Drug Name

Dosage & Route

Action

Indication

Adverse Effects

Contraindication

Nursing Responsibility

DIAZEPAM (dye-az'e-pam) Apo-Diazepam, Diastat, Diazemuls , E-Pam , Meval , Novodipam , Valium, Valrelease, Vivol Classifications: CENTRAL NERVOUS SYSTEM AGENT; BENZODIAZEPINE ANTICONVULSANT; ANXIOLYTIC

Status Epilepticus Adult: IV/IM 510 mg, repeat if needed at 10 15 min intervals up to 30 mg, then repeat if needed q24h Child: IV/IM <5 y, 0.20.5 mg slowly q2 5min up to 5 mg; >5 y, 1 mg slowly q25min up to 10 mg, repeat if needed q24 h Anxiety, Muscle Spasm, Convulsions, Alcohol Withdrawal Adult: PO 210 mg b.i.d. to q.i.d. or 1530 mg/d sustained release IV/IM 210 mg, repeat if needed in 34 h Geriatric: PO 12 mg 12 times/d (max: 10 mg/d) Child: PO >6 mo, 1 2.5 mg b.i.d. or t.i.d.

Psychotherapeutic agent related to chlordiazepoxide; reportedly superior in antianxiety and anticonvulsant activity, with somewhat shorter duration of action. Like chlordiazepoxide, it appears to act at both limbic and subcortical levels of CNS.

Drug of choice for status epilepticus. Management of anxiety disorders, for shortterm relief of anxiety symptoms, to allay anxiety and tension prior to surgery, cardioversion and endoscopic procedures, as an amnesic, and treatment for restless legs. Also used to alleviate acute withdrawal symptoms of alcoholism, voiding problems in older adults, and adjunctively for relief of skeletal muscle spasm associated with cerebral palsy, paraplegia, athetosis, stiff-man syndrome, tetanus.

Body as a Whole: Throat and chest pain. CNS: Drowsiness, fatigue, ataxia, confusion, paradoxic rage, dizziness, vertigo, amnesia, vivid dreams, headache, slurred speech, tremor; EEG changes, tardive dyskinesia. CV: Hypotension, tachycardia, edema, cardiovascular collapse. Special Senses: Blurred vision, diplopia, nystagmus. GI: Xerostomia, nausea, constipation, hepatic dysfunction. Urogenital: Incontinence, urinary retention, gynecomastia (prolonged use), menstrual irregularities, ovulation failure. Respiratory: Hiccups, coughing, laryngospasm. Other: Pain, venous thrombosis, phlebitis at injection site.

Injectable form: Shock, coma, acute alcohol intoxication, depressed vital signs, obstetrical patients, infants <30 d of age. Tablet form: Infants <6 mo of age, acute narrow-angle glaucoma, untreated open-angle glaucoma; during or within 14 d of MAO inhibitor therapy. Safe use during pregnancy (category D) and lactation is not established.

Assessment & Drug Effects

Monitor for adverse reactions. Most are dose related. Physician will rely on accurate observation and reports of patient response to the drug to determine lowest effective maintenance dose. Monitor for therapeutic effectiveness. Maximum effect may require 12 wk; patient tolerance to therapeutic effects may develop after 4 wk of treatment. Observe necessary preventive precautions for suicidal tendencies that may be present in anxiety states accompanied by depression. Observe patient closely and monitor vital signs when diazepam is given parenterally; hypotension, muscular weakness, tachycardia, and respiratory depression may occur. Lab tests: Periodic CBC and liver function tests during prolonged therapy. Supervise ambulation. Adverse reactions such as drowsiness and ataxia are more likely to occur in older adults and debilitated or those receiving larger doses. Dosage adjustment may be necessary. Monitor I&O ratio, including urinary and bowel elimination.