AdultPediatricGeriatricDosage Forms & Strengths tablet: Schedule IV 2mg 5mg 10mg oral solution: Schedule IV 1mg/1mL 5mg/mL rectal gel (Diastat Acudial): Schedule IV 2.5mg/0.5mL 10mg/2mL 20mg/4mL injectable solution: Schedule IV 5mg/mL intramuscular device: Schedule IV 5mg/mL intranasal spray (Valtoco): Schedule IV 5mg/0.1mL 7.5mg/0.1mL 10mg/0.1mL Anxiety Indicated for management of anxiety disorders or for short-term relief of the symptoms of anxiety 2-10 mg PO q6-12hr, OR 2-5 mg IV/IM q3-4hr if necessary, for moderate anxiety disorders; 5-10 mg IV/IM q3-4hr for severe anxiety disorders Alcohol Withdrawal Aid in symptomatic relief of acute agitation, tremor, impending or acute delirium tremens, hallucinations 10 mg PO q6-8hr during first 24hr; reduce to 5 mg PO q6-8hr PRN OR 10 mg IV/IM, initially may give additional doses of 5-10 mg IV q6-8hr as needed Endoscopic Precedures Adjunct use, if apprehension, anxiety or acute stress reactions present prior to endoscopic procedures ≤10 mg adequate; may give up to 20 mg IV, particularly when concomitant narcotics omitted; if IV cannot be used, 5-10 mg IM approximately 30 min prior to procedure Titrate IV dosage to desired sedative response, such as slurring of speech, with slow administration immediately prior to procedure Dosage of narcotics should be reduced by at least a third and in some cases may be omitted Preoperative Sedation If atropine, scopolamine or other premedications desired, they must be administered in separate syringes 10 mg (IM preferred) before surgery Sedation in the ICU 5-10 mg IV 1-2 hours before surgery; 0.03-0.1 mg/kg q30min to 6hr Muscle Spasm May be used adjunctively for relief of skeletal muscle spasm due to reflex spasm to local pathology (eg, inflammation of the muscles or joints, secondary to trauma); spasm associated with local pathology, cerebral palsy, athetosis, stiff-man syndrome, or tetanus 2-10 mg PO q6-8hr PRN, OR 5-10 mg, IV/IM initially, THEN 5-10 mg q3-3hr, if necessary; administer larger doses for tetanus Seizure Disorder Indicated for acute treatment of intermittent, stereotypic episodes of frequent seizure activity (ie, seizure clusters, acute repetitive seizures) distinct from a patient’s usual seizure pattern Used adjunctively in convulsive disorders, although it has not proved useful as the sole therapy 2-10 mg PO q6-12hr Intranasal spray 0.2 mg/kg intranasally as single dose Adolescent or adult weight-based dosing 14-27 kg: 5 mg (one 5-mg device); 1 spray in 1 nostril 28-50 kg: 10 mg (one 10-mg device); 1 spray in 1 nostril 51-75 kg: 15 mg (two 7.5-mg devices); 1 spray in each nostril ≥76 kg: 20 mg (two 10-mg devices); 1 spray in each nostril Second dose and maximum dose Second dose: When required, may be administered after at least 4 hr after initial dose; if the second dose is administered, use a new blister pack of diazepam intranasal Maximum dosage: Not to exceed 2 doses to treat a single episode Treatment frequency: Do not use for more than 1 episode q5days and no more than 5 episodes/month Diazepam gel (rectal) 0.2 mg/kg PR or 10-20 mg as single dose Rectal gel is measured in 2.5-mg increments from 2.5-20 mg/dose; calculate dose and round upward to next measurable dose May prescribe second dose of diazepam rectal gel; when required, may be given 4-12 hr after first dose Adolescent or adult weight-based dosing 14-25 kg: 5 mg 26-37 kg: 7.5 mg 38-50 kg: 10 mg 51-62 kg: 12.5 mg 63-75 kg: 15 mg 76-87 kg: 17.5 mg 88-111 kg: 20 mg Status Epilepticus 5-10 mg initially (IV preferred); injection may be repeated if necessary, at 10-15 minute intervals up to 30 mg maximum; may repeat in 2 to 4 hours if necessary; however, consider that residual active metabolites may persist Use extreme caution in individuals with chronic lung disease or unstable cardiovascular status Administer IV slowly; administer IM if IV administration impossible OR 0.2-0.5 mg/kg PR; round up dose to nearest 2.5 mg increment; not to exceed 20 mg as single dose Cardioversion 5-15 mg IV within 5-10 min prior to procedure to relieve anxiety and tension and to reduce recall