From the Guidelines
No, Valium and Ativan should not be administered intranasally (IN) for opioid overdose, as the recommended treatment is naloxone, which can be administered intravenously, intramuscularly, intranasally, or subcutaneously, with a typical dose of 0.04 to 0.4 mg IV or IM, or 2 mg IN, repeated in 3 to 5 minutes if necessary 1.
When considering the administration of any medication, especially in emergency situations, it's crucial to prioritize the most effective and safest option based on current guidelines and evidence. For opioid-associated resuscitative emergencies, the focus should be on reversing opioid-induced CNS and respiratory depression. Naloxone is specifically designed for this purpose and has an excellent safety profile, making it the preferred choice over benzodiazepines like Valium (diazepam) and Ativan (lorazepam) for this indication 1.
Key points to consider in the management of opioid overdose include:
- The importance of recognizing opioid-associated life-threatening emergencies, which can present with cardiac arrest, respiratory arrest, or severe CNS and respiratory depression 1.
- The role of naloxone in rapidly reversing opioid-induced CNS and respiratory depression, with its administration being recommended in various routes depending on the clinical scenario and the rescuer's training 1.
- The potential for naloxone to precipitate acute withdrawal syndrome in opioid-dependent patients, though this is rarely life-threatening and can be minimized by using the lowest effective dose 1.
In clinical practice, especially in real-life emergency situations, the decision to administer any medication should be guided by the most recent and highest quality evidence available, prioritizing interventions that have been proven to improve morbidity, mortality, and quality of life outcomes. For opioid overdose, the use of naloxone is well-supported by evidence, making it the cornerstone of treatment 1.
From the Research
Administration of Valium and Ativan
- Valium (diazepam) and Ativan (lorazepam) are both benzodiazepines, which are commonly prescribed as anxiolytics, sedatives, and anticonvulsants 2.
- These medications act on the GABAA receptor by increasing the conductance of chloride through ionic channels, promoting a state of central nervous system depression 2.
- The clinical properties of benzodiazepines, including Valium and Ativan, are dependent upon the composition of the different subunits of the GABAA receptor 2.
Routes of Administration
- Intravenous routes of administration are commonly used for benzodiazepines, particularly in the treatment of status epilepticus 2.
- Non-intravenous routes of midazolam, such as rectal diazepam, are considered equally efficacious alternatives to intravenous lorazepam 2.
- Outpatient therapy with benzodiazepines for the acute treatment of seizures is currently limited to rectal diazepam, but alternative routes of administration are under development 2.
Safety and Efficacy
- Benzodiazepines, including Valium and Ativan, have been shown to have adverse effects, such as sedation, tolerance, and potential for addiction and misuse in some patients 2, 3.
- Non-selective benzodiazepines, such as Valium and Ativan, may also adversely impact respiration through a variety of mechanisms 4.
- The use of benzodiazepines in older adults is generally advised against due to the high risk of serious adverse effects, and alternative therapies should be considered 5.