Valium (Diazepam) Dosing Chart
The recommended dosing for Valium (diazepam) should be individualized based on the indication, with specific dosing ranges for adults ranging from 2-10 mg taken 2-4 times daily depending on the condition being treated. 1
Adult Dosing by Indication
| Indication | Dosage | Frequency | Notes |
|---|---|---|---|
| Anxiety Disorders | 2-10 mg | 2-4 times daily | Adjust based on severity |
| Acute Alcohol Withdrawal | 10 mg | 3-4 times during first 24 hours | Reduce to 5 mg 3-4 times daily as needed |
| Muscle Spasm | 2-10 mg | 3-4 times daily | Adjunctive therapy |
| Seizure Disorders | 2-10 mg | 2-4 times daily | Adjunctive therapy |
| Geriatric Patients | 2-2.5 mg | 1-2 times daily initially | Increase gradually as needed |
| Sedation for Procedures | 5-10 mg | Single dose | Administer slowly over 1 minute [2] |
Pediatric Dosing
| Age Group | Dosage | Frequency | Notes |
|---|---|---|---|
| Children >6 months | 1-2.5 mg | 3-4 times daily initially | Increase gradually as needed |
| Children <6 months | Not recommended | - | - |
Special Situations
| Situation | Dosing Approach | Notes |
|---|---|---|
| Delirium | 0.5-1 mg | Every 2 hours as needed; may add benzodiazepine if agitated [2] |
| Anxiety with inability to swallow | Consider midazolam 2.5-5 mg | Subcutaneously every 2-4 hours as needed [2] |
| Severe Alcohol Withdrawal | May require higher doses | Some cases may need 260-480 mg/day in intensive care settings [3] |
| Tapering | Reduce by ~25% | Every 1-2 weeks to minimize withdrawal symptoms [4] |
Administration Routes
- Oral tablets: Standard administration
- Sublingual: Oral tablets can be used sublingually (off-label) 2
- Intravenous: Administer slowly over 1-2 minutes to avoid respiratory depression
- Intramuscular: Deep IM injection possible but may cause local irritation
Important Considerations
- Respiratory Depression: Risk increases when combined with opioids or other sedatives
- Elderly Patients: Use reduced doses (50% or less of standard adult dose)
- Hepatic Impairment: Reduce dose due to decreased clearance
- Renal Impairment: Consider alternative benzodiazepines (like lorazepam) in severe renal dysfunction
- Dependence Risk: Physical and psychological dependence can develop with prolonged use
- Withdrawal: Taper gradually to discontinue; abrupt cessation can cause withdrawal symptoms
Symptom-Triggered vs. Fixed Schedule Dosing
For alcohol withdrawal, symptom-triggered dosing (administering medication only when symptoms appear) has been shown to reduce total medication requirements compared to fixed-schedule dosing 5.
Monitoring Parameters
- Respiratory rate and depth
- Level of sedation
- Blood pressure
- Heart rate
- Mental status
Contraindications
- Severe respiratory insufficiency
- Severe hepatic impairment
- Myasthenia gravis
- Sleep apnea
- Acute narrow-angle glaucoma
Remember that diazepam has a relatively long half-life and active metabolites, which can lead to accumulation with repeated dosing, especially in elderly patients or those with impaired metabolism.