What is the recommended dose of oral diazepam (Benzodiazepine)?

Recommended Dosage of Oral Diazepam

The recommended oral dose of diazepam for adults is 2 mg to 10 mg, 2 to 4 times daily, depending on the severity of symptoms and indication. 1

Adult Dosing by Indication

• Management of Anxiety Disorders:

  • 2 mg to 10 mg, 2 to 4 times daily depending on symptom severity 1

• Acute Alcohol Withdrawal:

  • 10 mg, 3 or 4 times during the first 24 hours
  • Reducing to 5 mg, 3 or 4 times daily as needed 1
  • Loading dose approach: 20 mg orally every 2 hours until symptoms resolve (median of three 20-mg doses) 2

• Relief of Skeletal Muscle Spasm:

  • 2 mg to 10 mg, 3 or 4 times daily 1

• Adjunctive Therapy in Convulsive Disorders:

  • 2 mg to 10 mg, 2 to 4 times daily 1

• Status Epilepticus:

  • IV: 0.1-0.3 mg/kg every 5-10 minutes (maximum: 10 mg per dose) 3
  • Rectal: 0.5 mg/kg up to 20 mg (when IV access unavailable) 3

• Conscious Sedation for Endoscopic Procedures:

  • Initial induction dose: 5 to 10 mg over 1 minute
  • Additional doses at 5-minute intervals if required 3

Special Populations

• Geriatric Patients or Debilitating Disease:

  • Start with 2 mg to 2.5 mg, 1 or 2 times daily initially
  • Increase gradually as needed and tolerated 1
  • Dose reduction of 50% or more is indicated in the elderly 3

• Pediatric Patients:

  • Not for use in children under 6 months
  • 1 mg to 2.5 mg, 3 or 4 times daily initially
  • Increase gradually as needed and tolerated 1

• Renal Failure Patients:

  • No dose adjustment required as diazepam is metabolized in the liver 3
  • The recommended doses vary from 0.1 to 0.8 mg per kg of body weight in a single oral dose for conscious sedation 3

Important Considerations

• Respiratory Monitoring:

  • Increased risk of apnea when diazepam is given rapidly or combined with other sedative agents 3
  • Monitor oxygen saturation and respiratory effort 3
  • Be prepared to support ventilation if necessary 3

• Discontinuation:

  • Use a gradual taper to discontinue diazepam or reduce dosage to minimize withdrawal reactions 1
  • If withdrawal reactions develop, consider pausing the taper or increasing to previous dosage level 1

• Duration of Treatment:

  • For insomnia: Limit prescriptions to a few days, occasional use, or courses not exceeding 2 weeks 4
  • For anxiety: Use in single doses, very short (1-7 days) or short (2-4 weeks) courses 4
  • Long-term prescription should be avoided when possible 4

• Potential Adverse Effects:

  • Psychomotor impairment, especially in the elderly 4
  • Occasionally paradoxical excitement 4
  • With long-term use: tolerance, dependence, and withdrawal effects 4

• Drug Interactions:

  • Synergistic effect on respiratory depression when combined with opioids 3
  • Higher risk of adverse effects when combined with other CNS depressants 5

Diazepam Milligram Equivalency

• Mean daily diazepam milligram equivalency (DME) in clinical practice is approximately 10.6 mg 5
• Higher doses (≥15 DME/day) are associated with concurrent use of opioids or stimulants 5

Remember that diazepam has a long half-life and active metabolites, which provides a natural tapering effect when discontinuing therapy 2. This characteristic makes it suitable for both intermittent dosing and short-term treatment regimens.