Home Drug Guide Diazepam

Drug Guide

Generic Name

Diazepam

Brand Names Valium, Valrelease, Dizac, Diastat, Diastat Acudial, Q-pam, Diazepam Intensol, Valtoco, Libervant

Classification

Therapeutic: Antianxiety agent, Muscle relaxant, Anticonvulsant

Pharmacological: Benzodiazepine

FDA Approved Indications

  • Anxiety disorders
  • Muscle spasms
  • Prevention of agitation caused by alcohol withdrawal
  • Seizure disorders
  • Acute seizure management (rectal gel, nasal spray)

Mechanism of Action

Enhances the effect of the neurotransmitter gamma-aminobutyric acid (GABA) at the GABA-A receptor, producing sedative, anxiolytic, muscle relaxant, and anticonvulsant effects.

Dosage and Administration

Adult: Doses vary by indication; for anxiety, 2-10 mg 2-4 times daily. For seizures, initial dose typically 5-10 mg 2-4 times daily, titrated as needed.

Pediatric: Dosing based on weight, typically 0.2-0.5 mg/kg/dose up to 5 mg, administered multiple times daily.

Geriatric: Start at lower dose (e.g., 2-5 mg at bedtime) due to increased sensitivity and risk of adverse effects.

Renal Impairment: Use cautiously; dose adjustments may be required.

Hepatic Impairment: Use with caution; may need dose reduction due to decreased metabolism.

Pharmacokinetics

Absorption: Well absorbed orally with variable bioavailability.

Distribution: Widely distributed with high lipid solubility; crosses the blood-brain barrier and placental barrier.

Metabolism: Hepatically metabolized primarily by CYP3A4 and CYP2C19 to inactive metabolites.

Excretion: Excreted mainly in urine as conjugates and metabolites.

Half Life: Total half-life approximately 20-50 hours, variable with duration and frequency of use.

Contraindications

  • Hypersensitivity to benzodiazepines
  • Acute narrow-angle glaucoma
  • Severe respiratory insufficiency
  • Severe hepatic impairment

Precautions

  • History of substance abuse, respiratory depression, hepatic or renal impairment, use in pregnancy and lactation (category D)

Adverse Reactions - Common

  • Sedation (Common)
  • Dizziness (Common)
  • Fatigue (Common)
  • Muscle weakness (Common)

Adverse Reactions - Serious

  • Respiratory depression (Rare)
  • Physical or psychological dependence (Rare with prolonged use)
  • Anterograde amnesia (Less common)

Drug-Drug Interactions

  • Additive CNS depressants (opioids, alcohol, other sedatives)

Drug-Food Interactions

  • CNS depressants may be potentiated by alcohol

Drug-Herb Interactions

  • Kava kava, valerian (risk of additive sedative effects)

Nursing Implications

Assessment: Monitor for effectiveness, sedation level, respiratory status, signs of dependence.

Diagnoses:

  • Risk for injury due to dizziness or sedation.
  • Impaired gas exchange related to respiratory depression.

Implementation: Administer with food or milk to decrease gastrointestinal upset. Taper dose gradually to discontinue.

Evaluation: Assess for reduced anxiety, seizure control, relief of muscle spasms, and monitor for adverse effects.

Patient/Family Teaching

  • Do not operate heavy machinery or drive until response is known.
  • Avoid alcohol and other CNS depressants.
  • Report any excessive drowsiness, confusion, or respiratory difficulties.
  • Do not discontinue abruptly to prevent withdrawal symptoms.

Special Considerations

Black Box Warnings:

  • Potential for severe sedation, respiratory depression, coma, and death, especially when combined with opioids.

Genetic Factors: Metabolism may be affected by CYP2C19 polymorphisms affecting drug levels.

Lab Test Interference: May cause false-positive results for certain laboratory tests, including liver function tests.

Overdose Management

Signs/Symptoms: Excessive sedation, confusion, diminished reflexes, respiratory depression, coma.

Treatment: Supportive care, airway management, monitoring vital signs; flumazenil may be used as an antidote but with caution due to seizure risk.

Storage and Handling

Storage: Store at room temperature away from light and moisture.

Stability: Stable under recommended storage conditions for shelf life indicated on packaging.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.