What is the maximum dose of diazepam (Diazepam) for pediatric patients experiencing seizures?

Maximum Dose of Diazepam for Pediatric Seizures

For pediatric status epilepticus, the maximum single dose of IV diazepam is 10 mg per dose, with a maximum cumulative dose of 30 mg when repeated at 10-15 minute intervals. 1, 2

Intravenous Administration for Status Epilepticus

The recommended IV dosing is 0.1-0.3 mg/kg administered slowly over approximately 2 minutes, with a maximum of 10 mg per single dose. 1, 2

Age-Specific Maximum Dosing:

• Infants over 30 days and children under 5 years: 0.2-0.5 mg slowly every 2-5 minutes up to a maximum of 5 mg total 2
• Children 5 years or older: 1 mg every 2-5 minutes up to a maximum of 10 mg total 2

Repeat Dosing Protocol:

• If seizures persist, the dose may be repeated at 10-15 minute intervals 2
• The absolute maximum cumulative dose is 30 mg 2
• If necessary, therapy may be repeated in 2-4 hours, though residual active metabolites may persist and should be considered before readministration 2

Rectal Administration (When IV Access Unavailable)

The rectal dose is 0.5 mg/kg up to a maximum of 20 mg per dose. 1

• Rectal administration showed 81% efficacy in stopping seizures in prehospital settings 3
• Absorption may be erratic compared to IV administration 1

Critical Safety Considerations

Diazepam must be followed immediately by a long-acting anticonvulsant due to rapid redistribution and potential seizure recurrence within 15-20 minutes. 1

Respiratory Monitoring:

• Increased risk of apnea occurs with rapid IV administration or when combined with other sedative agents 1
• Oxygen saturation and respiratory effort must be monitored continuously 1
• Respiratory assistance should be available, particularly for tetanus cases 2

Administration Technique:

• Administer slowly over 2 minutes to avoid pain at the IV site 1
• Extreme caution is required in individuals with chronic lung disease or unstable cardiovascular status 2

Important Clinical Pitfalls

Do NOT use flumazenil to reverse diazepam in seizure patients, as it counteracts anticonvulsant effects and may precipitate seizures. 1

• Paradoxical agitation may occur, especially in younger children 1
• Diazepam has a shorter duration of action compared to lorazepam, which may explain higher recurrence rates 3
• In comparative studies, rectal diazepam produced less respiratory depression than IV diazepam (0% vs 13% requiring intubation) 3

Comparative Efficacy Note

While diazepam remains an option, lorazepam (0.1 mg/kg IV, maximum 4 mg) and diazepam (0.2 mg/kg IV, maximum 10 mg) showed equivalent efficacy (72.1% vs 72.9%) and safety profiles in pediatric status epilepticus. 4 However, the American Academy of Pediatrics currently recommends lorazepam as first-line treatment due to its longer duration of action. 5