ORAL USE IS APPROPRIATE FOR MANY INDICATIONS AND MODIFIED-RELEASE FORMULATIONS ARE AVAILABLE IN SOME COUNTRIES. RECTAL USE MAY BE BY SUPPOSITORY OR RECTAL SOLUTION OR GEL. DIAZEPAM IS ALSO GIVEN BY DEEP INTRAMUSCULAR OR SLOW INTRAVENOUS INJECTION, ALTHOUGH ABSORPTION AFTER INTRAMUSCULAR INJECTION MAY BE ERRATIC AND PROVIDES LOWER BLOOD CONCENTRATIONS THAN THOSE AFTER ORAL DOSES. INTRAVENOUS INJECTION SHOULD BE CARRIED OUT SLOWLY INTO A LARGE VEIN OF THE ANTECUBITAL FOSSA AT A RECOMMENDED RATE OF NO MORE THAN 1 ML OF A 0.5% SOLUTION (5 MG) PER MINUTE. IT IS ADVISABLE TO KEEP THE PATIENT IN THE SUPINE POSITION AND UNDER MEDICAL SUPERVISION FOR AT LEAST AN HOUR AFTER THE DOSE. DIAZEPAM MAY BE GIVEN BY CONTINUOUS INTRAVENOUS INFUSION; BECAUSE OF THE RISK OF PRECIPITATION OF DIAZEPAM, SOLUTIONS SHOULD BE FRESHLY PREPARED FOLLOWING THE MANUFACTURER'S DIRECTIONS REGARDING DILUENT AND CONCENTRATION OF DIAZEPAM. DIAZEPAM IS SUBSTANTIALLY ADSORBED ONTO SOME PLASTICS .FACILITIES FOR RESUSCITATION SHOULD ALWAYS BE AVAILABLE WHEN DIAZEPAM IS GIVEN INTRAVENOUSLY.
DIAZEPAM MAY BE GIVEN FOR SEVERE ANXIETY IN ORAL DOSES OF 2 MG THREE TIMES DAILY TO A MAXIMUM OF 30 MG DAILY. A WIDER DOSE RANGE OF 4 TO 40 MG DAILY IN DIVIDED DOSES IS USED IN THE USA WITH CHILDREN OVER 6 MONTHS OF AGE RECEIVING UP TO 10 MG DAILY. DIAZEPAM MAY BE GIVEN AS A RECTAL SOLUTION IN A DOSE OF 500 MICROGRAMS/KG REPEATED AFTER 12 HOURS IF NECESSARY OR AS SUPPOSITORIES IN A DOSE OF 10 TO 30 MG. DIAZEPAM MAY SOMETIMES HAVE TO BE GIVEN BY INTRAMUSCULAR OR INTRAVENOUS INJECTION WHEN A DOSE OF UP TO 10 MG MAY BE USED, REPEATED IF NECESSARY AFTER 4 HOURS.
THE BENZODIAZEPINES HAVE A LIMITED ROLE IN INSOMNIA AND DIAZEPAM IS USED FOR THE SHORT-TERM MANAGEMENT OF INSOMNIA ASSOCIATED WITH ANXIETY. THE BNF RECOMMENDS A DOSE OF 5 TO 15 MG BY MOUTH AT BEDTIME, ALTHOUGH DOSES UP TO 30 MG ARE LICENSED. DOSES OF 1 TO 5 MG AT BEDTIME HAVE BEEN USED IN CHILDREN AND ADOLESCENTS AGED FROM 12 TO 18 YEARS TO CONTROL NIGHT TERRORS AND SLEEPWALKING.
