Modulates postsynaptic effects of GABA-A transmission, resulting in an increase in presynaptic inhibition. Appears to act on part of the limbic system, as well as on the thalamus and hypothalamus, to induce a calming effect. Variable, dependent on dose and frequency PO [hypnotic action] ; min IV [sedative action].
Doxapram, glycopyrrolate, heparin, hydromorphone, ketorolac? Atropine, epinephrine, hydroxyzine, lidocaine, meperidine, morphine, norepinephrine, pentobarbital, Na bicarbonate. Cisatracurium may be incompatible at higher concentration , dobutamine, fentanyl, hydromorphone may be incompatible at higher concentration , methadone, morphine sulfate, nafcillin, quinidine, remifentanil may be incompatible at higher concentration , sufentanil.
If infusion is selected, adding the infusion solution to the diazepam injection and not the other way around may prevent precipitate formation. Place patient on side facing you with upper leg bent forward, lubricate rectal applicator tip, gently insert syringe tip in rectum and slowly push plunger. Adding plans allows you to compare formulary status to other drugs in the same class.
To view formulary information first create a list of plans. Your list will be saved and can be edited at any time. The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.
By clicking send, you acknowledge that you have permission to email the recipient with this information. Sign Up It's Free! If you log out, you will be required to enter your username and password the next time you visit. Brand and Other Names: Share Email Print Feedback Close. Schedule IV 2mg 5mg 10mg. Titrate dose to 10 mg or less immediately before procedure, not to exceed cumulative dose of 20 mg; reduce dose of narcotic by one third or omit, OR IM: Dosage Modifications Renal impairment: No dose adjustment recommended unless administered for prolonged period; decrease dose in prolonged periods Hepatic impairment: Acute Repetitive Seizures Orphan Orphan indication for management of acute repetitive seizures as intranasal, buccal soluble film, or SC administration Sponsors Intranasal: Neurelis Pharmaceuticals, Inc; B N.
IV 6 months-5 years: Use lower dose Dosing Considerations Due to long-acting metabolite, not considered a drug of choice in the elderly; associated with falls. Significant - Monitor Closely. All Interactions Sort By: Serious Neutropenia Jaundice Local effects: Pain, swelling, thrombophlebitis, carpal tunnel syndrome, tissue necrosis Phlebitis if too rapid IV push.
Postmarketing Reports Injury, poisoning and procedural complications: Enters breast milk; not recommended Minor tranquilizers should be avoided in first trimester of pregnancy due to increased risk of congenital malformations Maternal use shortly before delivery is associated with floppy infant syndrome good and consistent evidence Prenatal benzodiazepine exposure slightly increased oral cleft risk limited or inconsistent evidence Pregnancy Categories A: Variable, dependent on dose and frequency PO [hypnotic action] ; min IV [sedative action] Peak plasma time: Administration IV Incompatibilities Solution: See IV Preparation Additive: Bleomycin, dobutamine, doxorubicin, floxacillin, fluorouracil, furosemide Syringe: Cisatracurium may be incompatible at higher concentration , dobutamine, fentanyl, hydromorphone may be incompatible at higher concentration , methadone, morphine sulfate, nafcillin, quinidine, remifentanil may be incompatible at higher concentration , sufentanil Not specified: Storage Store intact vials at room temperature; protect from light.
Print without Office Info. Print with Office Info. Formulary Formulary Patient Discounts. Create Your List of Plans. View explanations for tiers and restrictions. Tier Description 1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs. Dose to be delivered by the AcuDial applicator is locked into the device prior to dispensing.
Prescription should indicate the appropriate dose to be locked into the applicator, the appropriate rectal tip size, and the number of packages 2 applicators per package to be dispensed. Pharmacist must dial in and lock the correct dose to be administered prior to dispensing Diastat AcuDial. While holding the barrel of the applicator in one hand, turn the cap of the applicator to select the dose.
Remove the protective cap from the syringe and ensure that the seal pin is removed with the cap. Lubricate the rectal applicator tip with the water-soluble lubricant jelly provided by the manufacturer. Leave the patient on their side facing the caregiver, note the time the dose was given, and observe the patient. If bowel leakage occurs, a supplemental dose may be required.
Discard Diastat and Diastat AcuDial rectal delivery systems and all unused materials in the garbage in a safe place away from children; do not reuse. Prior to discarding AcuDial applicator in the garbage, dispose of any gel remaining in the applicator. Children 30 days to 5 years of age: Initially, 1 mg; may repeat every 2—5 minutes to a maximum total dose of 10 mg.
Children 2—5 years of age: Children 6—11 years of age: Initially, 2—5 mg for moderate or 5—10 mg for severe acute anxiety; may repeat in 3—4 hours. Titrate dosage to obtain desired sedative response e. Initially, 10 mg some clinicians recommend up to 20 mg , then 5—10 mg every hour if necessary, although an interval of 3—4 hours may be satisfactory. Alternatively, some clinicians recommend 10 mg initially, followed by 10 mg at 20—30 minutes intervals until patient is calm.
Maximum recommended frequency for administration by caregivers outside hospital is 1 treatment course every 5 days and 5 treatment courses per month. Initially, 2—5 mg as a single dose. Dosage to be administered should be adjusted downward for the commercially available prefilled applicators of rectal gel. Use the smallest effective dosage in debilitated patient and patients with low serum albumin concentrations.
