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Normally the search retrieves all newsitems in which all the search terms occur. However, this behaviour may be modified by using quotation marks, wildcards and Boolean operators in the following ways:. News Search: Your Journey Begins www. By relevance. Search Options Search terms: The word or words being searched for. This is a required field. Ordering: Results may be ordered by date with the newest newsitems at the top or by relevance. In relvance ordering, the frequency and placement of the search terms in the news item affect the ranking. Advanced Search Normally the search retrieves all newsitems in which all the search terms occur. Quotation marks: By enclosing a series of words in quotation marks, one indicates that they should occur in that specific order. Wildcards may be applied to the words as well. A minus sign: A minus sign or hyphen - immediately in front of a word or a phrase in quotation marks indicates that it should not occur in any news item found. Parentheses may be used for grouping. In order to search for these words themselves, one must place them inside quotation marks. Warning: Yellow More. Top News 'No one would have run away from this'. The damage could amount to 17 billion ISK. Rushdie happy with his stay in Iceland. Breaking news: A volcanic eruption has started on the Reykjanes peninsula. The girl has died.

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The FDA is alerting health care providers and emergency responders that certain lots of AtroPen atropine , CANA diazepam , morphine sulfate, and pralidoxime chloride autoinjectors manufactured by Meridian Medical Technologies can be used beyond the labeled expiration date, which should help mitigate potential shortages of these drugs. Concomitant use of benzodiazepines and opioids may result in profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs for patients for whom alternative treatment options are inadequate. Limit dosages and durations to the minimum required. Follow patients for signs and symptoms of respiratory depression and sedation. Buccal film: The buccal film Libervant is approved for use in pediatric patients 2 to 5 years of age. The unapproved use of the buccal film exposes users to risks of abuse, misuse, and addiction, which can lead to overdose or death. Injection, oral, nasal spray, rectal gel: The use of benzodiazepines, including diazepam, exposes users to risks of abuse, misuse, and addiction, which can lead to overdose or death. Before prescribing diazepam and throughout treatment, assess each patient's risk for abuse, misuse, and addiction. Buccal film: The continued use of benzodiazepines may lead to clinically significant physical dependence. The risks of dependence and withdrawal increase with longer treatment duration and higher daily dose. Although the buccal film is indicated only for intermittent use, if used more frequently than recommended, abrupt discontinuation or rapid dosage reduction of the buccal film may precipitate acute withdrawal reactions, which can be life-threatening. For patients using the buccal film more frequently than recommended, to reduce the risk of withdrawal reactions, use a gradual taper to discontinue diazepam. Oral: The continued use of benzodiazepines, including diazepam, may lead to clinically significant physical dependence. Abrupt discontinuation or rapid dosage reduction of diazepam after continued use may precipitate acute withdrawal reactions, which can be life-threatening. To reduce the risk of withdrawal reactions, use a gradual taper to discontinue diazepam or reduce the dosage. Injection, nasal spray, rectal gel: The continued use of benzodiazepines, including diazepam, may lead to clinically significant physical dependence. Although diazepam is indicated only for intermittent use, if used more frequently than recommended, abrupt discontinuation or rapid dosage reduction may precipitate acute withdrawal reactions, which can be life-threatening. For patients using diazepam more frequently than recommended, to reduce the risk of withdrawal reactions, use a gradual taper to discontinue diazepam. Buccal film eg, Libervant :. Children 2 to 5 years: Buccal: Dosing varies with weight. May repeat dose in 4 hours; do not exceed 2 doses in 24 hours. Do not repeat dose if patient has difficulty breathing or excessive sedation. Do not exceed maximum treatment frequency of 1 episode every 5 days and 5 episodes per month. Intranasal eg, Valtoco :. Quantity and type of nasal device. Rectal gel formulation eg, Diastat :. Weight-based dosing : Round dose up to the nearest 2. Do