Diazepam
Mechanism :
Diazepam is a benzodiazepine. Benzodiazepines presumably exert their effects by binding at stereo specific receptors at several sites within the central nervous system. All benzodiazepines cause a dose-related central nervous system depressant activity.
Indication :
- Status epilepticus
- Sedation (for procedures)
- Muscle Spasms
Contraindications :
Respiratory depression, especially seen with coexistent respiratory disease or myasthenia gravis; There is potential for growing dependence, therefore only short-term use is recommended; Acute porphyria.
Dosing :
Sedative/Muscle Relaxant:
Under 6 years:
Not recommended.
Above 12 years:
0.12 mg/kg/day orally in 3-4 divided doses OR 0.04-0.2 mg/kg intravenous/intramuscular every 2-4 hours; Max: 0.6 mg/kg every 8 hours.
Status Epilepticus:
Per rectal:
2-6 years:
0.5 mg/kg, repeat after 4-12 hours as per requirement.
6-12 years:
0.3 mg/kg, repeat after 4-12 hours as per requirement.
Above 12 years:
0.2 mg/kg, repeat after 4-12 hours as per requirement.
Intravenous:
6 months-5 years:
0.2-0.5 mg intravenously, can be repeated every 2-5 minutes; Max: 5 mg. Can be repeated 2-4 hours later as per requirement.
Above 5 years:
1 mg slow intravenous infusion every 2-5 minutes; Max: 10 mg: can be repeated after 2-4 hours if needed.
Adverse Effect :
Drowsiness, fatigue, ataxia, venous thrombosis and phlebitis at the site of injection, confusion, depression, dysarthria, headache, hypoactivity, slurred speech, syncope, tremor, vertigo, bradycardia, cardiovascular collapse, hypotension, blurred vision, diplopia, nystagmus, urticaria, skin rash, hiccups, changes in salivation, neutropenia, jaundice.
Interaction :
CNS depressants: Caution with other CNS depressants.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function |
| 10-20 | Use small doses and titrate to response |
| <10 | Use small doses and titrate to response |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Not dialysed. Dose as in GFR<10 mL/min |
| HD | Not dialysed. Dose as in GFR<10 mL/min |
| HDF/High flux | Unknown dialysability. Dose as in GFR<10 mL/min |
| CAV/VVHD | Not dialysed. Dose as in GFR=10– 20 mL/min |
Hepatic Dose :
Use with caution. Adjust dose as per clinical response.