5 minutes to 4 hours)
- Anticonvulsant: 5-10 mg IV which may be repeated at 10 - 15 min. intervals (up to 30 mg in an 8-hour period)
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| Administration: |
IV Direct
- Rate of administration should not exceed 5 mg/min
- Conflicting data about diazepam's solubility and stability in an infusion, therefore not recommended
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| Contraindications: |
- Respiratory depression and partial airway obstruction, especially when combined with narcotics or in patients with hypercarbic respiratory disease
- Known hypersensitivity to diazepam or its components.
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| Adverse Effects: |
- Respiratory depression and partial airway obstruction, especially when combined with narcotics or during rapid administration
- Hypotension
- Bradycardia, cardiac arrest
- Laryngospasm
- Headache, confusion, drowsiness, dizziness, excessive sedation
- Amnesia, lack of recall
- Slurred speech, ataxia, impaired coordination
- Paradoxical reaction (excitatory)
- May worsen depression or psychosis
- Rash, dermatitis
- Blurred vision, diplopia
- TWithdrawal; prolonged use of continuous benzodiazepines should be weaned
Diazepam is a vesicant and may cause thrombophlebitis, or progressive and severe tissue injury. Ensure IV patency before and after administration. Inject into the tubing of a rapidly flowing IV as close as possible to site. Central venous administration if possible.
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| Caution: |
- adverse effects may be amplified in the presence of hepatic or renal failure
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| Antidote: |
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| Drug Interactions: |
- diazepam + other CNS depressants = increased sedation
|
| Monitoring Therapy: |
- Respiratory rate
- Oxygen Saturation
- Blood pressure
- Response to sedation
- Delirium screening
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| Adult Critical Care Protocol: |
- May be administered IV direct or by IV infusion by a nurse in Adult Critical Care
- May be titrated by a nurse in Adult Critical Care.
- Continuous infusions must be administered by infusion device and the pump library must be enabled.
- Central venous access preferred due to vein irritation (consider alternate benzodiazepine for IV use)
- Order written to provide sedation during mechanical ventilation should be discontinued when patient is no longer receiving mechanical ventilation support.
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