not use more than 5 times per month or for more than 1 episode every 5 days. Children 2 to 5 years: Rectal: 0. Children 6 to 11 years: Rectal: 0. Febrile seizure, prophylaxis: Limited data available:. Note: Although there is evidence that prophylaxis with diazepam may reduce recurrence of febrile seizures, use is not routinely recommended since risks of toxicity generally outweigh the benefits Ref. General dosing: Note: Initiate therapy with lowest dose; dose should be individualized and titrated to effect and tolerability:. Weight-directed dosing Ref :. Cerebral palsy-associated spasticity: Limited data available. Note: Dose should be individualized and titrated to effect and tolerability. Diazepam should be considered short-term treatment as there is insufficient evidence regarding motor function improvement Ref. Weight-directed dosing: Children: Oral: 0. Doses up to 5 mg 4 times daily have been reported Ref. Tetanus-associated spasm:. Fixed dosing: Note: Respiratory support should be available during therapy. Oral: 0. IM, IV: 0. Sedation, anxiolysis, and amnesia prior to procedure: Limited data available:. Children: 0. Adolescents: 0. Infants and Children: Initial: 0. Adolescents: IV: 5 mg; may repeat with 2. Consult drug interactions database for more information. There are no dosage adjustments provided in the manufacturer's labeling; use with caution. The oral tablets are contraindicated in severe hepatic impairment. For additional information see 'Diazepam: Drug information'. Safety: Reduce dose or avoid use in patients receiving opioids or with significant chronic disease eg, respiratory compromise. Avoid use in patients with a history of substance use, misuse of medications, or depression, except for acute or emergency situations eg, status epilepticus Ref. Anxiety disorders monotherapy or adjunctive therapy alternative agent :. Note: Generally used short term for symptom relief until preferred therapy eg, serotonin reuptake inhibitor is effective eg, 4 to 6 weeks, followed by tapering. Long-term, low-dose eg, 2. Use with caution in patients with posttraumatic stress disorder; benzodiazepines may worsen symptoms Ref. Procedural anxiety premedication :. Note: In obese patients, non-weight-based dosing is preferred Ref. Note: Use is recommended in patients with severe toxicity eg, hypotension, QTc prolongation, hypokalemia in combination with other supportive measures eg, mechanical ventilation, epinephrine, cardiovascular monitoring Ref. Intoxication cocaine, methamphetamine, and other sympathomimetics off-label use : Based on limited data. IV: 2 to 10 mg every 3 to 10 minutes as needed for agitation, sedation, seizures, hypertension, and tachycardia until desired symptom control achieved; doses up to 20 mg may be considered in severe agitation based on response and tolerability. Large, cumulative doses may be required for some patients; monitor for respiratory depression and hypotension. Neuroleptic malignant syndrome adjunctive therapy off-label use :. Note: Following withdrawal of causative agent while continuing supportive care, use for moderate to severe muscle rigidity with elevated creatine kinase. May also use for any patient experiencing agitation Ref. IV: 10 mg every 8 hours until symptom resolution Ref. Note: If IV access is not available , IM diazepam is not recommended due to erratic absorption and slow time to peak drug levels IM midazolam is recommended Ref. Acute active seizures non-status epilepticus :. Intranasal: 0. Maximum dose: Two doses per episode. Do not use for more than 1 episode every 5 days or more than 5 episodes per month. Rectal gel generally for use in prehospital setting : 0. Status epilepticus alternative agent :. Rectal gel generally for use in prehospital setting off-label : 0. Serotonin syndrome serotonin toxicity off-label use :. IV: 5 to 10 mg every 8 to 10 minutes until symptoms resolve Ref. Substance withdrawal:. Alcohol withdrawal syndrome:. Note: Withdrawal will progress at different rates in some patients; flexibility in dosing and duration is warranted Ref. Regimens vary and depend on withdrawal history, degree of current withdrawal symptoms, blood alcohol concentration, and whether the patient is treated inpatient or in the ambulatory setting. Some experts recommend avoiding IM administration due to variable absorption Ref. The following are two suggested regimens. Symptom-triggered regimen:. IV, Oral: 5 to 10 mg as needed per institution-specific protocol until appropriate sedation achieved; dose and frequency determined by withdrawal symptom severity using a validated severity assessment scale, such as the CIWA-Ar