What is the typical dose for oral Valium (diazepam)?

Typical Oral Valium (Diazepam) Dosing

For anxiety management in adults, the typical oral dose of diazepam is 2-10 mg taken 2 to 4 times daily, with most patients responding well to 5-10 mg doses. 1, 2

Standard Adult Dosing by Indication

Anxiety Disorders

• Standard dose: 2-10 mg orally, 2 to 4 times daily depending on symptom severity 1, 2
• The FDA label indicates this range accommodates mild to severe anxiety, with dosing frequency adjusted based on clinical response 1, 2
• Meta-analysis data suggests 12-18 mg/day appears to be the maximal effective dose for neurotic anxiety states, with treatment duration of 2 or more weeks needed for optimal effect 3
• Notably, doses of only 6 mg/day showed no significant difference from placebo in controlled trials 3

Acute Alcohol Withdrawal

• Initial 24 hours: 10 mg orally, 3 to 4 times daily 1, 2
• Subsequent days: Reduce to 5 mg, 3 to 4 times daily as needed 1, 2
• Alternative loading dose strategy: 20 mg every 2 hours until asymptomatic (median of 3 doses over 7.6 hours effectively treats most patients) 4

Skeletal Muscle Spasm (Adjunctive)

• Dose: 2-10 mg orally, 3 to 4 times daily 1, 2

Convulsive Disorders (Adjunctive)

• Dose: 2-10 mg orally, 2 to 4 times daily 1, 2

Special Population Adjustments

Elderly or Debilitated Patients

• Initial dose: 2-2.5 mg orally, 1 to 2 times daily 1, 2
• Increase gradually only as needed and tolerated 1, 2
• For procedural sedation, reduce IV doses by 20% or more compared to younger adults 5, 6

Pediatric Patients (≥6 months)

• Initial dose: 1-2.5 mg orally, 3 to 4 times daily 1, 2
• Start with the lowest dose and increase gradually as required 1, 2
• Not approved for use under 6 months of age 1, 2

Renal Failure

• No dose adjustment required since diazepam is hepatically metabolized 5, 6
• Safe for use in dialysis patients 5, 6

Procedural Sedation Dosing

Endoscopic Procedures

• Initial IV dose: 5-10 mg over 1 minute 5, 6
• Additional doses at 5-minute intervals as needed 5, 6
• Total dose: 10 mg typically sufficient; up to 20 mg may be necessary if not co-administering narcotics 5, 6

Dental Sedation

• Single oral dose: 0.1-0.8 mg/kg body weight 5, 6

Critical Safety Considerations

Respiratory Monitoring

• Monitor respiratory function during administration, especially with IV use 5, 6
• Risk of respiratory depression increases when combined with opioids or in patients with underlying respiratory disease 5, 6
• Have resuscitation equipment readily available 5, 6

Withdrawal Risk Management

• Duration matters: Patients treated continuously for <8 months have only 5% withdrawal incidence, versus 43% for ≥8 months of treatment 7
• Use gradual taper to discontinue or reduce dosage 1, 2
• If withdrawal reactions develop, pause the taper or increase to the previous dosage level, then decrease more slowly 1, 2
• Withdrawal reactions are manageable and not life-threatening when properly tapered 7

Common Pitfalls to Avoid

• Underdosing anxiety: 6 mg/day is ineffective; aim for 12-18 mg/day divided doses for adequate anxiolysis 3
• Inadequate treatment duration: Allow at least 2 weeks for full therapeutic effect 3
• Abrupt discontinuation: Always taper gradually, especially after prolonged use (>8 months) 1, 2, 7
• Combining with CNS depressants: Enhanced sedation and respiratory depression risk requires dose reduction and close monitoring 5, 6