From the Research
The maximum recommended dose of diazepam for adults is typically 40 mg per day, divided into multiple doses. This dosage is supported by a recent study published in 2024, which compared the efficacy and safety of injectable lorazepam and diazepam in the treatment of severe alcohol withdrawal syndrome 1. The study found that the time with Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar) scores at goal during the first 24 hours was similar between the two groups, and the dosage requirement was also similar, with a median dose of 40 mg per day for diazepam.
For anxiety, the usual dosage ranges from 2-10 mg taken 2-4 times daily, while for muscle spasms, 2-10 mg may be given 3-4 times daily. Elderly or debilitated patients should receive lower doses, usually starting at half the standard adult dose. It's essential to note that diazepam has potential for tolerance, dependence, and addiction, so it should be used at the lowest effective dose for the shortest duration possible.
Some key points to consider when prescribing diazepam include:
- Side effects, such as drowsiness, fatigue, muscle weakness, and impaired coordination
- The risk of dangerous respiratory depression when combined with alcohol or other CNS depressants
- The need for gradual tapering of the dosage after prolonged use to avoid withdrawal symptoms
- The importance of monitoring patients for signs of over-sedation, particularly when using front-loaded lorazepam, as reported in a study published in 2021 2.
Overall, the use of diazepam should be guided by the principles of minimizing morbidity, mortality, and improving quality of life, and the dosage should be tailored to the individual patient's needs and response to treatment, as supported by the study published in 2017 3.