Ref. Fixed-dose regimen :. In addition to scheduled doses shown in the example regimen below, provide up to 5 additional as-needed 10 mg doses to be used over the 4-day treatment period for breakthrough symptoms Holt Opioid withdrawal autonomic instability and agitation alternative agent adjunctive therapy off-label use : Based on limited data. IV: 10 to 20 mg every 5 to 10 minutes until hemodynamically stable and adequate sedation achieved Ref. Vertigo, acute episodes alternative agent off-label use :. Note: Reserve use for symptomatic relief of episodes lasting several hours to days maximum duration: 3 days ; chronic use may impede adaptation and recovery Ref. IV, Oral: 1 to 5 mg every 12 hours as needed for up to 48 to 72 hours Ref. Reduce dose more rapidly in the beginning, and slow the dose reduction as the taper progresses because earlier stages of withdrawal are easier to tolerate Ref. The renal dosing recommendations are based upon the best available evidence and clinical expertise. Note: An increased incidence of CNS-related adverse effects has been reported in patients with hypoalbuminemia which is frequently observed in patients with end-stage kidney disease or critical illness Ref. Altered kidney function: No dosage adjustment necessary for any degree of kidney impairment; use with caution, especially with prolonged courses Ref. Hemodialysis, intermittent thrice weekly : Unlikely to be significantly dialyzable highly protein bound, large V d : No supplemental dose or dosage adjustment necessary; use with caution, especially with prolonged courses Ref. Peritoneal dialysis: Unlikely to be significantly dialyzable highly protein bound, large V d : No dosage adjustment necessary; use with caution, especially with prolonged courses Ref. PIRRT eg, sustained, low-efficiency diafiltration : No dosage adjustment necessary; use with caution, especially with prolonged courses Ref. There are no dosage adjustments provided in the manufacturer's labeling; use with caution because distribution and half-life may increase, and clearance may decrease significantly. The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Adverse reactions may vary by route of administration. Cardiovascular: Bradycardia, circulatory shock, syncope. Nervous system: Tonic-clonic type of status epilepticus. Gastrointestinal: Altered salivation, constipation, gastrointestinal distress, nausea. Hepatic: Increased serum alkaline phosphatase, increased serum transaminases, jaundice. Nervous system: Anterograde amnesia, central nervous system depression, depression, drug abuse, drug dependence, drug withdrawal, fatigue, hypoactivity, lethargy, myasthenia, paradoxical central nervous system stimulation, psychiatric signs and symptoms, rebound anxiety, slurred speech, tremor. Hypersensitivity to diazepam or any component of the formulation; acute narrow-angle glaucoma. Injection: Additional contraindications: Untreated open-angle glaucoma. Concerns related to adverse effects:. Monitor all patients for notable changes in behavior that might indicate suicidal thoughts or depression; notify health care provider immediately if symptoms occur. Disease-related concerns:. Oral tablet is contraindicated in patients with severe hepatic impairment. Benzodiazepines may cause significant respiratory depression. Oral tablet is contraindicated in patients with severe respiratory impairment or sleep apnea syndrome. Special populations:. Older adults may be at an increased risk of death with use; risk has been found highest within the first 4 months of use in older adult dementia patients Jennum ; Saarelainen Dosage form specific issues:. See manufacturer's labeling. Acute effects may be more prevalent in patients receiving concurrent barbiturates, opioids, or ethanol. Appropriate resuscitative equipment and qualified personnel should be available during administration and monitoring. Avoid use of the injection in patients in shock, coma, or in acute ethanol intoxication with depression of vital signs. Intra-arterial injection should be avoided. Tonic status epilepticus has been precipitated in patients treated with diazepam IV for absence status or absence variant status. Not recommended for chronic, daily use. Use with caution in patients with neurologic damage. Institute early treatment or refer patients in whom substance use disorder is suspected. Flumazenil may cause withdrawal in patients receiving long-term benzodiazepine therapy. Duration of action after a single dose is determined by redistribution rather than metabolism. Tolerance develops to the sedative, hypnotic, and antiseizure effects. It does not develop to