What is the appropriate dosage and administration protocol for Valium (diazepam) given a concentration of 5mg/ml?

Diazepam (Valium) 5mg/ml Administration Protocol

For a 5mg/ml concentration of diazepam (Valium), the standard adult dosage is 5-10mg administered intravenously over 1-2 minutes, with careful monitoring for respiratory depression. 1

Adult Dosing Guidelines by Indication

Anxiety Disorders

• Moderate anxiety: 2-5mg IV/IM, repeat in 3-4 hours if necessary 1
• Severe anxiety: 5-10mg IV/IM, repeat in 3-4 hours if necessary 1

Procedural Sedation

• Endoscopic procedures: Titrate IV dosage to desired sedative response (slurred speech)
  • Generally 10mg or less is adequate
  • Up to 20mg IV may be given, particularly when narcotics are omitted
  • If IV route unavailable: 5-10mg IM approximately 30 minutes before procedure 1

Status Epilepticus

• Adults: 5-10mg IV initially (preferred route)
  • May repeat at 10-15 minute intervals up to maximum 30mg
  • If necessary, therapy may be repeated in 2-4 hours 1
• Children under 5 years: 0.2-0.5mg/kg IV slowly every 2-5 minutes up to maximum 5mg 1
• Children 5+ years: 1mg IV every 2-5 minutes up to maximum 10mg 1

Muscle Spasm

• Initial dose: 5-10mg IV/IM
• Maintenance: 5-10mg every 3-4 hours as needed 1

Acute Alcohol Withdrawal

• Initial dose: 10mg IV/IM
• Maintenance: 5-10mg every 3-4 hours as needed 1

Administration Techniques

IV Administration (Preferred for Most Urgent Indications)

1. Inject slowly, taking at least one minute for each 5mg (1ml) given
2. Use larger veins; avoid small veins on dorsum of hand or wrist
3. Take extreme care to avoid intra-arterial administration or extravasation
4. Do not mix or dilute with other solutions or drugs in syringe or infusion container 1

IM Administration

• Inject deeply into muscle
• Note that absorption may be less predictable than IV route 2

Special Populations

Elderly or Debilitated Patients

• Use lower doses (usually 2-5mg)
• Increase dosage slowly
• Monitor closely for excessive sedation 1

Pediatric Patients

• For status epilepticus:
  • Infants >30 days and children <5 years: 0.2-0.5mg/kg IV slowly
  • Children 5+ years: 1mg IV every 2-5 minutes up to 10mg maximum 3

Monitoring and Safety

Required Monitoring

• Respiratory rate and effort
• Oxygen saturation
• Blood pressure
• Level of consciousness 4

Potential Adverse Effects

• Respiratory depression (especially when combined with opioids)
• Hypotension
• Paradoxical reactions (excitement/agitation, particularly in younger patients)
• Cognitive impairment and sedation 4

Reversal Agent

• Flumazenil can reverse benzodiazepine effects in overdose situations
• Dosage: 0.01-0.02mg/kg IV (maximum: 0.2mg)
• May repeat at 1-minute intervals to maximum cumulative dose of 0.05mg/kg or 1mg 3
• Note: May precipitate seizures in patients with underlying seizure disorders 3

Practical Considerations

• Diazepam 5mg/ml means each ml contains 5mg of active drug
• For a standard 10mg dose, administer 2ml
• Always have resuscitation equipment readily available during administration
• When used for procedural sedation, reduce dosage of narcotics by at least one-third 1

Remember that diazepam has a long half-life providing a natural tapering effect, which can be beneficial in conditions like alcohol withdrawal but requires careful consideration when discontinuing after prolonged use 4.