What is the administration protocol for intravenous (IV) diazepam injection?

Administration Protocol for Intravenous (IV) Diazepam Injection

For intravenous diazepam administration, the solution should be injected slowly, taking at least one minute for each 5 mg (1 mL) given, using appropriate veins while avoiding small veins on the dorsum of the hand or wrist. 1

Preparation and Administration Technique

• Inspect the diazepam solution visually for particulate matter and discoloration prior to administration (solution may appear colorless to light yellow) 1
• Do not mix or dilute diazepam with other solutions or drugs in the same syringe or infusion container 1
• When direct IV administration is not feasible, inject slowly through the infusion tubing as close as possible to the vein insertion site 1
• For continuous infusion (in specific situations only), dilute to at least 1:40 (5 mg in 40 mL) in dextrose 5% in water, normal saline, Ringer's injection, or lactated Ringer's injection and use within 6 hours 2
• For higher dilutions of 1:50 or greater (5 mg in 50 mL or more), the solution remains stable for up to 24 hours 2

Dosing Guidelines by Indication

Status Epilepticus and Severe Seizures

• Adults: 5-10 mg IV initially, may repeat at 10-15 minute intervals up to maximum 30 mg 1
• Children 5 years or older: 1 mg every 2-5 minutes up to maximum 10 mg 1
• Infants over 30 days and children under 5 years: 0.2-0.5 mg slowly every 2-5 minutes up to maximum 5 mg 1

Anxiety Disorders

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

Muscle Spasm

• 5-10 mg IV initially, then 5-10 mg in 3-4 hours if necessary 1
• For tetanus, larger doses may be required 1

Acute Alcohol Withdrawal

• 10 mg IV initially, then 5-10 mg in 3-4 hours if necessary 1

Safety Considerations

• Facilities for respiratory assistance must be readily available when administering IV diazepam 1
• Use extreme caution in elderly patients, very ill patients, and those with limited pulmonary reserve due to risk of apnea and/or cardiac arrest 1
• Monitor oxygen saturation and respiratory effort closely throughout administration 3
• Concomitant use with opioids, barbiturates, alcohol, or other CNS depressants increases depression risk with potential for apnea 1
• When used with narcotic analgesics, reduce the narcotic dose by at least one-third 1

Special Populations and Considerations

• For elderly or debilitated patients: Use lower doses (usually 2-5 mg) and increase dosage slowly 1
• Pediatric use: Administer slowly over a three-minute period in a dosage not exceeding 0.25 mg/kg to reduce risk of apnea or prolonged somnolence 1
• Not recommended for obstetrical use due to placental transfer of the drug 1

Common Pitfalls to Avoid

• Avoid rapid injection which may cause pain at injection site, respiratory depression, or precipitate seizures 3, 1
• Avoid intra-arterial administration or extravasation which can cause severe tissue damage 1
• Never use small veins such as those on the dorsum of the hand or wrist 1
• Do not administer to patients in shock, coma, or acute alcoholic intoxication with depression of vital signs 1
• Be aware that flumazenil may be used to reverse life-threatening respiratory depression but will also counteract anticonvulsant effects and may precipitate seizures 3