What is the dosing for diazepam (Diazepam) intravenous (IV)?

Diazepam IV Dosing Guidelines

The initial intravenous dose of diazepam for endoscopic procedures is 5 to 10 mg administered over 1 minute, with additional doses administered at 5-minute intervals if required. 1

Adult Dosing by Indication

Moderate Anxiety Disorders and Symptoms of Anxiety

• 2 mg to 5 mg IV (administer slowly)
• May repeat in 3 to 4 hours if necessary 2

Severe Anxiety Disorders and Symptoms of Anxiety

• 5 mg to 10 mg IV (administer slowly)
• May repeat in 3 to 4 hours if necessary 2

Acute Alcohol Withdrawal

• 10 mg IV initially
• Then 5 mg to 10 mg in 3 to 4 hours if necessary 2

Endoscopic Procedures

• Titrate IV dose to desired sedative response (e.g., slurring of speech)
• Generally 10 mg or less is adequate
• Up to 20 mg IV may be given, particularly when concomitant narcotics are omitted 2
• When used with opioids, 10 mg is typically sufficient, though up to 20 mg may be necessary if narcotics are not being coadministered 1

Muscle Spasm

• 5 mg to 10 mg IV initially
• Then 5 mg to 10 mg in 3 to 4 hours if necessary
• For tetanus, larger doses may be required 2

Status Epilepticus and Severe Recurrent Convulsive Seizures

• 5 mg to 10 mg IV initially (preferred route)
• May repeat if necessary at 10 to 15 minute intervals up to maximum dose of 30 mg
• If necessary, therapy may be repeated in 2 to 4 hours 2

Preoperative Medication

• 10 mg IM (preferred route) before surgery 2

Cardioversion

• 5 mg to 15 mg IV within 5 to 10 minutes prior to procedure 2

Pediatric Dosing

Status Epilepticus (Infants over 30 days and children under 5 years)

• 0.2 mg to 0.5 mg IV slowly every 2 to 5 minutes up to maximum of 5 mg 2

Status Epilepticus (Children 5 years or older)

• 1 mg IV every 2 to 5 minutes up to maximum of 10 mg 2

Tetanus (Infants over 30 days of age)

• 1 mg to 2 mg IV slowly, repeated every 3 to 4 hours as necessary 2

Tetanus (Children 5 years or older)

• 5 mg to 10 mg IV repeated every 3 to 4 hours as needed 2

Special Considerations

Dose Adjustments

• Dose reduction is required in debilitated or elderly patients 1

Administration Technique

• Administer slowly to avoid respiratory depression
• For endoscopic procedures, administer immediately prior to the procedure 2

Monitoring

• Monitor for respiratory depression, which is more likely in patients with underlying respiratory disease or those receiving combinations of benzodiazepines and opioids 1
• Monitor oxygen saturation and respiratory effort 1
• Be prepared to support ventilation if needed 1

Side Effects and Precautions

• Major side effects include coughing, respiratory depression, and dyspnea 1
• Respiratory depression is dose-dependent and results from depression of central ventilatory response to hypoxia and hypercapnea 1
• Flumazenil may be administered to reverse life-threatening respiratory depression, but it will also counteract anticonvulsant effects and may precipitate seizures 1

Pharmacokinetics

• Onset of action is rapid when administered intravenously
• Duration of effect is longer than midazolam 3

Important Cautions

• Extreme caution must be exercised with individuals with chronic lung disease or unstable cardiovascular status 2
• Respiratory assistance should be available, particularly when treating tetanus 2
• There is an increased incidence of apnea when diazepam is given rapidly IV or when used in combination with other sedative agents 1

Remember that diazepam has a synergistic effect with opioids on the risk of respiratory depression, so careful monitoring is essential when these medications are used together.