the anxiolytic or skeletal muscle relaxing effects Vinkers Chronic use of this agent may increase the perioperative benzodiazepine dose needed to achieve desired effect. Neonates and young infants have decreased metabolism of diazepam and desmethyldiazepam active metabolite , both can accumulate with repeated use and cause increased toxicity. Excipient information presented when available limited, particularly for generics ; consult specific product labeling. Libervant: 5 mg 1 ea, 2 ea ; 7. Libervant: 10 mg 1 ea, 2 ea \[contains disodium edta\]. Libervant: Diastat Pediatric: 2. Generic: 2. Valtoco 15 MG Dose: 2 devices, 7. Solution Auto-injector, Intramuscular:. Valium: 2 mg \[scored; contains corn starch\]. Concentrate diazePAM Oral. Film Libervant Buccal. Gel diazePAM Rectal. Solution diazePAM Injection. Tablets diazePAM Oral. Tablets Valium Oral. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly. Diastat: 10 mg 2 mL \[contains alcohol, usp, benzoic acid, benzyl alcohol, propylene glycol, sodium benzoate\]. Buccal: Keep in foil pouch until ready for use. With clean and dry hands, following directions provided on foil, open pouch and remove green-colored film. Stretch either cheek open with one hand and place the film on the inside of that cheek with other hand, then remove fingers from patient's mouth. Film will stick to inside of patient's cheek and dissolve; mouth may be opened or closed. Do not rub the film into the cheek or place film on the teeth. If film is spit out or blown out immediately after placement, attempt to place new film; if unable, alert emergency personnel. If film is accidentally swallowed or chewed during administration, no replacement dose is necessary. Do not administer with liquids. Intranasal: Device comes ready to use; do not test or prime device before use. Each device delivers 1 spray only. Administer 1 spray into 1 nostril from a single device. If a second device is needed for the full dose, administer the second spray in the alternate nostril from a new device. A second dose should not be administered if the patient is having trouble breathing or excessive sedation. Measure dose only with calibrated dropper provided. Continuous infusion is not recommended because of precipitation in IV fluids and absorption of drug into infusion bags and tubing. Vesicant; ensure proper needle or catheter placement prior to and during infusion; avoid extravasation. Apply dry cold compresses Ref. Rectal: Diastat AcuDial: Prescribed dose must be 'dialed in' and locked before dispensing; consult package insert for directions on setting prescribed dose. Prior to administration, confirm that the prescribed dose is visible and correct and that the green 'ready' band is visible. Diastat AcuDial and Diastat: Place patient on side facing person responsible for monitoring , with top leg bent forward. Insert rectal tip lubricated gently into rectum until rim fits snug against rectal opening; push plunger gently over 3 seconds. After additional 3 seconds, remove syringe; hold buttocks together while slowly counting to 3 to prevent leakage; keep patient on side, facing towards you and continue to observe patient; discard any unused medication, syringe, and all used materials safely away from children; do not reuse; see Administration and Disposal Instructions that come with product. Oral: Administer with food or water. Dilute or mix oral concentrate with water, juice, soda, applesauce, or pudding before use; measure dose only with calibrated dropper provided. Intranasal: Do not test or prime before use. Administer one spray into one nostril. Some doses require an additional spray into the alternate nostril; refer to dosing for additional details. Do not administer a second dose if the patient is having trouble breathing or is excessively sedated. IM: Administer undiluted deep into the muscle mass. IV: Administer undiluted by slow IV push; do not mix with other solutions or medications. Rapid injection may cause respiratory depression or hypotension. Avoid intra-arterial administration. Apply dry cold or warm compresses Ref. Rectal gel: Prior to administration, confirm that prescribed dose is visible and correct and that the green 'ready' band is visible. Place patient on side facing person responsible for monitoring , with top leg bent forward. Insert rectal tip lubricated gently into rectum until rim fits snugly against rectal opening; push plunger gently over 3 seconds. After additional 3 seconds, remove syringe; hold buttocks together while slowly counting to 3 to prevent leakage; keep patient on side, facing towards you, and continue to observe patient; discard