Nurses Compass
Drug Guide
Diazepam
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.