Diazepam

Drug Data Generic Name Diazepam Trade Name Valium Minimum Dose 2mg/day Maximum Dose 60mg/day

Classification Pharmacologic Class Benzodiazepine Therapeutic Class Antiepileptic, Anxiolytic, Skeletal muscle relaxant Pregnancy Risk Factor D

Contents Diazepam Availability and color - Tablets-2, 5, 10 mg - Oral solution1mg/mL, 5mg/mL - Rectal pediatric gel- 2.5, 5, 10mg - Injection5mg/mL Routes of administration Oral Intramuscular Intravenous Rectal

Mechanism of Action

Indication

Contraindications

Adverse Reaction

Nursing Responsibilities

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 stabilization.

General Indications - Short-term management of anxiety - Insomnia associated with anxiety - Sleepwalking - Night terrors - Premedication before anaesthesia - Adjunct in the management of seizures - Muscle spasms - Acute symptoms of alcohol withdrawal - Premedication before anaesthesia

Concentrations - Hypersensitivity - Preexisting CNS depression or coma - Respiratory depression - Acute pulmonary insufficiency or sleep apnea - Severe hepatic impairment - Acute narrow angle glaucoma - Children < 6 mth - Pregnancy and lactation.

CNS: Transient, mild drowsiness initially; sedation, depression, lethargy, apathy, fatigue, disorientation, restlessness, confusion, delirium, headache, slurred speech, dysarthria, stupor, rigidity, tremor, mild paradoxical excitatory reactions, extrapyramidal symptoms, visual and auditory disturbances CV: Bradycardia, tachycardia, CV collapse, hypertension and hypotension, edema Dependence: Drug dependence with withdrawal syndrome Dermatologic: Urticaria, pruritus, skin rash, dermatitis GI: Constipation, diarrhea, dry mouth, salivation, nausea, anorexia, vomiting, difficulty in swallowing, elevation in blood enzymes, hepatic impairment GU: Incontinence, urinary retention, changes in libido, menstrual irregularities Hematologic: Decreased Hct, blood dyscrasias Other: Phlebitis, thrombosis, hiccups, fever, diaphoresis, paresthesias, muscular disturbances, gynecomastia, pain, burning, redness after IM injection

Before - Discuss risk of fetal abnormalities with patients desiring to become pregnant. - Instruct about side effects of drug: Drowsiness, dizziness, GI upset, dreams, difficulty concentrating, fatigue, nervousness, crying. - Assess for hypersensitivity. - Reduce dose of opioid analgesics with IV diazepam; dose should be reduced by at least one-third or eliminated. - Instruct not to stop taking the drug without consulting the health care provider. - Observe the 15 rights of drug administration.

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 374-376

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 374-376

Pharmacokinetics A: Readily and completely absorbed from the GI tract, peak plasma concentrations after 30-90 min (oral). Rapidly absorbed, peak plasma concentrations after 10-30 min (rectal). D: Readily crosses the blood-brain barrier; redistributed into fat depots and tissues. Protein-binding: 98-99%. M: Extensively hepatic; converted to desmethyldiazepam, oxazepam and temazepam. E: Urine (as free or conjugated metabolites)

Precaution - Impaired renal and hepatic function - Chronic pulmonary insufficiency - Organic cerebral changes; elderly - History of alcohol or drug addiction. Drug interaction Drug to drug - Increased CNS depression with alcohol, omeperazole - Increased pharmacologic effects of diazepam if combined with cimetidine, disulfiram, hormonal contraceptives - Decreased effects of diazepam with theophyllines, ranitidine

Drug Half Life 20-80 hr

Drug to food - none reported

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 374

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 374-376

Source: http://mims.com.ph/, Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 374-376

Source: http://mims.com.ph/

Source: http://mims.com.ph/

During - Do not administer intrarterially; may produce arteriospasm, gangrene. - Carefully monitor P. BP, respiration during IV administration. - Change from IV therapy to oral therapy as soon as possible. - Do not use small veins for IV injection. - Instruct to take drug exactly as prescribed. After - Maintain patients receiving parenteral benzodiazepines in bed for 3 hours. - Do not permit ambulatory patients to operate a vehicle following an injection. - Instruct patient to report adverse reactions. - Monitor EEG in patients treated for status epilepticus, seizures may recur after initial control. - Monitor liver and renal function, CBC during long term therapy. - Taper dosage gradually after long-term therapy. - Document that drug has been given.