any unused medication, syringe, and all used materials; do not reuse; see manufacturer's Administration and Disposal Instructions. May consider use of parenteral formulation rectally if gel not available Ref. Protect from light. Do not refrigerate autoinjector. Do not freeze. Only open blister pack immediately prior to administration. Discard opened bottle of concentrated oral solution after 90 days. An FDA-approved patient medication guide, which is available with the product information and as follows, must be dispensed with this medication:. Buccal: Acute treatment of intermittent, stereotypic episodes of frequent seizure activity ie, seizure clusters, acute repetitive seizures that are distinct from patient's usual seizure pattern FDA approved in ages 2 to 5 years. Beers Criteria: Diazepam is identified in the Beers Criteria as a potentially inappropriate medication to be avoided in patients 65 years and older due to risk of abuse, misuse, physical dependence, and addiction. In addition, older adults have an increased risk of impaired cognition, delirium, falls, fractures, and motor vehicle accidents with benzodiazepine use, and slower metabolism of long-acting benzodiazepines eg, diazepam. However, benzodiazepines may be appropriate in the elderly when used for seizure disorders, rapid eye movement sleep behavior disorder, benzodiazepine or ethanol withdrawal, severe generalized anxiety disorder, or periprocedural anesthesia Beers Criteria \[AGS \]. For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program. Specifically, the risk for cholestasis may be increased. Risk C: Monitor therapy. Risk X: Avoid combination. Management: Use caution if coadministering blonanserin and CNS depressants; dose reduction of the other CNS depressant may be required. Strong CNS depressants should not be coadministered with blonanserin. Risk D: Consider therapy modification. Initiate buprenorphine at lower doses in patients already receiving CNS depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used. Management: Consider decreasing the dose of or possibly discontinuing benzodiazepines prior to initiating clozapine. Monitor for respiratory depression, hypotension, and other toxicities if these agents are combined. Use of daridorexant with alcohol is not recommended, and the use of daridorexant with any other drug to treat insomnia is not recommended. Management: Monitor for increased CNS depression during coadministration of dexmedetomidine and CNS depressants, and consider dose reductions of either agent to avoid excessive CNS depression. Management: Do not use disulfiram with dosage forms that contain ethanol. Management: Consider dose reductions of droperidol or of other CNS agents eg, opioids, barbiturates with concomitant use. Management: Reduce the dose of CNS depressants when combined with flunitrazepam and monitor patients for evidence of CNS depression eg, sedation, respiratory depression. Use non-CNS depressant alternatives when available. Management: Consider avoiding this combination if possible. If required, monitor patients closely for increased adverse effects of the CYP3A4 substrate. Management: Consider a decrease in the CNS depressant dose, as appropriate, when used together with hydroxyzine. Ilaprazole: May increase the serum concentration of Benzodiazepines. Management: Dosage adjustments of lemborexant and of concomitant CNS depressants may be necessary when administered together because of potentially additive CNS depressant effects. Close monitoring for CNS depressant effects is necessary. Melatonin: May enhance the sedative effect of Benzodiazepines. Management: Clinicians should generally avoid concurrent use of methadone and benzodiazepines when possible; any combined use should be undertaken with extra caution. Specifically, a disulfiram-like reaction may occur and CNS depressant effects may be increased. Management: Avoid products containing alcohol in patients treated with methotrimeprazine. Metoclopramide may increase the serum concentration of DiazePAM. A disulfiram-like reaction may occur. Management: Monitor closely for hypotension, respiratory or central nervous system depression, and bradycardia if olanzapine is combined with benzodiazepines. Use of parenteral benzodiazepines with IM olanzapine is not recommended. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Specifically, a disulfiram-like reaction may occur. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. Ritonavir may decrease the serum concentration of DiazePAM. Specifically, the risk of neuropsychiatric adverse effects may be increased. Management: Avoid coadministration of ropeginterferon alfa-2b and other CNS depressants. If this combination cannot be avoided, monitor patients for neuropsychiatric adverse effects eg, depression, suicidal ideation, aggression, mania. Specifically, sleepiness and dizziness may be enhanced. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended. Teduglutide: May increase the serum concentration of Benzodiazepines. Theophylline Derivatives: May diminish the therapeutic effect of Benzodiazepines. Yohimbine: May diminish the therapeutic effect of Antianxiety Agents. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol. Management: Consider alternatives to the use of zuranolone with other CNS depressants or alcohol. If combined, consider a zuranolone dose reduction and monitor patients closely for increased CNS depressant effects. Evaluate pregnancy status prior to use. Pregnancy testing is recommended before treating acute alcohol withdrawal symptoms ASAM Therapy for anxiety should be individualized BAP \[McAllister-Williams \] ; avoid the use of benzodiazepines for the treatment of anxiety disorders in patients planning to become pregnant Larsen Diazepam and its metabolites N-desmethyldiazepam, temazepam, and oxazepam cross the placenta Kanto ; McElhatton In-utero exposure to benzodiazepines has the potential to cause harm to the fetus. Teratogenic effects have been observed in some studies; however, a clear association has not been reported and additional data are needed Bellantuono ; Freeman ; Grigoriadis ; Noh ; Szpunar ; Tinker ; Wikner Newborns exposed to diazepam in utero should be monitored for feeding problems, respiratory depression, sedation, and withdrawal. The short-term use of a long-acting benzodiazepine may be used in pregnant patients requiring treatment of acute alcohol withdrawal symptoms WHO ; however, the use of shorter-acting benzodiazepines is preferred in patients at risk for preterm delivery or when treatment is needed during the third trimester ASAM Monitor newborns for fetal alcohol spectrum disorders in addition to benzodiazepine intoxication ASAM Therapy for anxiety during pregnancy should be individualized. Untreated or inadequately treated psychiatric illness may lead to poor adherence to prenatal care and adverse pregnancy outcomes ACOG Benzodiazepines are not preferred when pharmacologic treatment for anxiety disorders is needed during pregnancy BAP \[McAllister-Williams \]; Larsen ; however, if a benzodiazepine is needed, diazepam may be considered for the treatment of anxiety in pregnant patients based on the trimester of exposure. If possible, avoid scheduled doses of benzodiazepines in the month prior to delivery to reduce the risk of withdrawal symptoms in the newborn Larsen When treating pregnant patients for seizure disorders, monotherapy with the lowest effective dose and avoidance of medications known to have a high incidence of teratogenic effects is recommended Harden ; Wlodarczyk Data collection to monitor pregnancy and infant outcomes following exposure to diazepam is ongoing. Heart rate, respiratory rate, blood pressure, mental status; with long-term therapy: Liver enzymes, CBC. Long-acting benzodiazepine. Binds to stereospecific benzodiazepine receptors on the postsynaptic GABA neuron at several sites within the central nervous system, including the limbic system, reticular formation. Enhancement of the inhibitory effect of GABA on neuronal excitability results by increased neuronal membrane permeability to chloride ions. This shift in chloride ions results in hyperpolarization a less excitable state and stabilization. Sedation: Pediatric patients: IV: 4 to 5 minutes Krauss Status epilepticus: IV: 1 to 3 minutes; Rectal: 2 to 10 minutes. Sedation: Pediatric patients: IV: 60 to minutes Krauss IV: 1. Oral: 1. N-desmethyldiazepam and temazepam are both further metabolized to oxazepam. Temazepam and oxazepam are largely eliminated by glucuronidation. Half-life elimination: Note: Diazepam accumulates upon multiple dosing and the terminal elimination half-life is slightly prolonged. Oral: Parent: 44 to 48 hours; Desmethyldiazepam: hours Greenblatt b. Rectal: Parent: 45 to 46 hours; Desmethyldiazepam: 71 to 99 hours Cloyd IM: Median: 1 hour range: 0. Oral: 15 minutes to 2. Excretion: Urine predominantly as glucuronide conjugates. Hepatic function impairment: In mild and moderate cirrhosis, the average half-life increases 2- to 5-fold, with individual half-lives over hours reported. There is also an increase in volume of distribution, and average clearance decreases by almost half. Half-life is also prolonged with hepatic fibrosis to 90 hours range: 66 to hours , with