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Diazepam Dosage

Medically reviewed on December 12, 2017.

Applies to the following strengths: 15 mg; 5 mg/mL; 2 mg; 5 mg; 10 mg; 5 mg/5 mL; 2.5 mg; 20 mg

Usual Adult Dose for Anxiety

ORAL: 2 to 10 mg orally 2 to 4 times a day

PARENTERAL:
Moderate Anxiety Disorders and Symptoms: 2 to 5 mg IM or IV, repeated in 3 to 4 hours if necessary
Severe Anxiety Disorders and Symptoms: 5 to 10 mg IM or IV, repeated in 3 to 4 hours if necessary

Comments:
-Oral doses should be determined by the severity of symptoms.
-Anxiety associated with the stress of everyday life usually does not require treatment with this drug.

Use: Management of anxiety disorders and short-term relief of anxiety symptoms

Usual Adult Dose for Alcohol Withdrawal

ORAL:
-Initial dose: 10 mg orally 3 to 4 times a day for the first 24 hours
-Maintenance dose: 5 mg orally 3 to 4 times a day as needed

PARENTERAL: 10 mg IM or IV once, then 5 to 10 mg IM or IV in 3 to 4 hours if necessary

Use: Symptomatic relief of acute agitation, tremor, impending/acute delirium tremens, and hallucinations in acute alcohol withdrawal

Usual Adult Dose for Muscle Spasm

ORAL: 2 to 10 mg orally 3 to 4 times a day

PARENTERAL: 5 to 10 mg IM or IV, then 5 to 10 mg IM or IV in 3 to 4 hours if necessary

Comment: Larger parenteral doses may be necessary for patients with tetanus.

Use: Adjunctive treatment for the relief of skeletal muscle spasm due to reflex spasm to local pathology, spasticity caused by upper motor neuron disorders, athetosis, and stiff-man syndrome (e.g., inflammation of the muscles/joints secondary to trauma, cerebral palsy, paraplegia)

Usual Adult Dose for Seizures

ORAL: 2 to 10 mg orally 2 to 4 times a day

RECTAL:
-Initial dose: 0.2 mg/kg rectally, rounded upward to the next available dose. A 2.5 mg rectal dose may be given as a partial replacement if patients expel a portion of the initial dose
-If necessary, a second dose of 0.2 mg/kg may be given rectally 4 to 12 hours after the first dose.
-Maximum Frequency: May be used to treat up to 1 seizure episode every 5 days, and no more than 5 episodes/month

Uses:
-Management of selected, refractory patients with epilepsy on stable regimens of antiepileptic drugs who require intermittent use of this drug to control bouts of increased seizure activity
-Adjunctive treatment for convulsive disorders

Usual Adult Dose for Endoscopy or Radiology Premedication

PARENTERAL:
Cardioversion: 5 to 15 mg IV once 5 to 10 minutes before the procedure

Endoscopic Procedures:
IV: Usually less than 10 mg, but some patients require up to 20 mg IV, especially when narcotics are omitted
-IV titration: The IV dose should be titrated to desired sedative response (e.g., slurring of speech) with slow administration immediately before the procedure.

IM: 5 to 10 mg IM once 30 minutes prior to the procedure

Comments:
-Narcotic dosing should be reduced by approximately 33%, and may be omitted in some patients.
-The IV route is preferred, but IM administration may be used if IV administration is not possible.

Uses:
-Adjunct prior to endoscopic procedures if apprehension, anxiety, or acute stress reactions are present and to diminish recall of the procedures
-Prior to cardioversion for the relief of anxiety and tension and to diminish the patient's recall of the procedure

Usual Adult Dose for Status Epilepticus

PARENTERAL:
-Initial dose: 5 to 10 mg IV once, repeated at 10 to 15 minute intervals to a maximum dose of 30 mg if necessary

Comments:
-The IV route is preferred; however, the IM route may be used if IV administration is impossible.
-Treatment may be repeated every 2 to 4 hours, but active metabolites may persist during readministration.
-Patients with chronic lung disease or unstable cardiovascular conditions should be given this drug with extreme caution.

Use: Adjunct to status epilepticus and severe recurrent convulsive seizures

Usual Adult Dose for Light Anesthesia

PARENTERAL:
Preoperative Medication: 10 mg IM once before surgery

Comments:
-The IM route is preferred when given as a preoperative medication.
-Atropine, scopolamine, and other premedications should be administered in separate syringes.

