Diazepam

DEA Class;  Rx

Common Brand Names; Valium, Diastat, Diastat AcuDial, Valtoco, 

Documented hypersensitivity

Acute alcohol intoxication

Myasthenia gravis (allowable in limited circumstances)

Acute narrow-angle glaucoma and open-angle glaucoma unless patients receiving appropriate therapy

Severe respiratory depression

IV use in shock, coma, depressed respiration, patients who recently received other respiratory depressants

Sleep apnea

Children <6 months

Severe hepatic insufficiency (PO)

• Ataxia (3%)
• Euphoria (3%, rectal gel)
• Incoordination (3%, rectal gel)
• Somnolence (>1%)
• Rash (3%, rectal gel)
• Diarrhea (4%, rectal gel)
• Dizziness (3%; rectal gel)
• Asthma (2%; rectal gel)
• Hypotension
• Fatigue
• Muscle weakness
• Respiratory depression
• Urinary retention
• Depression
• Incontinence
• Blurred vision
• Dysarthria
• Headache
• Skin rash
• Changes in salivation
• Drowsiness
• Venous thrombosis
• Confusion
• Hypoactivity
• Slurred speech
• Syncope
• Tremor
• Vertigo
• Constipation
• Nausea
• Changes in libido
• Bradycardia

Efficacy and safety of parenteral diazepam has not been established in neonate (30 days or less of age); prolonged central nervous system depression has been observed in neonates, apparently due to inability to biotransform diazepam into inactive metabolites; benzyl alcohol has been reported to be associated with a fatal gasping syndrome in premature infants

Not recommended for chronic, daily use as an anticonvulsant because of potential for development of tolerance to diazepam; chronic daily use of diazepam may increase frequency and/or severity of tonic-clonic seizures, requiring an increase in dosage of standard anticonvulsant medication; in such cases, abrupt withdrawal of chronic diazepam may also be associated with a temporary increase in the frequency and/or severity of seizures

Concomitant use of benzodiazepines, including diazepam, and opioids may result in profound sedation, respiratory depression, coma, and death; reserve concomitant prescribing of benzodiazepines and opioids for use in patients for whom alternative treatment options are inadequate; reduce opiate dose one-third when diazepam is added

Advise both patients and caregivers about risks of respiratory depression and sedation when diazepam is used with opioids; advise patients not to drive or operate heavy machinery until the effects of concomitant use with the opioid have been determined

Use caution in COPD, sleep apnea, renal/hepatic disease, open-angle glaucoma (questionable), depression, suicide ideation, impaired gag reflex, history of drug abuse, or obese patients (prolonged action when discontinued)

Use of benzodiazepines, including diazepam, both used alone and in combination with other CNS depressants, may lead to potentially fatal respiratory depression

May impair ability to perform hazardous tasks

Use with caution in patients with a history of drug abuse or acute alcoholism; tolerance, psychological, and physical dependence may occur with prolonged use (>10 days)

Use of drug, particularly in patients at elevated risk, necessitates counseling about risks and proper use of drug along with monitoring for signs and symptoms of abuse, misuse, and addiction; do not exceed recommended dosing frequency

Avoid or minimize concomitant use of CNS depressants and other substances associated with abuse, misuse, and addiction (eg, opioid analgesics, stimulants); advise patients on proper disposal of unused drug; if a substance use disorder is suspected, evaluate patient and institute (or refer them for) early treatment, as appropriate

There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to AEDs, such as diazepam injection, during pregnancy

Present in breastmilk

Reports of sedation, poor feeding and poor weight gain in infants exposed to diazepam through breast milk; there are no data on effects of diazepam on milk production