DIAZEPAM

Mechanism of Action :

Diazepam is a long-acting benzodiazepine with anticonvulsant, anxiolytic, sedative, muscle relaxant and amnestic properties. It increases neuronal membrane permeability to chloride ions by binding to stereospecific benzodiazepine receptors on the postsynaptic GABA neuron within the CNS and enhancing the GABA inhibitory effects resulting in hyperpolarisation and stabilisation.

Indication, Dosage and Frequency :

Oral
SHORT-TERM MANAGEMENT OF ANXIETY
Adult: 2 mg tid. Max: 30 mg daily.
Elderly: Dose reduction may be required.
INSOMNIA ASSOCIATED WITH ANXIETY
Adult: 5-15 mg at bedtime.
Elderly: Dose reduction may be required.
SLEEPWALKING
Child: and adolescents (up to 18 yr): 1-5 mg at bedtime.
Elderly: Dose reduction may be required.
NIGHT TERRORS
Child: and adolescents (up to 18 yr): 1-5 mg at bedtime.
Elderly: Dose reduction may be required.
ANAESTHETIC PREMEDICATION
Adult: 5-15 mg given before general anaesthesia.
Child: 1-12 mth: 250 mcg/kg; 1-5 yr: 2.5 mg; 5-12 yr: 5 mg.
Elderly: Dose reduction may be required.
ADJUNCT IN THE MANAGEMENT OF SEIZURES
Adult: 2-60 mg daily in divided doses.
Elderly: Dose reduction may be required.
MUSCLE SPASMS
Adult: 2-15 mg daily in divided doses, increased up to 60 mg daily in severe spastic disorders e.g. cerebral palsy. Max: 60 mg/day.
Child: 1-12 mth: 250 mcg/kg; 1-5 yr: 2.5 mg; 5-12 year: 5 mg; 12-18 yr: 10 mg. Max: 40 mg/day.
Elderly: Dose reduction may be required.
ACUTE SYMPTOMS OF ALCOHOL WITHDRAWAL
Adult: 5-20 mg repeated after 2-4 hr if necessary. Alternatively, 10 mg 3-4 times daily on the 1st day reduced to 5 mg 3-4 times daily as required.
Elderly: Dose reduction may be required.
Intravenous
ANAESTHETIC PREMEDICATION
Adult: 100-200 mcg/kg.
Child: >1 mth: 100-200 mcg/kg. Max: 1 mth-12 yr: 5 mg/day; 12-18 yr: 20 mg/day.
Elderly: Dose reduction may be required.
MUSCLE SPASM ASSOCIATED WITH TETANUS
Adult: 100-300 mcg/kg given every 1-4 hr by IV inj. Alternatively, 3-10 mg/kg is given over 24 hr by continuous IV infusion or by nasoduodenal tube using a suitable liquid oral dose preparation.
Child: >1 mth: 100-300 mcg/kg given every 1-4 hr by IV inj. Alternatively, 3-10 mg/kg is given over 24 hr by continuous IV infusion or by nasoduodenal tube using a suitable liquid oral dose preparation.
Elderly: Dose reduction may be required.

Interactions :

Increased clearance of diazepam when used with phenytoin, carbamazepine and phenobarbital. Reversible deterioration of parkinsonism may occur when given together with levodopa. Combination with lithium may produce hypothermia.
Grape juice may increase serum levels and toxicity.