of procedure Dosage Modifications Renal impairment: Oral: Data not available No dose adjustment recommended unless administered for prolonged period; decrease dose in prolonged periods Rectal gel: Not studied; use caution Intranasal spray: Not studied Hepatic impairment Rectal gel: Not studied; use caution Intranasal spray: Not studied Prescribing information describes literature review showing diazepam 0.1-0.15 mg/kg IV had prolonged half-life by 2- to 5-fold in patients with alcoholic cirrhosis Oral administration Mild to moderate: Use with caution and consider dose adjustment; average half-life is increased in mild and moderate cirrhosis; average increase has been variously reported from 2-fold to 5-fold, with individual half-lives over 500 hr reported Severe: Contraindicated Dosing Considerations Adjust dose periodically to reflect changes in patient’s age or weight May use 2.5-mg dose as a partial replacement dose for patients who may expel a portion of first dose Long-term (>4 months) effectiveness of diazepam has not been assessed by systematic clinical studies Periodically reassess the efficacy for each patient Once acute symptomatology has been properly controlled with diazepam injection, the patient may be placed on oral therapy if further treatment required Discontinuation or dosage reduction Use a gradual taper to discontinue diazepam tablets or reduce dosage to avoid withdrawal reactions If any withdrawal reaction develops, consider pausing taper or increasing dose to previous tapered dosage level; subsequently decrease dose more slowly Seizures (Orphan) Intermittent use to control bouts of increased seizure activity or Dravet syndrome by various administrative routes Orphan sponsors SC: Xeris Pharmaceuticals, Inc, .3208 Red River Street, Suite 300, Austin, Texas 78705 Autoinjector: Meridian Medical Technologies, Inc., 6350 Stevens Forest Rd, Suite 301, Columbia, Maryland 21046 Dosage Forms & Strengths tablet: Schedule IV 2mg 5mg 10mg oral solution: Schedule IV 1mg/1mL 5mg/mL rectal gel (Diastsat Acudial): Schedule IV 2.5mg/0.5mL 10mg/2mL 20mg/4mL injectable solution: Schedule IV 5mg/mL intramuscular device: Schedule IV 5mg/mL intranasal spray (Valtoco): Schedule IV 5mg/0.1mL 7.5mg/0.1mL 10mg/0.1mL Sedative/Muscle Relaxant Indicated for spasm associated with local pathology, cerebral palsy, and tetanus <6 months: Not recommended Potentially toxic dose in patients <6 years: >0.5 mg/kg >6 years 1-2.5 mg PO q6-8hr; increase gradually as needed and tolerated 0.12-0.8 mg/kg/day PO divided q6-8hr, not to exceed 10 mg/dose OR 5-10 mg or 0.04-0.2 mg/kg IV/IM q3-4hr; no more than 0.6 mg/kg within 8 hours; respiratory assistance should be available Seizure Disorder Indicated for treatment of intermittent, stereotypic episodes of frequent seizure activity (ie, seizure clusters, acute repetitive seizures) distinct from a patient’s usual seizure pattern in patients with epilepsy aged ≥2 years (rectal gel) or ≥6 years (intranasal) <2 years: Safety and efficacy not established Diazepam gel (rectal) Rectal gel is measured in 2.5-mg increments from 2.5-20 mg/dose; calculate dose and round upward to next measurable dose May prescribe second dose of diazepam rectal gel; when required, may be given 4-12 hr after first dose 2-6 years (0.5 mg/kg PR) weight-based dosing 6-10 kg: 5 mg 11-15 kg: 7.5 mg 16-20 kg: 10 mg 21-25 kg: 12.5 mg 26-30 kg: 15 mg 31-35 kg: 17.5 mg 36-44 kg: 20 mg 6-12 years (0.3 mg/kg PR) weight-based dosing 10-16 kg: 5 mg 17-25 kg: 7.5 mg 26-33 kg: 10 mg 34-41 kg: 12.5 mg 42-50 kg: 15 mg 51-58 kg: 17.5 mg 59-74 kg: 20 mg ≥12 years (0.2 mg/kg PR) weight-based dosing 14-25 kg: 5 mg 26-37 kg: 7.5 mg 38-50 kg: 10 mg 51-62 kg: 12.5 mg 63-75 kg: 15 mg 76-87 kg: 17.5 mg 88-111 kg: 20 mg Intranasal spray <6 years: Safety and efficacy not established Administer intranasally as a single dose 6-11 years (0.3 mg/kg) weight-based dosing 10-18 kg: 5 mg (one 5-mg device); 1 spray in 1 nostril 19-37 kg: 10 mg (one 10-mg device); 1 spray in 1 nostril 38-55 kg: 15 mg (two 7.5-mg devices); 1 spray in each nostril 56-74 kg: 20 mg (two 10-mg devices); 1 spray in each nostril ≥12 years (0.2 mg/kg) weight-based dosing 14-27 kg: 5 mg (one 5-mg device); 1 spray in 1 nostril 28-50 kg: 10 mg (one 10-mg device); 1 spray in 1 nostril 51-75 kg: 15 mg (two 7.5-mg devices); 1 spray in each nostril ≥76 kg: 20 mg (two 10-mg devices); 1 spray in each nostril Second dose and maximum dose Second dose: When required, may be administered after at least 4 hr after initial dose; if the second dose is administered, use a new blister pack of diazepam intranasal Maximum dosage: Not to exceed 2 doses to treat a single episode Treatment frequency: Do not use for more than 1 episode q5days and no more than 5 episodes/month Status Epilepticus Potentially toxic dose in patients <6 years: >0.5 mg/kg PR 2-6 years: 0.5 mg/kg; may repeat in 4-12 hours PRN 6-12 years: 0.3 mg/kg; may repeat in 4-12 hours PRN >12 years: 0.2 mg/kg; may repeat in 4-12 hours PRN IV >30 days – 5 years: 0.2-0.5 mg slowly q2-5 min up to 5 mg maximum (IV preferred); children ≥5 years, 1 mg q2-5 min up to a maximum of 10 mg (slow IV administration preferred); repeat in 2 to 4 hr if necessary; EEG monitoring of the seizure may be helpful >5 years: 1 mg IV given slowly every 2-5 min; not to exceed 10 mg total dose; may repeat in 2-4 hours if necessary Dosage Modifications Renal impairment Rectal gel: Not studied; use caution Intranasal spray: Not studied Oral: Data not available Hepatic impairment Rectal gel: Not studied; use caution Intranasal spray: Not studied Prescribing information describes literature review showing diazepam 0.1-0.15 mg/kg IV had prolonged half-life by 2- to 5-fold in patients with alcoholic cirrhosis Oral administration Mild to moderate: Use with caution; average half-life increased in mild and moderate cirrhosis; average increase has been reported from 2-fold to 5-fold, with individual half-lives over 500 hr Severe: Contraindicated Dosing Considerations Long-term (>4 months) effectiveness of diazepam has not been assessed by systematic clinical studies Periodically reassess the efficacy of each patient Intranasal spray Not approved for use in neonates or infants Prolonged CNS depression observed with neonates treated with diazepam Serious adverse reactions including fatal reactions and gasping syndrome occurred in premature neonates and low-birth-weight infants who received drugs containing benzyl alcohol as a preservative (diazepam intranasal contains benzyl alcohol 10.5 mg/0.1mL) Reduce hazardous risks in children with slow IV dosing Administer drug slowing to obtain maximal clinical effect with minimum dose, and thereby, reduced risk of hazardous side effects (eg, apnea, prolonged somnolence) Administer slowly over 3-min period (not to exceed 0.25 mg/kg) May repeat dose after 15-30 minutes If symptom relief not obtained after 3rd administration, adjunctive therapy appropriate for the condition is recommended Discontinuation or dosage reduction Use a gradual taper to discontinue diazepam tablets or reduce dosage to avoid withdrawal reactions If any withdrawal reaction develops, consider pausing taper or increasing dose to previous tapered dosage level; subsequently decrease dose more slowly Dosing Considerations Due to long-acting metabolite, not considered a drug of choice in the elderly; associated with falls Rectal gel: Use lower doseInteraction CheckerEnter a drug name and diazepamNo Results No Interactions Found Interactions FoundContraindicatedSerious - Use AlternativeSignificant - Monitor CloselyMinorAll Interactions Sort By: SeverityName Contraindicated (0)Serious - Use Alternative (37)abametapirabametapir will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir.apalutamideapalutamide will decrease the level or effect of diazepam by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP2C19 inducer, with drugs that are CYP2C19 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered.apalutamide will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.benzhydrocodone/acetaminophenbenzhydrocodone/acetaminophen, diazepam. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered.