Diazepam Dosing Recommendations
For status epilepticus, diazepam should be administered at 0.1-0.3 mg/kg IV every 5-10 minutes, with a maximum of 10 mg per dose. 1, 2
Status Epilepticus Dosing
- IV: 0.1-0.3 mg/kg every 5-10 minutes (maximum: 10 mg per dose)
- Administer over approximately 2 minutes to avoid pain at IV site
- Rectal: 0.5 mg/kg up to 20 mg (useful when IV access unavailable)
- IM route is not recommended due to risk of tissue necrosis
Important Administration Considerations
- Diazepam should be followed immediately by a long-acting anticonvulsant (such as phenytoin/fosphenytoin) because it is rapidly redistributed and seizures often recur within 15-20 minutes 1
- Lorazepam may be preferred for status epilepticus due to its prolonged duration of anticonvulsant activity 1
- Monitor oxygen saturation and respiratory effort during administration 1, 2
- Be prepared to support ventilation if respiratory depression occurs
Sedation/Anxiolysis Dosing
For procedural sedation or anxiety:
- IV: 0.05-0.10 mg/kg given over 2-3 minutes (maximum single dose: 5 mg)
- Peak effect occurs at 3-5 minutes
- Dose/observe and redose/observe every 3-5 minutes to avoid oversedation
- Standard adult dosage: 5-10 mg IV over 1 minute, with additional doses at 5-minute intervals if needed (maximum 20 mg usually sufficient) 2
Special Considerations and Precautions
Respiratory Concerns
- Increased risk of apnea when:
- Flumazenil (0.01-0.02 mg/kg IV) may be administered to reverse life-threatening respiratory depression, but it also counteracts anticonvulsant effects and may precipitate seizures 1
Adverse Effects
- May cause paradoxical excitement or agitation, especially in younger patients 1, 2
- Cognitive impairment including sedation, confusion, and memory problems 2
- Increased fall risk, particularly in elderly patients 2
Contraindications
- Severe respiratory insufficiency
- Sleep apnea syndrome
- Severe hepatic impairment
- Myasthenia gravis
- Acute narrow-angle glaucoma 2
Dosing in Special Populations
- Patients with reduced clearance (elderly, liver disease) require lower doses to prevent excessive sedation 2
- For long-term use, keep dosages minimal and courses short (ideally 4 weeks maximum) to prevent tolerance, dependence, and withdrawal effects 3
Diazepam is a versatile medication with multiple indications, but careful attention to proper dosing, monitoring, and patient selection is essential to maximize benefits while minimizing risks.