Use: Premedication for the relief of anxiety and tension in patients undergoing surgical procedures

Usual Geriatric Dose for Seizures

ORAL:
-Initial dose: 2 to 2.5 mg orally once to 2 times a day

RECTAL:
-Initial dose: 0.2 mg/kg rectally, rounded downward to the next available dose. A 2.5 mg rectal dose may be given as a partial replacement if patients expel a portion of the initial dose
-If necessary, a second dose of 0.2 mg/kg may be given rectally 4 to 12 hours after the first dose.
-Maximum Frequency: May be used to treat up to 1 seizure episode every 5 days, and no more than 5 episodes/month

Comment: Oral doses may be increased gradually as needed and tolerated, but should be limited to the smallest effective amount

Uses:
-Management of selected, refractory patients with epilepsy on stable regimens of antiepileptic drugs who require intermittent use of this drug to control bouts of increased seizure activity
-Adjunctive treatment in convulsive disorders

Usual Geriatric Dose for Alcohol Withdrawal

ORAL:
-Initial dose: 2 to 2.5 mg orally once to 2 times a day

PARENTERAL:
-Initial dose: 2 to 5 mg IM or IV, repeated in 3 to 4 hours if necessary

Comments:
-Doses may be increased gradually as needed and tolerated, but should be limited to the smallest effective amount.
-Maintenance doses should be determined by clinical need and patient tolerance.

Uses:
-Management of anxiety disorders and short-term relief of anxiety symptoms
-Symptomatic relief of acute agitation, tremor, impending/acute delirium tremens, and hallucinations in acute alcohol withdrawal
-Adjunctive treatment for the relief of skeletal muscle spasm due to reflex spasm to local pathology, spasticity caused by upper motor neuron disorders, athetosis, and stiff-man syndrome (e.g., inflammation of the muscles/joints secondary to trauma, cerebral palsy, paraplegia)

Usual Geriatric Dose for Anxiety

ORAL:
-Initial dose: 2 to 2.5 mg orally once to 2 times a day

PARENTERAL:
-Initial dose: 2 to 5 mg IM or IV, repeated in 3 to 4 hours if necessary

Comments:
-Doses may be increased gradually as needed and tolerated, but should be limited to the smallest effective amount.
-Maintenance doses should be determined by clinical need and patient tolerance.

Uses:
-Management of anxiety disorders and short-term relief of anxiety symptoms
-Symptomatic relief of acute agitation, tremor, impending/acute delirium tremens, and hallucinations in acute alcohol withdrawal
-Adjunctive treatment for the relief of skeletal muscle spasm due to reflex spasm to local pathology, spasticity caused by upper motor neuron disorders, athetosis, and stiff-man syndrome (e.g., inflammation of the muscles/joints secondary to trauma, cerebral palsy, paraplegia)

Usual Geriatric Dose for Muscle Spasm

ORAL:
-Initial dose: 2 to 2.5 mg orally once to 2 times a day

PARENTERAL:
-Initial dose: 2 to 5 mg IM or IV, repeated in 3 to 4 hours if necessary

Comments:
-Doses may be increased gradually as needed and tolerated, but should be limited to the smallest effective amount.
-Maintenance doses should be determined by clinical need and patient tolerance.

Uses:
-Management of anxiety disorders and short-term relief of anxiety symptoms
-Symptomatic relief of acute agitation, tremor, impending/acute delirium tremens, and hallucinations in acute alcohol withdrawal
-Adjunctive treatment for the relief of skeletal muscle spasm due to reflex spasm to local pathology, spasticity caused by upper motor neuron disorders, athetosis, and stiff-man syndrome (e.g., inflammation of the muscles/joints secondary to trauma, cerebral palsy, paraplegia)

Usual Pediatric Dose for Seizures

ORAL:
6 months and older:
-Initial dose: 1 to 2.5 mg orally 3 to 4 times a day

RECTAL:
2 to 5 years:
-Initial dose: 0.5 mg/kg rectally, rounded upward to the next available dose. A 2.5 mg rectal dose may be given as a partial replacement if patients expel a portion of the initial dose
-If necessary, a second dose of 0.5 mg/kg may be given rectally 4 to 12 hours after the first dose.
-Maximum Frequency: 1 episode every 5 days, and no more than 5 episodes/month

6 to 11 years:
-Initial dose: 0.3 mg/kg rectally, rounded upward to the next available dose. A 2.5 mg rectal dose may be given as a partial replacement if patients expel a portion of the initial dose
-If necessary, a second dose of 0.3 mg/kg may be given rectally 4 to 12 hours after the first dose.
-Maximum Frequency: 1 episode every 5 days, and no more than 5 episodes/month

12 years and older:
-Initial dose: 0.2 mg/kg rectally, rounded upward to the next available dose. A 2.5 mg rectal dose may be given as a partial replacement if patients expel a portion of the initial dose
-If necessary, a second dose of 0.2 mg/kg may be given rectally 4 to 12 hours after the first dose.
-Maximum Frequency: May be used to treat up to 1 seizure episode every 5 days, and no more than 5 episodes/month

Comment: Oral doses may be increased gradually as needed and tolerated, but should be limited to the smallest effective amount.

