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DiazePAM

Classification

HIgh alert medication

Controlled and targeted substance

Benzodiazepine anticonvulsant, sedative, anxiolytic, and amnesic

Indications

CCP: Treatment of prolonged seizures (> 5 minutes) or recurrent seizures

CCP: Sedation prior to electrical therapies (e.g., synchronized cardioversion, external cardiac pacing)

Contraindications

Hypersensitivity to benzodiazepines
Acute narrow-angle glaucoma
Myasthenia gravis
Hypoglycemic seizures

Adult dosages

CCP: Status seizures

5 mg IV over 5 minutes
May repeat once if needed for ongoing seizures

CCP: Sedation

2-5 mg IV, in increments; give slowly to a maximum total dose of 30 mg

Pediatric Considerations And Dosing

Follow weight-based dosing

CCP: All indications

2 mg/kg IV/IO or PR
Maximum total dose of 20 mg

Mechanism Of Action

Binds to receptor sites in the central nervous system, promoting interaction between gamma aminobutyric acid (GABA) and its receptors on neurons, which become permeable to chloride. An influx of chloride makes the interior of the cell more negative and the cell takes longer to depolarize, suppressing the spread of seizure activity and raising the seizure threshold.

Pharmacokinetics

Onset: 1-5 minutes (IV/PR)
Peak: 15 minutes (IV); 5-90 minutes (PR)
Duration: 15-60 minutes (IV); dose dependent (PR)

Adverse Effects

May cause hypotension
Benzodiazepines as a class inhibit neuronal uptake of adenosine, which may result in peripheral vasodilation
DiazePAM may depress respirations

Overdose

Overdose management generally requires supportive care only. Provide appropriate airway management, ensure adequate oxygenation and ventilation, and support blood pressure as required.

Warning And Precautions

May precipitate when diluted with other solutions. Do not dilute or mix with any other material including saline.
Exercise caution in patients who have consumed alcohol or other intoxicants.

Drug Interactions

There is an increased risk of toxicity in patients taking cimetidine, siulfiram, and oral contraceptives. Diazepam’s effectiveness is decreased when given to patients taking ranitidine or theophylline.