Diazepam Drug Study

Diazepam
Brand Name: Apo-Diazepam (CAN), Diastat, Diazemuls (CAN),
Diazepam Intensol, Valium, Vivol (CAN)
Pregnancy Category D, C-IV controlled substance
Drug classes: Benzodiazepine, Antianxiety agent, Antiepileptic agent,
Skeletal muscle relaxant, centrally acting

Therapeutic actions
Exact mechanisms of action not understood; acts mainly at the limbic
system and reticular formation; may act in spinal cord and
at supraspinal sites to produce skeletal muscle relaxation; potentiates the
effects of GABA, an inhibitory neurotransmitter; anxiolytic effects occur at
doses well below those necessary to cause sedation, ataxia; has little effect
on cortical function.

Indications
Management of anxiety disorders or for short-term relief of symptoms
of anxiety
Acute alcohol withdrawal; may be useful in symptomatic relief of
acute agitation, tremor, delirium tremens, hallucinosis
Muscle relaxant: adjunct for relief of reflex skeletal muscle spasm due
to local pathology (inflammation of muscles or joints) or secondary to
trauma; spasticity caused by upper motoneuron disorders (cerebral
palsy and paraplegia); athetosis, stiff-man syndrome
Treatment of tetanus (parenteral)

 Antiepileptic: adjunct in status epilepticus and severe recurrent

convulsive seizures (parenteral); adjunct in convulsive disorders (oral)
Preoperative: relief of anxiety and tension and to lessen recall in
patients prior to surgical procedures, cardioversion,
and endoscopic procedures (parenteral)
Management of selected, refractory patients with epilepsy who
require intermittent use to control bouts of increased seizure activity
(rectal)
Unlabeled use: treatment of panic attacks

Contraindications
Contraindicated with hypersensitivity to benzodiazepines; psychoses,
acute narrow-angle glaucoma, shock, coma, acute alcoholic
intoxication; pregnancy (cleft lip or palate, inguinal hernia, cardiac
defects, microcephaly, pyloric stenosis when used in first trimester;
neonatal withdrawal syndrome reported in newborns); lactation.

Adverse effects
Transient, mild drowsiness initially; sedation, depression, lethargy, apathy,
fatigue, light-headedness, disorientation, restlessness, confusion, crying,
delirium, headache, slurred speech, dysarthria, stupor, rigidity,
tremor, dystonia, vertigo, euphoria, nervousness, difficulty in concentration,
vivid dreams, psychomotor retardation, extrapyramidal symptoms; mild
paradoxical excitatory reactions, during first 2 wk of treatment, visual and
auditory disturbances, diplopia, nystagmus, depressed hearing, nasal
congestion
Bradycardia, tachycardia, CV collapse, hypertension and hypotension,
palpitations, edema
Drug dependence with withdrawal syndrome when drug is discontinued
(common with abrupt discontinuation of higher dosage used for longer than

4 mo); IV diazepam: 1.7% incidence of fatalities; oral benzodiazepines

ingested alone; no well-documented fatal overdoses
Urticaria, pruritus, skin rash, dermatitis
Constipation; diarrhea, dry mouth; salivation; nausea; anorexia; vomiting;
difficulty in swallowing; gastric disorders; elevations of blood enzymes--LDH,
alkaline phosphatase, AST, ALT; hepatic dysfunction; jaundice
Incontinence, urinary retention, changes in libido, menstrual irregularities
Decreased hematocrit, blood dyscrasias
Phlebitis and thrombosis at IV injection sites, hiccups, fever,
diaphoresis, paresthesias, muscular disturbances, gynecomastia; pain,
burning, and redness after IM injection

Drug Interactions:
Increased CNS depression with alcohol, omeprazole
Increased pharmacologic effects of diazepam if combined
with cimetidine, disulfiram, hormonal contraceptives
Decreased effects of diazepam with theophyllines, ranitidine

Nursing considerations
Do not administer intra-arterially; may produce arteriospasm,
gangrene.
Change from IV therapy to oral therapy as soon as possible.
Do not use small veins (dorsum of hand or wrist) for IV injection.
Reduce dose of narcotic analgesics with IV diazepam; dose should be
reduced by at least one-third or eliminated.

 Carefully monitor P, BP, respiration during IV administration.

Maintain patients receiving parenteral benzodiazepines in bed for 3
hr; do not permit ambulatory patients to operate a vehicle following an
injection.
Monitor EEG in patients treated for status epilepticus; seizures may
recur after initial control, presumably because of short duration of drug
effect.
Monitor liver and kidney function, CBC during long-term therapy.
Taper dosage gradually after long-term therapy, especially in epileptic
patients.
Arrange for epileptic patients to wear medical alert ID indicating that
they are epileptics taking this medication.
Discuss risk of fetal abnormalities with patients desiring to become
pregnant.