DIAZEPAM MAY BE GIVEN FOR PREMEDICATION BEFORE GENERAL ANAESTHESIA OR TO PROVIDE SEDATIVE COVER FOR MINOR SURGICAL OR INVESTIGATIVE PROCEDURES. DOSES BY MOUTH ARE IN THE RANGE OF 5 TO 15 MG; A DOSE OF 10 MG AS A RECTAL SOLUTION MAY ALSO BE SUITABLE. THE BNFC HAS SUGGESTED GIVING ORAL DOSES TO CHILDREN BASED ON AGE AS FOLLOWS: 1 MONTH TO 1 YEAR, 250 MICROGRAMS/KG; 1 TO 5 YEARS, 2.5 MG; 5 TO 12 YEARS, 5 MG. WHEN GIVEN BY INTRAVENOUS INJECTION THE DOSE IS USUALLY 100 TO 200 MICROGRAMS/KG IN ADULTS AND CHILDREN AGED 1 MONTH AND OVER; THE BNFC SUGGESTS A MAXIMUM DOSE OF 5 MG FOR THOSE AGED UP TO 12 YEARS AND 20 MG FOR ADOLESCENTS UP TO 18 YEARS OLD. SOME REGARD THE PERIOPERATIVE USE OF DIAZEPAM IN CHILDREN UNDESIRABLE SINCE ITS EFFECT AND ONSET OF ACTION ARE UNRELIABLE AND PARADOXICAL EFFECTS MAY OCCUR. DIAZEPAM MAY ALSO BE GIVEN FOR SEDATION DURING MINOR SURGICAL AND MEDICAL PROCEDURES; DOSES OF 10 TO 20 MG, GIVEN BY INTRAVENOUS INJECTION OVER 2 TO 4 MINUTES ARE RECOMMENDED; CHILDREN AGED 1 MONTH AND OVER MAY BE GIVEN SIMILAR INTRAVENOUS DOSES AS THOSE USED FOR PREMEDICATION (SEE ABOVE). ALTERNATIVELY, THE BNFC SUGGESTS AN ORAL DOSE MAY BE GIVEN TO CHILDREN AND ADOLESCENTS, 45 TO 60 MINUTES BEFOREHAND, AS FOLLOWS: 1 MONTH TO 12 YEARS, 200 TO 300 MICROGRAMS/KG (MAXIMUM OF 5 MG); 12 TO 18 YEARS, 100 TO 200 MICROGRAMS/KG (MAXIMUM OF 20 MG). ADULTS AND CHILDREN AGED 1 YEAR AND OVER MAY ALSO BE GIVEN 500 MICROGRAMS/KG AS A RECTAL SOLUTION; THE BNFC HAS SUGGESTED ALTERNATIVE DOSES BASED ON AGE AS FOLLOWS: 1 TO 3 YEARS, 5 MG; 3 TO 12 YEARS, 5 TO 10 MG; 12 TO 18 YEARS, 10 MG.
DIAZEPAM IS USED IN A VARIETY OF SEIZURES. IT IS GIVEN BY MOUTH AS AN ADJUNCT IN SOME TYPES OF EPILEPSY; FOR THIS PURPOSE, 2 TO 60 MG MAY BE GIVEN DAILY IN DIVIDED DOSES. A RECTAL GEL FORMULATION IS ALSO AVAILABLE FOR ADJUNCTIVE USE IN THE MANAGEMENT OF EPISODES OF INCREASED SEIZURE ACTIVITY IN ADULTS AND CHILDREN AGED 2 YEARS AND OVER WITH REFRACTORY EPILEPSY; DOSES RANGE FROM 200 TO 500 MICROGRAMS/KG, DEPENDING ON AGE, REPEATED AFTER 4 TO 12 HOURS IF NECESSARY. FOR FEBRILE CONVULSIONS, STATUS EPILEPTICUS, AND CONVULSIONS DUE TO POISONING, GIVING A RECTAL SOLUTION MAY BE APPROPRIATE; SUPPOSITORIES ARE NOT SUITABLE BECAUSE ABSORPTION IS TOO SLOW. RECOMMENDED DOSES FOR THE RECTAL SOLUTION DIFFER BUT A TYPICAL DOSE IS 500 MICROGRAMS/KG FOR ADULTS AND CHILDREN OVER 10 KG, REPEATED EVERY 12 HOURS IF NECESSARY; IF CONVULSIONS ARE NOT CONTROLLED BY THE FIRST DOSE THE USE OF OTHER ANTICONVULSIVE MEASURES IS RECOMMENDED. RECTAL SOLUTIONS ARE NOT LICENSED FOR SUCH USE IN CHILDREN UNDER 1 YEAR OF AGE IN THE UK, BUT THE BNFC SUGGESTS GIVING THE FOLLOWING DOSES, REPEATED AFTER 5 MINUTES IF NECESSARY, BASED ON AGE: NEONATES, 1.25 TO 2.5 MG; 1 MONTH TO 2 YEARS, 5 MG. FOR OLDER CHILDREN IT RECOMMENDS: 2 TO 12 YEARS, 5 TO 10 MG; 12 TO 18 YEARS, 10 MG. ALTERNATIVELY, DIAZEPAM MAY BE GIVEN INTRAVENOUSLY TO ADULTS IN A DOSE OF 10 TO 20 MG GIVEN AT A RATE OF 5 MG/MINUTE AND REPEATED IF NECESSARY AFTER 30 TO 60 MINUTES. OTHER SCHEDULES INVOLVE GIVING SMALLER AMOUNTS MORE FREQUENTLY OR GIVING DIAZEPAM INTRAMUSCULARLY, THOUGH AGAIN ABSORPTION MAY BE TOO SLOW. ONCE THE SEIZURES HAVE BEEN CONTROLLED, A SLOW INTRAVENOUS INFUSION PROVIDING UP TO 3 MG/KG OVER 24 HOURS HAS BEEN USED TO PROTECT AGAINST RECURRENCE. DOSES BY INTRAVENOUS INJECTION IN CHILDREN ARE WITHIN THE RANGE OF 200 TO 300 MICROGRAMS/KG; ALTERNATIVELY 1 MG MAY BE GIVEN FOR EACH YEAR OF AGE. THE BNFC HAS SUGGESTED THAT NEONATES AND CHILDREN AGED FROM 1 MONTH TO 12 YEARS MAY BE GIVEN DOSES OF 300 TO 400 MICROGRAMS/KG BY INTRAVENOUS INJECTION OVER 3 TO 5 MINUTES, REPEATED AFTER 10 MINUTES IF NECESSARY.
