Diazepam Dosage

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Usual Adult Dose for Anxiety

Oral: 2 to 10 mg 2 to 4 times a day.
IM or IV: 2 to 5 mg (moderate anxiety) or 5 to 10 mg (severe anxiety) for one dose. May repeat in 3 to 4 hours, if necessary.

Usual Adult Dose for Alcohol Withdrawal

Oral: 10 mg 3 to 4 times during the first 24 hours, then 5 mg 3 to 4 times a day as needed.
IM or IV: 5 to 10 mg one time. May repeat in 3 to 4 hours, if necessary.

Usual Adult Dose for ICU Agitation

Initial dose: 0.02 to 0.08 mg/kg IV over 2 to 5 minutes every 0.5 to 2 hours to control acute agitation.
Maintenance dose: 0.4 to 0.2 mg/kg/hr by continuous IV infusion.

Usual Adult Dose for Muscle Spasm

Oral: 2 to 10 mg 3 to 4 times a day.
IM or IV: 5 to 10 mg initially, then 5 to 10 mg in 3 to 4 hours, if necessary. For tetanus, larger doses may be required.

Usual Adult Dose for Seizures

Oral: 2 to 10 mg 2 to 4 times a day.
Rectal gel: 0.2 mg/kg, rounded up to the nearest available unit dose. A supplemental dose of 2.5 mg may be added for more precise titration or if a portion of the first dose is expelled. May repeat in 4 to 12 hours. Maximum of 1 episode every 5 days, or 5 episodes per month.

Usual Adult Dose for Endoscopy or Radiology Premedication

IV: 10 mg or less is usually adequate; however up to 20 mg may be necessary to produce the desired sedation in some patients.
IM: If IV cannot be used, 5 to 10 mg 30 minutes prior to the procedure.
Dosage of narcotics should be reduced by at least a third and in some cases may be omitted.

Usual Adult Dose for Status Epilepticus

IV or IM: 5 to 10 mg initially (IV preferred).
May be repeated at 10 to 15 minute intervals up to a maximum dose of 30 mg.
If necessary, may be repeated again in 2 to 4 hours.

Usual Adult Dose for Light Anesthesia

Premedication for Anesthesia:
10 mg, IM (preferred route), 1 to 2 hours before surgery.

Usual Pediatric Dose for Seizures

Rectal gel:
Infants less than 6 months old: Not recommended; product contains benzoic acid, benzyl alcohol, ethanol 10%, propylene glycol, and sodium benzoate. Prolonged CNS depression has been reported in neonates receiving diazepam.
Infants and Children 6 months to 2 years: Dose not established
2 to 5 years: 0.5 mg/kg, rounded up to the nearest available unit dose.
6 to 11 years: 0.3 mg/kg, rounded up to the nearest available unit dose.
12 years or greater: 0.2 mg/kg, rounded up to the nearest available unit dose.
A supplemental dose of 2.5 mg may be added in 10 minutes for more precise titration or if a portion of the first dose is expelled. May repeat in 4 to 12 hours. Maximum of 1 episode every 5 days, or 5 episodes per month.

Usual Pediatric Dose for Status Epilepticus

Neonates: IV: (This is not recommended as a first line agent because the injection contains benzoic acid, benzyl alcohol, and sodium benzoate): 0.1 to 0.3 mg/kg/dose given over 3 to 5 minutes, every 15 to 30 minutes to a maximum total dose of 2 mg.

Infants greater than 30 days old and Children: IV: 0.1 to 0.3 mg/kg dose given over 3 to 5 minutes, every 5 to 10 minutes (maximum of 10 mg/dose).

Manufacturer recommendation:

Infants greater than 30 days old and Children less than 5 years: IV: 0.2 to 0.5 mg slow IV every 2 to 5 minutes up to a maximum total dose of 5 mg. Repeat in 2 to 4 hours if needed.

Children greater than or equal to 5 years: IV: 1 mg slow IV every 2 to 5 minutes up to a maximum of 10 mg. Repeat in 2 to 4 hours if needed.

