Diazepam*

• Diazepam

• Valium

Classification:

• Benzodiazepine

Mechanism of Action:

• Improves the action of gamma amino butyric acid, which depresses the CNS at limbic thalamic and hypothalamic levels, producing anti-anxiety effects
• Anticonvulsant: slows the spread of irritable foci in the cortex, thalamus and limbic areas of the brain.
• Skeletal muscle relaxant: inhibits polysynaptic afferent pathways
• Induces amnesia

Indications:

• Seizures/Status epilepticus
• Post ETI sedation
• Seizures in pre-eclampsia uncontrolled by magnesium
• Premedication before cardioversion and/or pacing
• Skeletal muscle relaxant
• Acute anxiety states
• Acute alcohol withdraw including delirium tremens
• Cocaine overdose
  

Contraindications:

• Known history of hypersensitivity
• Hypotension (BP less than 100)
• Acute narrow (closed) angle glaucoma
  

Precautions:

• Use with caution in the elderly
• Incompatible with many medications
• Use the minimal dose possible for patients with heart failure/pulmonary edema or head injured patients who have normal or low BP.
• Consider other differential diagnoses such as sepsis or alcoholic ketoacidosis or upper GI bleeding when alcohol withdrawal is suspected.
• Compromised respiratory status
• Concomitant use of CNS depressant drugs or medications
• Can cause local venous irritation
  • Inject into relatively large veins
  • Should not be given faster than 1 ml/min

Adverse Effects:

• Hypotension
• Drowsiness
• Headache
• Amnesia
• Respiratory depression
• Blurred vision
• Nausea and vomiting

Dose:

Adult:

• Actively seizing: 5 mg IV/IO slow push; repeat immediately x 1 if required (maximum total dose of 10 mg).
• Post ETI sedation: 2.5-5.0 mg IV/IO push as required (maximum total dose of 10 mg).
• Acute alcohol withdrawal (moderate/severe): 10 mg IV/IO slow push; repeat q 10 minutes if symptoms are still present [MCCP consultation required after 2 doses (20 mg) for discussion regarding further dosing to achieve a goal of the patient resting comfortably but rousable to voice].

Pediatric:

• Midazolam is the benzodiazepine of choice in the pediatric population.
• If diazepam is required: 0.2 mg/kg IV/IO over 1 minute or 0.5 mg/kg PR to a maximum of 5 mg; both can be repeated immediately as needed (maximum total dose of 10 mg) 

• IV, IO

• The effects of diazepam can be accentuated by CNS depressants such as opioids and alcohol.
• Pregnancy category D [potential benefits may warrant use of the drug in pregnant women despite potential risks (e.g., if it is required in a life-threatening situation)].

• Compendium of Pharmaceuticals and Specialties (CPS)
• Pharmacology for the Prehospital Professional 2^nd Edition