See Geriatric Patients under Dosage and Administration. Known hypersensitivity to diazepam or any ingredient in the formulation. Manufacturers state that diazepam is contraindicated in patients with acute angle-closure glaucoma, but may be administered to patients with open-angle glaucoma who are receiving appropriate therapy; b c however, clinical rationale for this contraindication has been questioned.
Concomitant use of benzodiazepines, including diazepam, and opiates may result in profound sedation, respiratory depression, coma, and death. Reserve concomitant use of diazepam and opiates for patients in whom alternative treatment options are inadequate. Performance of activities requiring mental alertness and physical coordination may be impaired.
Do not use in patients with depressive neuroses or psychotic reactions in which anxiety is not prominent. Consider possibility of respiratory depression with rectal administration. Equipment for resuscitation should be readily available whenever diazepam is administered IV. Concomitant use of other CNS depressants may increase the risk of apnea. Patients with a history of drug or alcohol dependence or abuse are at risk of habituation or dependence; use only with careful surveillance in such patients.
Abrupt discontinuance may result in symptoms of withdrawal similar to barbiturates. Abrupt withdrawal may be associated with a temporary increase in seizure frequency or severity. Effect on seizure activity after IV administration is short-lived; repeated administration may be necessary. Tonic status epilepticus has occurred following IV administration to control absence status or Lennox-Gastaut syndrome status epilepticus. Potential for local reactions e. Only caregivers who are deemed competent to recognize seizure episodes suitable for treatment, make the decision to initiate treatment, administer the drug, monitor the patient, and assess adequacy of response should administer diazepam rectal gel.
Use with caution in depressed patients; potential for suicidal tendencies. Perform blood counts and liver function tests periodically during long-term therapy. Diazepam and its metabolites are distributed into milk; discontinue nursing or the drug. CNS depression in neonates may be prolonged because of apparent inability to convert drug to inactive metabolites.
Increased risk of adverse CNS effects. Clearance may be decreased. Clearance of metabolites may be decreased. Drowsiness, c b ataxia, c b fatigue. Potential pharmacokinetic interaction altered diazepam elimination. Increased plasma diazepam concentrations c. Possible decreased renal excretion and increased plasma concentrations of digoxin Monitor serum digoxin concentrations; reduction of digoxin dosage may be necessary Clinical importance not determined; consider possible need for diazepam dosage reduction Risk of profound sedation, respiratory depression, coma, or death Whenever possible, avoid concomitant use Use concomitantly only if alternative treatment options are inadequate; use lowest effective dosages and shortest possible duration of concomitant therapy; monitor closely for respiratory depression and sedation In patients receiving diazepam, initiate opiate analgesic, if required, at reduced dosage and titrate based on clinical response Reduce opiate dosage by at least one-third and administer in small increments when diazepam is administered IV concurrently with an opiate analgesic b c.
In patients receiving an opiate analgesic, initiate diazepam, if required for any indication other than epilepsy, at lower dosage than indicated in the absence of opiate therapy and titrate based on clinical response Consider offering naloxone to patients receiving benzodiazepines and opiates concomitantly Possible false positive reactions for glucose with Clinistix and Diastix a.
Onset of anticonvulsant, anxiolytic, or sedative action occurs in 1—5 minutes following IV administration. Duration of anticonvulsant, anxiolytic, or sedative action is 15—60 minutes following IV administration. Diazepam and its metabolites cross the placenta and are distributed into milk. Geriatric patients and patients with hepatic impairment may have prolonged elimination half-lives of diazepam and its metabolites. Addition of diazepam injection to an IV infusion solution or plastic syringes may result in adsorption of diazepam to the plastic container and tubing.
Effects appear to be mediated through the inhibitory neurotransmitter GABA; the site and mechanism of action within the CNS appear to involve a macromolecular complex GABA A -receptor-chloride ionophore complex that includes GABA A receptors, high-affinity benzodiazepine receptors, and chloride channels. Importance of taking only as prescribed; do not increase dosage or duration of therapy or abruptly discontinue drug unless otherwise instructed by a clinician.
Risk of potentially fatal additive effects e. Potential for drug to impair mental alertness or physical coordination; use caution when operating machinery or performing hazardous tasks until effects on individual are known. Upon receiving Diastat AcuDial from the pharmacy and again prior to administering a dose, importance of verifying accuracy of prescription e. Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, and alcohol consumption.
Importance of informing clinicians about any concomitant illnesses, particularly depression. Importance of women informing their clinician if they are or plan to become pregnant or plan to breast-feed. Importance of informing patients of other important precautionary information. Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
Interaction of disulfiram with benzodiazepines. Klotz U, Reimann I. Delayed clearance of diazepam due to cimetidine. N Engl J Med. Influence of cimetidine on oral diazepam elimination with measurement of subsequent cognitive change. Br J Clin Pharmacol. Am J Hosp Pharm. Elevation of steady-state diazepam levels by cimetidine. Digoxin levels and diazepam.
Hypnotics and sedatives; ethanol: Neurohumoral transmission and the central nervous system: The GABA-benzodiazepine interaction fifteen years later. Ann NY Acad Sci. Benzodiazepine receptor subtypes and their possible clinical significance. From binding studies to the molecular biology of GABA receptors. Pharmacology of the benzodiazepine receptor.
Eur Arch Psychiatry Neurol Sci. Co-localization of GABA receptors and benzodiazepine receptors in the brain shown by monoclonal antibodies. Endogenous ligands of the benzodiazepine receptor.