Usual Pediatric Dose for Anxiety

1 to 12 years:
Oral: 0.12 to 0.8 mg/kg/day in divided doses every 6 to 8 hours as needed.

IM: 0.04 to 0.3 mg/kg every 2 to 4 hours as needed, up to a maximum of 0.6 mg/kg in 8 hours.

Febrile seizure prophylaxis in children: Oral: 1 mg/kg/day orally in divided doses every 8 hours. Initiate therapy at first sign of fever and continue for 24 hours after fever resolves.

Usual Pediatric Dose for Muscle Spasm

1 to 12 years:
Oral: 0.12 to 0.8 mg/kg/day in divided doses every 6 to 8 hours as needed.

IM: 0.04 to 0.3 mg/kg every 2 to 4 hours as needed, up to a maximum of 0.6 mg/kg in 8 hours.

Febrile seizure prophylaxis in children: Oral: 1 mg/kg/day orally in divided doses every 8 hours. Initiate therapy at first sign of fever and continue for 24 hours after fever resolves.

Usual Pediatric Dose for Seizure Prophylaxis

1 to 12 years:
Oral: 0.12 to 0.8 mg/kg/day in divided doses every 6 to 8 hours as needed.

IM: 0.04 to 0.3 mg/kg every 2 to 4 hours as needed, up to a maximum of 0.6 mg/kg in 8 hours.

Febrile seizure prophylaxis in children: Oral: 1 mg/kg/day orally in divided doses every 8 hours. Initiate therapy at first sign of fever and continue for 24 hours after fever resolves.

Usual Pediatric Dose for Light Sedation

Conscious sedation for procedures:
Oral:
1 to 12 years: 0.2 to 0.3 mg/kg orally 45 to 60 minutes before procedure, up to a maximum of 10 mg
13 to 18 years: 5 mg orally 45 to 60 minutes before procedure, may repeat with 2.5 mg dose.

Sedation:
1 to 12 years:
Oral: 0.02 to 0.3 mg/kg every 6 to 8 hours as needed.
IM: 0.04 to 0.3 mg/kg IM every 2 to 4 hours as needed, up to a maximum of 0.6 mg/kg in 8 hours.

13 to 18 years:
Oral: 2 to 10 mg 2 to 4 times a day as needed.
IM or IV: 2 to 10 mg 2 to 4 times a day as needed.

Usual Pediatric Dose for Tetanus

Less than 1 month: 0.83 to 1.67 mg/kg/hour by continuous IV infusion, or 1.67 to 3.33 mg/kg IV, slowly, every 2 hours (20 to 40 mg/kg/day). Diazepam injection is not recommended as the drug of choice for neonates due to its benzyl alcohol and propylene glycol content.

1 month to 5 years: 1 to 2 mg IM or IV, slowly, repeated every 3 to 4 hours as necessary, or 15 mg/kg/day in divided doses every 2 hours.

Greater than 5 years: 5 to 10 mg IM or IV, slowly, repeated every 3 to 4 hours as necessary.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

In mild and moderate cirrhosis, average half-life of diazepam is increased. The average increase has been variously reported from 2 to 5 fold, with individual half-lives over 500 hours. There is also an increase in volume of distribution, and average clearance decreases by almost half. Mean half-life is also prolonged with hepatic fibrosis to 90 hours, with chronic active hepatitis to 60 hours, and with acute viral hepatitis to 74 hours. In chronic active hepatitis, clearance is decreased by almost half.

Precautions

Should be used with caution in patients with renal or hepatic impairment.

Diazepam injection is not recommended for neonates due to its long half-life and prolonged central nervous system depression and potential toxicity associated with the benzyl alcohol preservative and propylene glycol solvent.

Safety and effectiveness have not been established in pediatric patients less than 6 months of age.

Dialysis

Diazepam is not dialyzable.

Other Comments

IV diazepam should be administered slowly over 2 to 5 minutes. Maximum IV push injection rate is 5 mg/minute for adults and 1 to 2 mg/minute for infants and children.

Oral concentrate should be diluted with liquids or semiliquid food immediately before use.

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