Uses:
-Management of selected, refractory patients with epilepsy on stable regimens of antiepileptic drugs who require intermittent use of this drug to control bouts of increased seizure activity
-Adjunctive treatment in convulsive disorders

Usual Pediatric Dose for Status Epilepticus

PARENTERAL:
IV Injection:
30 days to less than 5 years: 0.2 to 0.5 mg slow IV injection every 2 to 5 minutes, up to a maximum dose of 5 mg. Repeat in 2 to 4 hours if needed.

5 years and older: 1 mg slow IV injection every 2 to 5 minutes, up to a maximum dose of 10 mg. Repeat in 2 to 4 hours if needed.

Comment: EEG monitoring may be helpful to monitor seizure activity.

Use: Adjunct in status epilepticus and severe recurrent convulsive seizures

Usual Pediatric Dose for Anxiety

ORAL:
6 months and older:
-Initial dose: 1 to 2.5 mg orally 3 to 4 times a day

Comments:
-Doses may be increased gradually as needed and tolerated, but should be limited to the smallest effective amount.
-Maintenance doses should be determined by clinical need and patient tolerance.

Uses:
-Management of anxiety disorders and short-term relief of anxiety symptoms
-Symptomatic relief of acute agitation, tremor, impending/acute delirium tremens, and hallucinations in acute alcohol withdrawal
-Adjunctive treatment for the relief of skeletal muscle spasm due to reflex spasm to local pathology, spasticity caused by upper motor neuron disorders, athetosis, and stiff-man syndrome (e.g., inflammation of the muscles/joints secondary to trauma, cerebral palsy, paraplegia)

Usual Pediatric Dose for Muscle Spasm

ORAL:
6 months and older:
-Initial dose: 1 to 2.5 mg orally 3 to 4 times a day

Comments:
-Doses may be increased gradually as needed and tolerated, but should be limited to the smallest effective amount.
-Maintenance doses should be determined by clinical need and patient tolerance.

Uses:
-Management of anxiety disorders and short-term relief of anxiety symptoms
-Symptomatic relief of acute agitation, tremor, impending/acute delirium tremens, and hallucinations in acute alcohol withdrawal
-Adjunctive treatment for the relief of skeletal muscle spasm due to reflex spasm to local pathology, spasticity caused by upper motor neuron disorders, athetosis, and stiff-man syndrome (e.g., inflammation of the muscles/joints secondary to trauma, cerebral palsy, paraplegia)

Usual Pediatric Dose for Seizure Prophylaxis

ORAL:
6 months and older:
-Initial dose: 1 to 2.5 mg orally 3 to 4 times a day

Comments:
-Doses may be increased gradually as needed and tolerated, but should be limited to the smallest effective amount.
-Maintenance doses should be determined by clinical need and patient tolerance.

Uses:
-Management of anxiety disorders and short-term relief of anxiety symptoms
-Symptomatic relief of acute agitation, tremor, impending/acute delirium tremens, and hallucinations in acute alcohol withdrawal
-Adjunctive treatment for the relief of skeletal muscle spasm due to reflex spasm to local pathology, spasticity caused by upper motor neuron disorders, athetosis, and stiff-man syndrome (e.g., inflammation of the muscles/joints secondary to trauma, cerebral palsy, paraplegia)

Usual Pediatric Dose for Tetanus

PARENTERAL:
30 days to 5 years: 1 to 2 mg IM or slow IV injection, repeated every 3 to 4 hours as necessary

5 years and older: 5 to 10 mg IM or slow IV injection, repeated every 3 to 4 hours as necessary to control spasms

Comment: Respiratory assistance should be available for patients.

Use: Tetanus

Renal Dose Adjustments

Renal dysfunction:
-Oral formulations: Data not available
-Parenteral and rectal formulations: Use with caution

Liver Dose Adjustments

Patients with liver disease: Use with caution (parenteral and rectal formulations)
Mild to moderate hepatic insufficiency: Dose adjustment(s) may be required; however, no specific guidelines have been suggested. Caution recommended. (oral formulations)
Severe hepatic insufficiency: Contraindicated (oral formulations)

Dose Adjustments

Debilitated patients:
Oral:
-Initial dose: 2 to 2.5 mg orally once or 2 times a day

Parenteral:
-Initial dose: 2 to 5 mg once a day

Rectal:
-Initial dose: 0.2 mg/kg rectally, rounded downward to the next available dose. A 2.5 mg rectal dose may be given as a partial replacement if patients expel a portion of the initial dose
-If necessary, a second dose of 0.2 mg/kg may be given rectally 4 to 12 hours after the first dose.
-Maximum Frequency: May be used to treat up to 1 seizure episode every 5 days, and no more than 5 episodes/month

Precautions

US BOXED WARNINGS:
RISKS FROM CONCOMITANT USE WITH OPIOIDS:
-Concomitant use of benzodiazepines and opioids may result in profound sedation, respiratory depression, coma, and death.
-Reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate.
-Limit dosages and durations to the minimum required.
-Follow patients for signs and symptoms of respiratory depression and sedation.

Safety and efficacy have not been established in patients younger than 30 days (parenteral formulations), 6 months (oral formulations), and 2 years (rectal formulations).

Consult WARNINGS section for additional precautions.

US Controlled Substance: Schedule IV

Dialysis

Data not available

Other Comments

Administration advice:
-IV administration: This drug should be injected slowly (at a rate of at least 1 minute for every 5 mg OR 1 mL/min), avoiding small veins. If direct IV injection is not possible, treatment should be injected slowly through infusion tubing as close as possible to vein insertion.
-Pediatric IV administration: The IV should be given slowly, over a 3-minute period at a rate of 0.25 mg/kg or slower. After 15 to 30 minutes, the initial dosage may be repeated. The use of emulsion for injection formulations should be carefully considered in pediatric patient populations.
-IM administration: This drug should be injected deeply into the muscle.
-Rectal formulations: Patients and caregivers should review administration steps included in the manufacturer product information.

Storage requirements:
-Emulsion for injection: When used as a continuous infusion, the mixed product should be used within 6 hours. When used as an injection, the dose should be drawn into a syringe immediately before administration.
-Oral concentrated solution: Once mixed into food/liquid, the solution should not be stored for future use.

Reconstitution/preparation techniques:
-Emulsion for injection: When used for continuous infusion, the emulsion may be added to dextrose 5% or 10% to make a solution with a concentration of 0.1 to 0.4 mg/mL.
-Oral concentrated solution: The concentrated solution should be dosed with the included calibrated dropper and mixed into liquids or semi-soft foods. Once the solution is added to the liquid/food, it should be mixed for a few seconds; patients should immediately consume the entire dose.
-Solution for injection: When used for continuous infusion, the solution should be used immediately after mixing with infusion fluid.

IV compatibility:
-Emulsion for Injection: When used as a continuous infusion, the emulsion may be mixed with intralipid 10% or 20%, but mixture with saline solutions should be avoided. Adsorption into plastic infusion equipment may occur, but may be less than with other formulations.
-Solution for Injection: When used as a continuous infusion, this formulation should be mixed with at least 200 mL of sodium chloride or dextrose in glass bottles. Adsorption into plastic bags may occur.

General:
-Rectal solution formulations are recommended in patients who require rapid treatment, but cannot receive IV formulations.
-Efficacy of long-term use (e.g., longer than 4 months) of the oral solution has not been established. Patients should be regularly reassessed for continued need of treatment, especially when they are symptom-free.
-Patients should receive the lowest effective dose for the shortest amount of time.
-If a third IV dose does not relieve symptoms in pediatric patients, adjunctive therapy appropriate to the condition should be used.

Monitoring:
-Renal function, especially in elderly patients with decreased renal function
-Periodic blood counts, especially in patients on long-term therapy
-Periodic liver function tests, especially in patients on long-term therapy
-Sedation, especially within 1 hour of administration AND when given a parenteral formulation

Patient advice:
-Advise patients to speak to their healthcare provider if they become pregnant, intend to become pregnant, or are breastfeeding.
-Inform patients that this drug may cause drowsiness, and they should avoid driving or operating machinery until the full effects of the drug are seen.
-Patients and their caregivers should be told to report any signs/symptoms of respiratory depression or profound sedation.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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