diazepam (Valium)

Class:  Anticonvulsant and sedative

Decription: Diazepam is a benzodiazepine commonly used as an anticonvulsant, hypnotic, and sedative.

Mechanism of Action:   Benzodiazepines bind to Type A gamma-aminobutyric acid, or "GABA" receptors is the brain. While benzodiazepines have no direct effect on the receptors, they do potentiate the effects of GABA in the brain.  GABA is the main inhibitory neurotransmitter of the CNS.  Increased levels of GABA cause sedation.  

Common Uses:  Diazepam is most commonly used as an anticonvulsant prehospital but is also used in many other areas.  It is an effective relaxant of skeletal muscles making it useful in orthopedic injuries.  It is also used in the management of anxiety, stress, and tremors associated with alcohol withdrawl.

Onset:  1-5 min. (IV),   15-30 min. (IM)

Peak Effects:  15 Min. (IV),   30-45 min. (IM)

Duration:  15-60 min.

Half Life:  20-50 hrs.

         Indications      

• major motor seizures
• status epilepticus
• premedication to cardioversion (induces amnesia)
• skeletal muscle relaxant
• acute anxiety states

Contraindications:  Hypersensitivity

Precautions 

 

• May require additional doses in the treatment of seizures due to the fast acting nature of the drug. 
• The injectable form can cause local venous irritation and should only be injected into large veins (anticubital fossa). 
• Flumazenil (Romazicon), should be available as an antidote. 

Dosage

• Seizure management -- 5-10 mg IV in large vein
• Acute anziety -- 2-5 mg IM
• Prior to cardioversion -- 5-15 mg IV

IV injections are to be administered by slow push.  No faster than 1 mL / min.

IM injection absorption rates vary.

In rare cases where afore mentioned methods are not available diazepam can be given rectally with a similar onset.

Interactions 

 

• IV line must be adequately flushed if given in conjunction with other medications.
• Antidepressants such as amitriptyline (Elavil, Etrafon), amoxapine (Ascendin), citalopram (Celexa), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), imipramine (Janimine, Tofranil), nortriptyline (Pamelor), paroxetine (Paxil), protriptyline (Vivactil), sertraline (Zoloft), or trimipramine (Surmontil)
• cimetidine (Tagamet)
• Barbiturates such as amobarbital (Amytal), butabarbital (Butisol), mephobarbital (Mebaral), secobarbital (Seconal), or phenobarbital (Luminal, Solfoton)
• MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate)
• Medicines to treat psychiatric disorders, such as chlorpromazine (Thorazine), haloperidol (Haldol), mesoridazine (Serentil), pimozide (Orap), or thioridazine (Mellaril)
• Narcotic medications such as butorphanol (Stadol), codeine, hydrocodone (Loratab, Vicodin), levorphanol (Levo-Dromoran), meperidine (Demerol), methadone (Dolophine, Methadose), morphine (Kadian, MS Contin,  Oramorph), naloxone (Narcan), oxycodone (OxyContin), propoxyphene (Darvon, Darvocet)

Side Effects

 

• Hypotension

• Drowsiness
• Headache
• Amnesia
• Respiratory depression
• Blurred vision
• Nausea or vomiting
• Ataxia (lack of muscle coordination)