Maximum Recommended Dose of Diazepam for Seizure Patients
For status epilepticus, the maximum single dose of diazepam is 10 mg per dose in adults and children ≥5 years, with a maximum cumulative dose of 30 mg over repeated administrations. 1, 2
Pediatric Dosing by Age
Children under 5 years:
- 0.2-0.5 mg/kg IV slowly every 2-5 minutes, up to a maximum single dose of 5 mg 1, 2
- May repeat in 2-4 hours if necessary, though residual active metabolites may persist 2
Children 5 years and older:
- 1 mg IV every 2-5 minutes up to a maximum single dose of 10 mg 1, 2
- Repeat dosing in 2-4 hours if needed 2
Infants over 30 days:
- 1-2 mg IM or IV slowly, repeated every 3-4 hours as necessary for tetanus-related seizures 1
Adult Dosing
For status epilepticus and severe recurrent convulsive seizures:
- Initial dose: 5-10 mg IV (preferred route) 2
- May repeat at 10-15 minute intervals up to a maximum cumulative dose of 30 mg 2
- If necessary, therapy may be repeated in 2-4 hours, but extreme caution must be exercised due to persistent active metabolites 2
For moderate anxiety/seizure-related agitation:
- Maximum single dose of 10 mg IM or IV, repeated in 3-4 hours if necessary 2
Critical Administration Guidelines
Route considerations:
- IV administration is strongly preferred over IM - administer slowly over approximately 2 minutes to avoid pain at injection site 1, 2
- IM route should be avoided when possible due to risk of tissue necrosis 1, 3
- Rectal administration: 0.5 mg/kg up to 20 mg when IV access unavailable, though absorption is erratic 1, 3
Essential Safety Monitoring
Respiratory precautions are mandatory:
- Monitor oxygen saturation continuously and be prepared to provide respiratory support 1, 3
- Increased incidence of apnea occurs with rapid IV administration or when combined with other sedatives 1, 3
- Flumazenil may reverse life-threatening respiratory depression but will also counteract anticonvulsant effects and may precipitate seizures 1, 3
Critical Pitfall: Short Duration of Action
Diazepam must be followed immediately by a long-acting anticonvulsant (phenytoin 18 mg/kg IV or fosphenytoin 20 mg PE/kg) because diazepam is rapidly redistributed and seizures often recur within 15-20 minutes 1, 3. This is the most common error in diazepam use for seizures.
Comparative Efficacy Data
Lorazepam may be preferred over diazepam - in a randomized trial of 384 patients with overt generalized convulsive status epilepticus, lorazepam achieved 64.9% success versus diazepam plus phenytoin at 55.8% (p=0.002 for lorazepam superiority over phenytoin alone) 4. However, diazepam plus phenytoin showed no significant difference in adverse reactions or 30-day outcomes 4.
Special Populations Requiring Caution
Extreme caution required in: