Diazepam IVP Dosing for Acute Agitation
For acute agitation in adults, the recommended diazepam IVP dose is 5-10 mg administered slowly over at least 1 minute, which may be repeated in 3-4 hours if necessary, with a maximum of 30 mg in a 24-hour period. 1
Dosing Guidelines
Adult Dosing
- Initial dose: 5-10 mg IV push 1
- Administration rate: Inject slowly, taking at least 1 minute for each 5 mg (1 mL) given 1
- Repeat dosing: May repeat in 3-4 hours if necessary 1
- Maximum daily dose: 30 mg 1
Special Populations
- Elderly or debilitated patients: Lower doses (2-5 mg) with slow increase in dosage 1
- When other sedative drugs are administered: Use lower initial doses (2-5 mg) 1
Administration Technique
- Injection method: Administer slowly, taking at least 1 minute for each 5 mg (1 mL) given 1
- Vein selection: Do not use small veins such as those on the dorsum of the hand or wrist 1
- Precautions:
- Extreme care should be taken to avoid intra-arterial administration or extravasation 1
- Do not mix or dilute diazepam with other solutions or drugs in syringe or infusion container 1
- If direct IV administration is not feasible, inject slowly through infusion tubing as close as possible to vein insertion 1
Clinical Considerations
Etiology-Based Approach
- For agitation due to medical/intoxication causes: Benzodiazepines are first-line therapy 2
- For agitation due to psychiatric causes: Either benzodiazepines or antipsychotics can be used 2
- For unknown etiology: Start with either benzodiazepine or antipsychotic; consider adding the other if first dose is ineffective 2
Safety Monitoring
- Respiratory monitoring: Facilities for respiratory assistance should be readily available 1
- Risk factors for respiratory depression: Increased when combined with other sedative agents, particularly opioids 2
- Vital signs: Monitor oxygen saturation and respiratory effort during administration 2
Potential Adverse Effects
- Respiratory: May cause respiratory depression, especially when combined with other CNS depressants 2
- Cardiovascular: May cause hypotension 1
- Neurological: Paradoxical agitation may occur, especially in younger patients 2
- Sedation: Excessive sedation may occur, particularly in elderly or debilitated patients 1
Alternative Approaches
- When IV access is unavailable: Consider intramuscular administration, though absorption may be erratic 2
- For severe agitation: Consider combination therapy with a benzodiazepine plus a first-generation antipsychotic 2
- For continued agitation: If diazepam is ineffective, consider alternative agents such as lorazepam (0.05-0.15 mg/kg IV) or haloperidol (5 mg IV/IM) 2
Clinical Pearls
- Diazepam has a rapid onset of action when given IV, with peak effect occurring within 15 minutes 2
- The long half-life of diazepam provides a natural tapering effect, which can be beneficial but requires careful monitoring 2
- For transition to maintenance therapy, consider switching to oral diazepam once acute agitation is controlled 1
- Always inspect parenteral drug products visually for particulate matter and discoloration prior to administration 1
Remember that while diazepam is effective for acute agitation, it should be used as part of a comprehensive approach that includes identifying and treating the underlying cause of agitation.