chronic active hepatitis to 60 hours range: 26 to 76 hours , and with acute viral hepatitis to 74 hours range: 49 to hours. In chronic active hepatitis, clearance is decreased by almost half. Older adult: The half-life is increased by approximately 1 hour for each year of age beginning with a half-life of 20 hours at 20 years of age, as the volume of distribution is increased, and clearance is decreased. Consequently, there may be lower peak concentrations, higher trough concentration with multiple doses, and it may take longer to reach steady state. Version October Uptodate Reference Title. Go To Link. Diazepam: Pediatric drug information Diazepam: Pediatric drug information. All Rights Reserved. For additional information see 'Diazepam: Drug information' and 'Diazepam: Patient drug information' For abbreviations, symbols, and age group definitions show table. ALERT: US Boxed Warning Risks from concomitant use with opioids: Concomitant use of benzodiazepines and opioids may result in profound sedation, respiratory depression, coma, and death. Abuse, misuse, and addiction: Buccal film: The buccal film Libervant is approved for use in pediatric patients 2 to 5 years of age. Dependence and withdrawal reactions: Buccal film: The continued use of benzodiazepines may lead to clinically significant physical dependence. Febrile seizure, prophylaxis Febrile seizure, prophylaxis: Limited data available: Note: Although there is evidence that prophylaxis with diazepam may reduce recurrence of febrile seizures, use is not routinely recommended since risks of toxicity generally outweigh the benefits Ref. Tetanus-associated spasm: Fixed dosing: Note: Respiratory support should be available during therapy. IV: Infants and Children: Initial: 0. Dosing: Kidney Impairment: Pediatric There are no dosage adjustments provided in the manufacturer's labeling; use with caution. Dosing: Hepatic Impairment: Pediatric There are no dosage adjustments provided in the manufacturer's labeling; use with caution. Dosing: Adult For additional information see 'Diazepam: Drug information' Dosage guidance: Safety: Reduce dose or avoid use in patients receiving opioids or with significant chronic disease eg, respiratory compromise. Anxiety disorders monotherapy or adjunctive therapy alternative agent : Note: Generally used short term for symptom relief until preferred therapy eg, serotonin reuptake inhibitor is effective eg, 4 to 6 weeks, followed by tapering. Procedural anxiety premedication : IV: 2 to 10 mg or 0. Intoxication Intoxication cocaine, methamphetamine, and other sympathomimetics off-label use : Based on limited data. Neuroleptic malignant syndrome Neuroleptic malignant syndrome adjunctive therapy off-label use : Note: Following withdrawal of causative agent while continuing supportive care, use for moderate to severe muscle rigidity with elevated creatine kinase. Acute active seizures non-status epilepticus : Intranasal: 0. Serotonin syndrome Serotonin syndrome serotonin toxicity off-label use : IV: 5 to 10 mg every 8 to 10 minutes until symptoms resolve Ref. Substance withdrawal Substance withdrawal: Alcohol withdrawal syndrome: Note: Withdrawal will progress at different rates in some patients; flexibility in dosing and duration is warranted Ref. Vertigo, acute episodes Vertigo, acute episodes alternative agent off-label use : Note: Reserve use for symptomatic relief of episodes lasting several hours to days maximum duration: 3 days ; chronic use may impede adaptation and recovery Ref. Dosing: Kidney Impairment: Adult The renal dosing recommendations are based upon the best available evidence and clinical expertise. Dosing: Hepatic Impairment: Adult There are no dosage adjustments provided in the manufacturer's labeling; use with caution because distribution and half-life may increase, and clearance may decrease significantly. Adverse Reactions The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Contraindications Hypersensitivity to diazepam or any component of the formulation; acute narrow-angle glaucoma. Warnings: Additional Pediatric Considerations Neonates and young infants have decreased metabolism of diazepam and desmethyldiazepam active metabolite , both can accumulate with repeated use and cause increased toxicity. Dosage Forms: US Excipient information presented when available limited, particularly for generics ; consult specific product labeling. Dosage Forms: Canada Excipient information presented when available limited, particularly for generics ; consult specific product labeling. Controlled Substance C-IV. Administration: Pediatric Buccal: Keep in foil pouch until ready for