Page 113 - 2026 SMOG

DIAZEPAM (VALIUM)
Class/Mechanism of Action
• Benzodiazepine
Acts as an Anxiolytic/Hypnotic, anticonvulsant, and sedative.
˚ Long Half Life: 25–100hr; Onset of action—IV: Almost Immediate; Duration—IV: 20–30min
Indications
• Labeled Indications
Anxiety disorders
˚ Convulsive Disorders and Alcohol Withdrawal Symptoms
˚ Skeletal muscle relaxant
˚ ˚ Induce sedation and amnesia (Midazolam is the primary medication)
Contraindications
• Hypersensitivity to Diazepam or any component of the formulation or other benzodiazepines
• Acute narrow—angle glaucoma
• Untreated open—angle glaucoma
Adverse Reactions/Precautions
• No Analgesic properties (Narcotic pain control is needed for RSI/Intubated trauma patients)
• May Cause Respiratory depression: Do not give without a stable IV line and BVM (airway control) ready.
• Hypotension, vasodilation
• Amnesia, confusion, drowsiness, slurred speech (Paradoxical reactions possible: aggressiveness,
agitation, anxiety, inappropriate behavior)
• Pregnancy: Category D
• Lactation: Not Recommended
Dose/Administration
PEDIATRIC
ADULT
(Always reference Broselow Tape)
Anxiety Sedation/Muscle Relaxation/Anxiety
• Oral/IV/IM (oral and IV doses more reliable) • IV/IM (IV doses more reliable)
2–10mg q3–6hr prn (max DAILY dose: Infants & Children: 0.05–0.1mg/kg over
˚ 40mg/day) ˚ 3–5min, titrate slowly to effect (max TOTAL
Status Epilepticus/Seizures dose: 0.25mg/kg)
• IV (SLOW) Adolescents: 5mg IV; may repeat with 2.5mg
5–10mg over 2min; repeat q3–5min prn ˚ if needed
˚ (max TOTAL dose: 30mg for acute seizures) Status Epilepticus
Sedation in ICU Patient • IV
• IV 0.15–0.20mg/kg/dose to a max of 10mg/dose;
Loading dose: 5–10mg ˚ may repeat dose once in 5min
˚ Maintenance dose: 0.03–0.1mg/kg q30min Muscle Spasm Associated with Tetanus
˚ to 6hr • IV/IM
Muscle Spasm Associated with Tetanus Infants >30 days and Children <5 years:
• IV ˚ 1–2mg q3–4hr prn
˚ Initial: 10–30mg q1–4hr prn ˚ Children ≥5 years: 5–10mg q3–4hr prn
Nerve Agent Exposure (CBRNE)
• IV
10–20mg for seizures associated with Nerve
˚ Agent exposure (up to 40mg may be needed)
• IM
Administer 3 ATNAA (atropine/2-Pam
˚ autoinjector) and 1 CANA (10mg Diazepam
autoinjector)
2026 Standard Medical Operating Guidelines (SMOG) • 105