eizures. diazepam is a useful premedication (the i.m. route is preferred) for relief of anxiety and tension in patients who are to undergo surgical procedures. intravenously, prior to cardioversion for the relief of anxiety and tension and to diminish the patient's recall of the procedure.

diazepam, exposes users to the risks of abuse, misuse, and addiction, which can lead to overdose or death. abuse and misuse of benzodiazepines often (but not always) involve the use of doses greater than the maximum recommended dosage and commonly involve concomitant use of other medications, alcohol, and/or illicit substances, which is associated with an increased frequency of serious adverse outcomes, including respiratory depression, overdose, or death (see drug abuse and dependence; abuse). before prescribing diazepam and throughout treatment, assess each patient's risk for abuse, misuse, and addiction. use of diazepam, particularly in patients at elevated risk, necessitates counseling about the risks and proper use of diazepam along with monitoring for signs and symptoms of abuse, misuse, and addiction. do not exceed the recommended dosing frequency; avoid or minimize concomitant use of cns depressants and other substances associated with abuse, misuse, and addiction (e.g., opioid analgesics, stimulants); and advise patients on the proper disposal of unused drug. if a substance use disorder is suspected, evaluate the patient and institute (or refer them for) early treatment, as appropriate. dependence and withdrawal reactions after use of diazepam more frequently than recommended for patients using diazepam more frequently than recommended, to reduce the risk of withdrawal reactions, use a gradual taper to discontinue diazepam (a patient-specific plan should be used to taper the dose). patients at an increased risk of withdrawal adverse reactions after benzodiazepine discontinuation or rapid dosage reduction include those who take higher dosages, and those who have had longer durations of use. acute withdrawal reactions the continued use of benzodiazepines may lead to clinically significant physical dependence. although diazepam is indicated only for intermittent use (see indications and usage and dosage and administration), if used more frequently than recommended, abrupt discontinuation or rapid dosage reduction of diazepam or administration of flumazenil (a benzodiazepine antagonist) may precipitate acute withdrawal reactions, which can be life-threatening (e.g., seizures) (see drug abuse and dependence; dependence). protracted withdrawal syndrome in some cases, benzodiazepine users have developed a protracted withdrawal syndrome with withdrawal symptoms lasting weeks to more than 12 months (see drug abuse and dependence; dependence). when used intravenously, the following procedures should be undertaken to reduce the possibility of venous thrombosis, phlebitis, local irritation, swelling, and, rarely, vascular impairment; the solution should be injected slowly, taking at least one minute for each 5 mg (1 ml) given; do not use small veins, such as those on the dorsum of the hand or wrist; extreme care should be taken to avoid intra-arterial administration or extravasation. do not mix or dilute diazepam with other solutions or drugs in syringe or infusion container. if it is not feasible to administer diazepam directly intravenous., it may be injected slowly through the infusion tubing as close as possible to the vein insertion. extreme care must be used in administering diazepam injection, particularly by the intravenous route, to the elderly, to very ill patients and to those with limited pulmonary reserve because of the possibility that apnea and/or cardiac arrest may occur. concomitant use of barbiturates, alcohol or other central nervous system depressants increases depression with increased risk of apnea. resuscitative equipment including that necessary to support respiration should be readily available. when diazepam is used with a narcotic analgesic, the dosage of the narcotic should be reduced by at least one-third and administered in small increments. in some cases the use of a narcotic may not be necessary. diazepam injection should not be administered to patients in shock, coma, or in acute alcoholic intoxication with depression of vital signs. as is true of most cns-acting drugs, patients receiving diazepam should be cautioned against engaging in hazardous occupations requiring complete mental alertness, such as operating machinery or driving a motor vehicle. tonic status epilepticus has been precipitated in patients treated with intravenous diazepam for petit mal status or petit mal variant status. usage in pregnancy an increased risk of congenital malformations associated with the use of minor tranquilizers (diazepam, meprobamate and chlordiazepoxide) during the first trimester of pregnancy has been suggested in several studies. because use of these drugs is rarely a matter of urgency, their use during this period should almost always be avoided. the possibility that a woman of childbearing potential may be pregnant at the time of institution of therapy should be considered. patients should be advised that if they become pregnant during therapy or intend to become pregnant they should communicate with their physicians about the desirability of discontinuing the drug. in humans, measurable amounts of diazepam were found in maternal and cord blood, indicating placental transfer of the drug. until additional information is available, diazepam injection is not recommended for obstetrical use. use in children efficacy and safety of parenteral diazepam has not been established in the neonate (30 days or less of age). prolonged central nervous system depression has been observed in neonates, apparently due to inability to biotransform diazepam into inactive metabolites. in pediatric use, in order to obtain maximal clinical effect with the minimum amount of drug and thus to reduce the risk of hazardous side effects, such as apnea or prolonged periods of somnolence, it is recommended that the drug be given slowly over a three-minute period in a dosage not to exceed 0.25 mg/kg. after an interval of 15 to 30 minutes the initial dosage can be safely repeated. if, however, relief of symptoms is not obtained after a third administration, adjunctive therapy appropriate to the condition being treated is recommended. benzyl alcohol has been reported to be associated with a fatal gasping syndrome in premature infants.

dren.) the solution should be injected slowly, taking at least one minute for each 5 mg (1 ml) given. do not use small veins, such as those on the dorsum of the hand or wrist. extreme care should be taken to avoid intra-arterial administration or extravasation. do not mix or dilute diazepam with other solutions or drugs in syringe or infusion flask. if it is not feasible to administer diazepam directly iv., it may be injected slowly through the infusion tubing as close as possible to the vein insertion. once the acute symptomatology has been properly controlled with diazepam injection, the patient may be placed on oral therapy with diazepam if further treatment is required. parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. note: solution may appear colorless to light yellow. image description image description

ance. in peroral endoscopic procedures, coughing, depressed respiration, dyspnea, hyperventilation, laryngospasm and pain in throat or chest have been reported. because of isolated reports of neutropenia and jaundice, periodic blood counts and liver function tests are advisable during long-term therapy.