TOXBASE Factsheet

Diazepam
Updated 11/2003

Type of product:
A benzodiazepine.

Ingredients:
Diazepam Tablets - 2 mg, 5 mg, 10 mg Capsules - 2mg, 5mg Oral solution/5 mL - 2 mg, 5 mg Injection - 5 mg/ mL Rectal tubes - 2 mg/mL, 4 mg/mL Suppositories - 10 mg

Toxicity:
Benzodiazepines are remarkably safe when taken alone in overdosage. Serious toxicity in children or adults is rare. The therapeutic half-life of diazepam is 21-37 hours.

Benzodiazepines (3) f&m

Updated 11/2003

Features:
Benzodiazepines commonly cause drowsiness, ataxia, dysarthria and nystagmus. Coma, hypotension and respiratory depression occasionally occur but are seldom serious if these drugs are taken alone. Coma usually lasts only a few hours but in elderly people it may be more protracted and cyclical. Benzodiazepine respiratory depressant effects are more serious in patients with severe chronic obstructive airways disease. Benzodiazepines potentiate the effects of other central nervous system depressants, including alcohol.

Management:
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1. Maintain a clear airway and adequate ventilation if indicated. 2. The benefit of gastric decontamination is uncertain. Consider activated charcoal (50 g for an adult, 10-15 g for a child) in adults who have taken more than 100 mg or children who have taken more than 1 mg/kg within 1 hour, provided they are not too drowsy. 3. Gastric lavage is unnecessary if these drugs have been taken alone. 4. Patients who are asymptomatic at 4 hours are unlikely to develop symptoms. 5. Supportive measures as indicated by the patient's clinical state. 6. Flumazenil (Anexate), a benzodiazepine antagonist, is available but should rarely be required. It has a short half-life (about an hour). Flumazenil is NOT TO BE USED IN MIXED OVERDOSE OR AS A "DIAGNOSTIC" TEST. Instructions for its use follow.

Flumazenil doses
Updated 5/2001

Manufacturer:
Roche Products Ltd

Brand name:
Anexate

Ingredients/5 mL ampoule:
Flumazenil 500 micrograms NB Flumazenil is used for the reversal of sedative effects of benzodiazepines in anaesthetic procedures. It should rarely be required in benzodiazepine overdose.

Flumazenil - adult doses

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NOT TO BE USED IN MIXED OVERDOSE OR AS A "DIAGNOSTIC" TEST The use of this antidote in acute benzodiazepine overdosage is not yet approved in the UK. It is licensed in Ireland for this use. Doses should be given intravenously over 30 seconds and only as few as is necessary to obtain the desired clinical response. The maximum total dose is 3 mg. First dose: 0.2 mg (2 mL) Wait 30 seconds. If unsuccessful Second dose: 0.3 mg (3 mL) Wait 30 seconds. If unsuccessful Third and subsequent doses: 0.5 mg (5 mL) If there is still no response then it is unlikely that flumazenil will reverse the CNS/respiratory depression. If drowsiness recurs, doses can be repeated at 20 minute intervals or as an intravenous infusion of 0.1-0.5 mg/hour, adjusted to individual response. Not more than 1 mg (0.5 mg/min) should be given at one time and not more than 3 mg in total.

Cautions/Adverse Effects
WARNING!! 1. The duration of action of flumazenil (half-life 52 minutes, duration of action 1-2 hours) is much shorter than that of the benzodiazepines commonly encountered in overdosage. Patients must therefore be kept under observation for a few hours in case toxicity recurs. 2. Flumazenil may precipitate: (a) a withdrawal syndrome in benzodiazepine-dependent patients (b) convulsions in epileptics. (c) arrhythmias in patients who have taken cardiotoxic drugs. 3. Do NOT give flumazenil for combined tricyclic antidepressant and benzodiazepine

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overdosage as convulsions and cardiac arrest may be precipitated. End

Flumazenil - paediatric doses

The use of this antidote in acute benzodiazepine overdosage is not yet approved in the UK, although it is in Ireland. Flumazenil should only be given to children if the features of benzodiazepine overdosage are such that the child may be at serious risk. Data on doses in childhood are not available. The following regime has been suggested for children over the age of 4 years. Flumazenil should be given intravenously over 30 seconds and not more than 2 doses should be given.

First dose:
10 micrograms/kg body weight Wait 30 seconds. If unsuccessful -

Second dose:
10 micrograms/kg body weight Not more than 2 doses should be given. An infusion of 10 micrograms/kg/hour may be used.

Cautions/Adverse Effects
WARNING!! 1. The duration of action of flumazenil (half-life 52 minutes, duration of action 1-2 hours) is much shorter than that of the benzodiazepines commonly encountered in overdosage. Patients
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must therefore be kept under observation for a few hours in case toxicity recurs. 2. Flumazenil may precipitate: (a) a withdrawal syndrome in benzodiazepine-dependent patients (b) convulsions in epileptics. (c) arrhythmias in patients who have taken cardiotoxic drugs. 3. Do NOT give flumazenil for combined tricyclic antidepressant and benzodiazepine overdosage as convulsions and cardiac arrest may be precipitated. End

Flumazenil - cautions/adverse effects

WARNING!! 1. The duration of action of flumazenil is much shorter than that of the benzodiazepines commonly encountered in overdosage. Patients must therefore be kept under observation for a few hours in case toxicity recurs. 2. Flumazenil may precipitate: (a) a withdrawal syndrome in benzodiazepine-dependent patients (b) convulsions in epileptics. (c) arrhythmias in patients who have taken cardiotoxic drugs. 3. Do NOT give flumazenil for combined tricyclic antidepressant and benzodiazepine overdosage as convulsions and cardiac arrest may be precipitated.

End

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