DIAZEPAM MAY BE GIVEN BY MOUTH IN DAILY DIVIDED DOSES OF 2 TO 15 MG TO ALLEVIATE MUSCLE SPASM. THE DOSE MAY BE INCREASED IN SEVERE SPASTIC DISORDERS, SUCH AS CEREBRAL PALSY, TO UP TO 60 MG DAILY IN ADULTS. THE BNFC SUGGESTS INITIAL ORAL DOSES IN CHILDREN AND ADOLESCENTS, BASED ON AGE AND GIVEN TWICE DAILY, AS FOLLOWS: 1 TO 12 MONTHS, 250 MICROGRAMS/KG; 1 TO 5 YEARS, 2.5 MG; 5 TO 12 YEARS, 5 MG; 12 TO 18 YEARS, 10 MG (MAXIMUM OF 40 MG DAILY). IF GIVEN BY INTRAMUSCULAR OR SLOW INTRAVENOUS INJECTION THE DOSE IS 10 MG REPEATED IF NECESSARY AFTER 4 HOURS. LARGER DOSES ARE USED IN TETANUS IN ADULTS AND CHILDREN AGED 1 MONTH AND OVER WITH 100 TO 300 MICROGRAMS/KG BEING GIVEN EVERY 1 TO 4 HOURS BY INTRAVENOUS INJECTION. ALTERNATIVELY 3 TO 10 MG/KG MAY BE GIVEN OVER 24 HOURS BY CONTINUOUS INTRAVENOUS INFUSION OR BY NASODUODENAL TUBE USING A SUITABLE LIQUID ORAL DOSE FORM. DIAZEPAM MAY ALSO BE GIVEN BY THE RECTAL ROUTE AS A RECTAL SOLUTION IN A DOSE OF 500 MICROGRAMS/KG FOR ADULTS AND CHILDREN OVER 10 KG IN WEIGHT, REPEATED EVERY 12 HOURS IF NECESSARY.
TETANUS, ADULT AND CHILD, BY INTRAVENOUS INJECTION, 100-300 MICROGRAMS/KG REPEATED EVERY 1-4 HOURS; BY INTRAVENOUS INFUSION (OR BY NASODUODENAL TUBE), 3-10 MG/KG OVER 24 HOURS, ADJUSTED ACCORDING TO RESPONSE
SYMPTOMS OF THE ALCOHOL WITHDRAWAL SYNDROME MAY BE CONTROLLED BY DIAZEPAM GIVEN BY MOUTH IN A DOSE OF 5 TO 20 MG, REPEATED IF REQUIRED AFTER 2 TO 4 HOURS; ANOTHER APPROACH IS TO GIVE 10 MG THREE OR FOUR TIMES ON THE FIRST DAY REDUCING TO 5 MG THREE OR FOUR TIMES DAILY AS REQUIRED. DIAZEPAM MAY NEED TO BE GIVEN BY INJECTION IF THE SYMPTOMS ARE SEVERE AND IF DELIRIUM TREMENS HAS DEVELOPED; 10 TO 20 MG BY INTRAMUSCULAR OR INTRAVENOUS INJECTION MAY BE ADEQUATE, ALTHOUGH SOME PATIENTS MAY REQUIRE HIGHER DOSES.