use. Administration: Adult Oral: Administer with food or water. Use Buccal: Acute treatment of intermittent, stereotypic episodes of frequent seizure activity ie, seizure clusters, acute repetitive seizures that are distinct from patient's usual seizure pattern FDA approved in ages 2 to 5 years. Older Adult: High-Risk Medication: Beers Criteria: Diazepam is identified in the Beers Criteria as a potentially inappropriate medication to be avoided in patients 65 years and older due to risk of abuse, misuse, physical dependence, and addiction. Drug Interactions. Reproductive Considerations Evaluate pregnancy status prior to use. Pregnancy Considerations Diazepam and its metabolites N-desmethyldiazepam, temazepam, and oxazepam cross the placenta Kanto ; McElhatton Monitoring Parameters Heart rate, respiratory rate, blood pressure, mental status; with long-term therapy: Liver enzymes, CBC. Mechanism of Action Long-acting benzodiazepine. Rectal: Well absorbed. Distribution: V d : Buccal film: 1. IM: Premature neonates GA: 28 to 34 weeks : 54 hours. Children 3 to 8 years: 18 hours Morselli Rectal: 1. Pharmacokinetics: Additional Considerations Adult Data Unless Noted Hepatic function impairment: In mild and moderate cirrhosis, the average half-life increases 2- to 5-fold, with individual half-lives over hours reported. Brand Names: International. J Am Geriatr Soc. Abrams GM, Wakasa M. Chronic complications of spinal cord injury and disease. Post TW, ed. Accessed July 21, Ahlfors CE. Benzyl alcohol, kernicterus, and unbound bilirubin. J Pediatr. Akerele E, Olupona T. Drugs of abuse. Psychiatr Clin North Am. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: an update. Obstet Gynecol. The ASAM clinical practice guideline on alcohol withdrawal management. J Addict Med. Modeling drug passage into human milk. Clin Pharmacol Ther. Acute amphetamine and synthetic cathinone 'bath salt' intoxication. Accessed October 29, Relationship of continuous infusion lorazepam to serum propylene glycol concentration in critically ill adults. Crit Care Med. Part I: anxiety disorders. World J Biol Psychiatry. Osmol gap as a surrogate marker for serum propylene glycol concentrations in patients receiving lorazepam for sedation. Barry JD. Goldfrank's Toxicologic Emergencies. Otolaryngol Head Neck Surg. Benzodiazepine exposure in pregnancy and risk of major malformations: a critical overview. Gen Hosp Psychiatry. Clinical practice guideline: Benign paroxysmal positional vertigo update. Boyer EW. Serotonin syndrome serotonin toxicity. Accessed May 7, Methamphetamine: Acute intoxication. Accessed May 16, b. Brandt R. Passage of diazepam and desmethyldiazepam into breast milk. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care. Neonatal deaths associated with use of benzyl alcohol—United States. Choy Y. Acute procedural anxiety and specific phobia of clinical procedures in adults: Treatment overview. Accessed May 2, A single-blind, crossover comparison of the pharmacokinetics and cognitive effects of a new diazepam rectal gel with intravenous diazepam. Diazepam and active metabolite in breast milk and their transfer to the neonate. Arch Dis Child. Craske M, Bystritsky A. Generalized anxiety disorder in adults: Management. Accessed January 19, Antiepileptic drugs and breastfeeding. Ital J Pediatr. Delgado J. Intoxication from LSD and other common hallucinogens. Diastat and Diastat AcuDial diazepam \[prescribing information\]. Diazepam carpuject \[prescribing information\]. Diazepam injection multi-dose vial \[prescribing information\]. Diazepam injection prefilled syringe \[prescribing information\]. Diazepam Intensol diazepam \[prescribing information\]. Diazepam intramuscular autoinjector \[prescribing information\]. Diazepam oral solution \[prescribing information\]. 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World Health Organization; Accessed March 24, Current recommendations for the treatment of tetanus during humanitarian emergencies. January Management of common neurologic symptoms in pediatric palliative care: seizures, agitation, and spasticity. Pediatr Clin North Am. Determination of a lorazepam dose threshold for using the osmol gap to monitor for propylene glycol toxicity. A comparison of midazolam and diazepam for conscious sedation during colonoscopy in a prospective double-blind study. Recognition, treatment, and prevention of propylene glycol toxicity. Semin Dial. One 5 mg device. One 10 mg device. Two 7. Two 10 mg devices. May repeat dose in 4 to 12 hours if needed. One spray in one nostril. One spray in each nostril.

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