see also benzodiazepines, anticonvulsants, sedatives, hypnotics and anxiolytics, induction agents

• 99% prot. bound; enterohep. circ; metab. to nordazepam → oxazepam;
• T½= 30-60hrs; Vd = 1.1L/kg; Clearance = 0.38ml/min/kg;
• redistribution half-times: diazepam 1hr;

• many prefer use of the water-soluble, shorter-acting midazolam
• adults:
  • initially 5-10 mg IVI, may repeat every 10-15 min to max 30 mg; repeat in 2-4 hrs if necessary. (MIMS)
• paediatric:
  • rectal:
    • 0.2-0.5mg/kg pr
    • solution is usually already made up in bottle diluted to 1mg/ml.
    • Give 0.2ml/kg pr stat and titrate to 0.8mg/kg pr as needed over 10min.
  • IV (repeat in 2-4 hrs if necessary):
    • 0.1-0.2mg/kg iv
    • 1 mth-5 yrs: 0.2-0.5 mg slow IVI every 2-5 min to max 5 mg; (MIMS)
    • greater than or equal to 5 yrs: 1 mg every 2-5 min to max 10 mg; (MIMS)
    • Draw up all of 2ml ampoule (ie. 10mg) of diazepam into 10ml syringe and dilute by adding 8ml N.Saline, thus making final concentration of 1mg/ml.
    • Give 0.1mg/kg IV over 1-2min, titrate to 0.4mg/kg (max. 10mg) as needed over 5-10min.

• adults:
  • ambulatory patients: 2mg tds or 2mg 1-2 times during the day and 5mg nocte
  • elderly/debility: avoid if possible, but if you must, then 2mg bd
    • see benzodiazepines in the elderly
  • hospitalised patients being observed: up to 10-15mg tds (max. 40mg/day)

• adults:
  • may require 10 mg IV or IMI initially, then 5-10 mg in 3-4 hrs if necessary
  • regular 10-20mg o doses may be given under close supervision in hospital according to your hospital's alcohol withdrawal guidelines, which usually include regular specific documentation of alcohol withdrawal status.
  • WARNING: large, frequent doses of this long acting agent may result in death from respiratory depression if unmonitored!