Diazepam Dosage for Acute Anxiety
For acute anxiety in adults, diazepam should be dosed at 2-10 mg, administered 2 to 4 times daily depending on symptom severity, with treatment courses ideally limited to 2-4 weeks maximum to minimize dependence risk. 1
Standard Adult Dosing
- Initial dose: 2-10 mg orally, 2-4 times daily based on anxiety severity 1
- Typical effective range: The maximal effective dose appears to be 12-18 mg/day with treatment duration of 2 or more weeks 2
- Lower doses (6 mg/day) show no significant difference from placebo 2
Special Population Adjustments
Elderly or Debilitated Patients
- Start with 2-2.5 mg once or twice daily initially 1
- Increase gradually as needed and tolerated 1
- Use lower doses (0.25-0.5 mg) when combining with other sedatives to avoid oversedation 3
Acute Stress Reactions
- Single doses or very short courses (1-7 days) are preferred 4
- Short courses of 2-4 weeks may be used for episodic anxiety or fluctuations in generalized anxiety 4
Treatment Duration Considerations
Duration directly impacts withdrawal risk:
- Less than 8 months continuous treatment: 5% incidence of withdrawal reactions 5
- 8 months or more continuous treatment: 43% incidence of withdrawal reactions 5
- Optimal duration: Courses should ideally not exceed 2-4 weeks 4
Discontinuation Protocol
To minimize withdrawal reactions, use gradual tapering: 1
- If withdrawal symptoms develop, pause the taper or increase back to the previous dose level 1
- Subsequently decrease more slowly 1
- Withdrawal reactions, while distressing, are manageable with gradual dose reduction and do not include life-threatening complications when properly tapered 5
Clinical Advantages and Monitoring
Diazepam offers several benefits for acute anxiety:
- High efficacy with rapid onset of action 4
- Significantly more effective than placebo (relative risk 1.35, number needed to treat = 9) 2
- Equally effective as alprazolam for anxiety disorders 6
Key adverse effects to monitor:
- Psychomotor impairment, especially in elderly patients 4
- Sedation (can be attenuated with dose adjustment) 6
- Paradoxical excitement occasionally occurs 4
- Risk of tolerance and dependence with prolonged use 4
Common Pitfalls to Avoid
- Avoid long-term continuous use: Prescriptions beyond 4 weeks significantly increase dependence risk 4, 5
- Do not abruptly discontinue: Always taper gradually to prevent withdrawal reactions 1
- Avoid combining with other sedatives without dose reduction: Increased risk of respiratory depression and oversedation 3
- Do not use ineffective low doses: Doses below 6 mg/day show no benefit over placebo 2