From the FDA Drug Label
DOSAGE AND ADMINISTRATION Dosage should be individualized for maximum beneficial effect. ADULTS: USUAL DAILY DOSE: Management of Anxiety Disorders and Relief of Symptoms of Anxiety Depending upon severity of symptoms—2 mg to 10 mg, 2 to 4 times daily Geriatric Patients, or in the presence of debilitating disease. 2 mg to 2.5 mg, 1 or 2 times daily initially; increase gradually as needed and tolerated PEDIATRIC PATIENTS: ... initiate therapy with lowest dose and increase as required. ... 1 mg to 2. 5 mg, 3 or 4 times daily initially; increase gradually as needed and tolerated
The initial dose for initiating Valium (diazepam) is:
- 2 mg to 10 mg for adults with anxiety disorders, given 2 to 4 times daily
- 2 mg to 2.5 mg for geriatric patients or those with debilitating disease, given 1 or 2 times daily
- 1 mg to 2.5 mg for pediatric patients, given 3 or 4 times daily 1
From the Research
The initial dose of Valium (diazepam) for adults should be 2-10 mg, administered 2-4 times daily, with the specific dose depending on the condition being treated, as supported by the most recent and highest quality study 2. When considering the treatment of anxiety disorders, the initial dose typically ranges from 2-5 mg taken 2-3 times daily. For acute alcohol withdrawal, higher initial doses of 10 mg may be given 3-4 times during the first 24 hours, then reduced to 5 mg 3-4 times daily as needed, as discussed in the context of benzodiazepine use for alcohol withdrawal 3. Key considerations include:
- Starting with lower doses for elderly or debilitated patients, usually 2-2.5 mg 1-2 times daily, to minimize side effects like sedation and confusion.
- Being aware that diazepam can cause drowsiness, impaired coordination, and should not be combined with alcohol or other CNS depressants.
- The importance of avoiding long-term use when possible due to the risk of dependence and tolerance, as highlighted in studies on benzodiazepine withdrawal 4, 2. The mechanism of action of diazepam, enhancing the effect of the inhibitory neurotransmitter GABA in the brain, producing calming effects, is crucial for its therapeutic use 2. Comparative studies between different benzodiazepines, such as lorazepam and chlordiazepoxide, have shown similar efficacy in treating alcohol withdrawal, with considerations for pharmacokinetic differences and potential adverse events 5, 6. However, the most recent and highest quality evidence should guide clinical decision-making, prioritizing patient safety and minimizing risks associated with benzodiazepine use 2.