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diazepam (injection)

Pronunciation

Generic Name: diazepam (injection) (dye AZ e pam)
Brand Name: Valium, Zetran

What is diazepam?

Diazepam is a benzodiazepine (ben-zoe-dye-AZE-eh-peen). Diazepam affects chemicals in the brain that may be unbalanced in people with certain conditions.

Diazepam injection is used to treat anxiety disorders, alcohol withdrawal symptoms, or muscle spasms. Diazepam injection is also used to treat a seizure emergency called status epilepticus.

Diazepam injection is sometimes used as a sedative to help you relax before having surgery or other medical procedure.

Diazepam may also be used for purposes not listed in this medication guide.

What is the most important information I should know about diazepam?

You should not receive this medicine if you have narrow-angle glaucoma, or untreated open-angle glaucoma.

Using diazepam with other drugs that make you sleepy or slow your breathing can cause dangerous or life-threatening side effects. Tell your doctor if you regularly use a sleeping pill, narcotic pain medicine, prescription cough medicine, a muscle relaxer, or medicine for anxiety, depression, or seizures.

Do not drink alcohol shortly after receiving diazepam injection. Dangerous side effects or death could occur.

What should I discuss with my healthcare provider before receiving diazepam?

You should not be treated with diazepam if you are allergic to it, or if you have:

  • narrow-angle glaucoma; or

  • untreated open-angle glaucoma.

To make sure diazepam is safe for you, tell your doctor if you have:

  • a history of glaucoma;

  • asthma, emphysema, bronchitis, chronic obstructive pulmonary disorder (COPD), or other breathing problems;

  • kidney or liver disease;

  • a history of mental illness, depression, or suicidal thoughts or behavior;

  • heart disease; or

  • if you have recently used alcohol, sedatives, tranquilizers, or narcotic (opioid) medications.

Diazepam can cause birth defects in an unborn baby, and generally should not be used during pregnancy. However, status epilepticus is a life-threatening condition and the benefit of receiving this medicine to treat it may outweigh any risk to the unborn baby.

Diazepam can pass into breast milk and may harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

In an emergency situation, it may not be possible before you are treated with diazepam to tell your caregivers if you are pregnant or breast feeding. Make sure any doctor caring for your pregnancy or your baby knows you have received this medication.

How is diazepam injection given?

Diazepam is injected into a muscle, or into a vein through an IV. You will receive this injection in a medical or surgical setting. Diazepam injection is for short-term use only.

Diazepam injection is usually given as a single dose just before a surgery or medical procedure. For other conditions, this medicine is usually given until you are able to take medicine by mouth.

You may need to receive only one dose of diazepam if your condition improves after the medicine is given.

When injected into a vein, diazepam must be given slowly. Tell your caregivers if you feel any burning, pain, or swelling around the IV needle when this medicine is injected.

After treatment with diazepam injection, you will be watched to make sure the medication is working and does not cause harmful side effects.

Your breathing, blood pressure, oxygen levels, and other vital signs will be watched closely while you are in surgery.

Diazepam can make you very drowsy, dizzy, or light-headed. These effects may last longer in older adults. Use caution to avoid falling or accidental injury after you have received diazepam injection. You may need help getting out of bed for at least the first several hours.

What happens if I miss a dose?

Because you will receive diazepam in a clinical setting, you are not likely to miss a dose.

What happens if I overdose?

Since this medication is given by a healthcare professional in a medical setting, an overdose is unlikely to occur.

What should I avoid after receiving diazepam?

Do not drink alcohol shortly after receiving diazepam injection. Dangerous side effects or death could occur.

Diazepam injection can cause extreme drowsiness that may last for several hours after you have received the medication. Older adults may feel sleepy for even longer.

Avoid driving or doing anything that requires you to be awake and alert until the effects of this medicine have worn off completely.

Diazepam side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Tell your caregivers right away if you have:

  • weak or shallow breathing;

  • restlessness, feeling agitated or irritable;

  • unusual thoughts, hallucinations; or

  • a light-headed feeling, like you might pass out.

The sedative effects of diazepam may last longer in older adults. Accidental falls are common in elderly patients who use benzodiazepines. Use caution to avoid falling or accidental injury shortly after receiving diazepam injection.

Common side effects may include:

  • drowsiness;

  • tired feeling;

  • muscle weakness, loss of coordination; or

  • bruising or swelling around the IV needle.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Diazepam dosing information

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

What other drugs will affect diazepam?

Shortly after you are treated with this medicine, taking other drugs that make you sleepy or slow your breathing can cause dangerous side effects. Tell your doctor if you regularly use a sleeping pill, narcotic pain medicine, prescription cough medicine, a muscle relaxer, or medicine for anxiety, depression, or seizures.

Tell your doctor about all your current medicines and any you start or stop using, especially:

  • any other benzodiazepines (such as alprazolam, diazepam, Valium, Xanax, and others);

  • cimetidine;

  • medicine to treat mental illness; or

  • an MAO inhibitor--isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, tranylcypromine, and others.

This list is not complete. Other drugs may interact with diazepam, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Where can I get more information?

  • Your pharmacist can provide more information about diazepam.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 1.01.

Date modified: June 01, 2017
Last reviewed: March 02, 2017

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