From the Guidelines
The maximum daily dose of Valium (diazepam) a person can take in one day is 40 mg, divided into smaller doses of 5-10 mg every 6-8 hours. This dosage is based on the guidelines for the management of alcohol withdrawal syndrome, which recommends diazepam be administered orally, intravenously, or intramuscularly at a dose of 5-10 mg every 6-8 hours 1. It's essential to note that the dosage may vary depending on the individual's condition, response, and tolerance. For example, patients with anxiety or muscle spasms may require different dosing regimens.
When considering the use of diazepam, it's crucial to weigh the benefits against the potential risks, including the risk of dependence and withdrawal symptoms. The guidelines emphasize the importance of a standard fixed-dose regimen, which includes dose tapers over time 1.
Key points to consider when prescribing diazepam include:
- Starting with a lower dose and gradually increasing as needed and tolerated
- Monitoring for signs of dependence and withdrawal
- Gradually reducing the dosage when stopping treatment to minimize the risk of withdrawal symptoms
- Being cautious when prescribing diazepam to elderly patients or those with liver impairment, as they may require lower doses 1.
Overall, the goal is to use the minimum effective dose to achieve the desired therapeutic effect while minimizing the risk of adverse effects and dependence. The maximum daily dose of 40 mg should not be exceeded, and patients should be closely monitored for any signs of toxicity or adverse effects.
From the FDA Drug Label
The data currently available are inadequate to determine the mutagenic potential of diazepam. Reproduction studies in rats showed decreases in the number of pregnancies and in the number of surviving offspring following administration of an oral dose of 100 mg/kg/day (approximately 16 times the MRHD on a mg/m 2basis) prior to and during mating and throughout gestation and lactation No adverse effects on fertility or offspring viability were noted at a dose of 80 mg/kg/day (approximately 13 times the MRHD on a mg/m 2basis). Diazepam has been shown to be teratogenic in mice and hamsters when given orally at daily doses of 100 mg/kg or greater (approximately eight times the maximum recommended human dose [MRHD=1 mg/kg/day] or greater on a mg/m 2basis)
The FDA drug label does not answer the question.
From the Research
Maximum Daily Dose of Valium (Diazepam)
The maximum daily dose of Valium (diazepam) can vary depending on the individual and the condition being treated.
- In the treatment of severe alcohol withdrawal delirium, very high doses of diazepam (260-480 mg/day) have been used successfully 2.
- For moderate to severe alcohol withdrawal, diazepam has been shown to be effective in relieving symptoms, with a median number of 20-mg doses of three, given over a period of 7.6 hours (range = 1 to 12 and 0.33 to 45 hours) 3.
- A study on the application of a diazepam milligram equivalency algorithm found that the mean daily diazepam milligram equivalency (DME) was 10.60 (9.05), and 26.2% of individuals had a mean DME per day of at least 15 4.
Factors Affecting Dose Intensity
Several factors can affect the dose intensity of benzodiazepines, including:
- Age: Females had a 28% lower adjusted odds of receiving a benzodiazepine dose of at least 15 DME per day compared with males 4.
- Insurance: Individuals with Medicaid insurance and those with Medicare were more likely to be prescribed a benzodiazepine of at least 15 DME per day 4.
- Concurrent use of other medications: Higher benzodiazepine DMEs were dispensed to patients who concurrently used prescription opioids or stimulants 4.
Safety Considerations
It is essential to note that benzodiazepines, including diazepam, have important safety considerations, such as an increased risk of dependence and addiction, falls, and death from opioid overdose 4.