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Valium
diazepam
Black Box Warnings .
Risks from Concomitant Opioid Use
concomitant benzodiazepine use w/ opioids may result in profound sedation, resp. depression, coma, and death; reserve concomitant use for pts w/ inadequate alternative tx options; limit to minimum required dosage and duration; monitor pts for s/sx of resp. depression and sedation
Addiction, Abuse, and Misuse
benzodiazepines expose users to risk of abuse, misuse, and addiction, can lead to overdose or death; commonly involves concomitant use w/ other meds, alcohol, and/or illicit substances, which is assoc. w/ incr. frequency of serious adverse outcomes; assess risk for abuse, misuse, and addiction before prescribing and throughout tx
Dependence and Withdrawal Reactions
cont. benzodiazepine use may lead to clinically significant physical dependence; risk of dependence and withdrawal incr. w/ longer tx duration and higher daily dose; use gradual taper to D/C after cont. use as abrupt D/C or rapid dose reduction may cause acute withdrawal reactions, potentially life-threatening
Adult Dosing .
Dosage forms: TAB: 2 mg, 5 mg, 10 mg
Dosage Forms Discontinued in US
- [IM, IV not avail. as brand; see generic]
anxiety
- [2-10 mg PO bid-qid]
- Alt: 2-10 mg IM/IV q3-4h prn; Info: start 2-2.5 mg PO qd-bid or 2-5 mg IM/IV q3-4h prn in elderly or debilitated pts; taper dose gradually to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
sedation, procedural
- [cardioversion]
- Dose: 5-15 mg IV x1; Start: w/in 5-10min before procedure; Info: give 2-5 mg IV x1 in elderly or debilitated pts
- [endoscopy]
- Dose: up to 20 mg IV x1 immediately before procedure; Alt: 5-10 mg IM x1 30min before procedure; Info: give 2-5 mg IM/IV x1 in elderly or debilitated pts
- [preoperative]
- Dose: 10 mg IM x1; Start: before surgery: Info: give 2-5 mg IM x1 in elderly or debilitated pts
alcohol withdrawal, acute
- [fixed-dose regimen]
- Dose: 10 mg PO/IV/IM q6h x1 day, then 10 mg PO/IV/IM q8h x1 day, then 10 mg PO/IV/IM q12h x1 day, then 10 mg PO/IV/IM qhs for up to 2 days; Info: start 20 mg PO/IV/IM q2h x3 doses if high-risk or severe withdrawal; give additional doses prn; IV preferred to IM; refer to institution protocol
- [symptom-triggered regimen]
- Dose: 10 mg PO/IV/IM prn; Info: frequency determined by sx severity; start 10 mg PO/IV/IM q1h prn if high-risk or severe withdrawal; IV preferred to IM; refer to institution protocol
muscle spasm
- [2-10 mg PO tid-qid]
- Alt: 5-10 mg IM/IV q3-4h prn; Info: start 2-2.5 mg PO qd-bid or 2-5 mg IM/IV q3-4h prn in elderly or debilitated pts; larger doses may be required for tetanus; taper dose gradually to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
seizure disorder, adjunct tx
- [2-10 mg PO bid-qid]
- Info: start 2-2.5 mg PO qd-bid in elderly or debilitated pts; taper dose gradually to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
status epilepticus
- [5-10 mg IV x1]
- Max: 10 mg/dose; Info: may repeat dose x1 w/in 15min
confusional arousals (off-label)
- [5-10 mg PO qhs]
- Info: taper dose gradually to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
sleep terrors (off-label)
- [5-10 mg PO qhs]
- Info: taper dose gradually to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
sleepwalking (off-label)
- [5-10 mg PO qhs]
- Info: taper dose gradually to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
serotonin syndrome, adjunct tx (off-label)
- [5-10 mg PO q30-60min prn]
- Alt: 5-10 mg IM/IV q10min prn
renal dosing
- [see below]
- renal impairment: no adjustment; Info: metabolite accumulation possible
- HD/PD: no adjustment; no supplement; Info: metabolite accumulation possible
hepatic dosing
- [PO route]
- mild-moderate impairment: not defined, caution advised; severe impairment: contraindicated
- [IM/IV route]
- hepatic impairment: not defined, caution advised
Peds Dosing .
- Dosage forms: TAB: 2 mg, 5 mg, 10 mg
Dosage Forms Discontinued in US
- [IM, IV not avail. as brand; see generic]
anxiety
- [6 mo-12 yo]
- Dose: 0.12-0.8 mg/kg/day PO divided q6-8h; Alt: 0.04-0.2 mg/kg/dose IM/IV q2-6h prn; Max: 0.6 mg/kg/8h IM/IV; Info: taper dose gradually to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
- [13 yo and older]
- Dose: 2-10 mg PO bid-qid; Alt: 2-10 mg IM/IV q3-4h prn; Info: taper dose gradually to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
muscle spasm
- [6 mo-12 yo]
- Dose: 0.12-0.8 mg/kg/day PO divided q6-8h; Alt: 0.04-0.2 mg/kg/dose IM/IV q2-6h prn; Max: 0.6 mg/kg/8h IM/IV; Info: taper dose gradually to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
- [13 yo and older]
- Dose: 2-10 mg PO tid-qid; Alt: 5-10 mg IM/IV q3-4h prn; Info: taper dose gradually to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
tetanus, adjunct tx
- [1 mo-4 yo]
- Dose: 1-2 mg IM/IV q3-4h prn; Info: taper dose gradually to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
- [5 yo and older]
- Dose: 5-10 mg IM/IV q3-4h prn; Info: taper dose gradually to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
status epilepticus
- [1 mo and older]
- Dose: 0.15-0.2 mg/kg/dose IV x1; Max: 10 mg/dose; Info: may repeat dose x1 w/in 15min
renal dosing
- [see below]
- renal impairment: no adjustment; Info: metabolite accumulation possible
- HD/PD: no adjustment; no supplement; Info: metabolite accumulation possible
hepatic dosing
- [PO route]
- mild-moderate impairment: not defined, caution advised; severe impairment: contraindicated
- [IM/IV route]
- hepatic impairment: not defined, caution advised