diazepam(redirected from Rimapam)
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Pharmacologic class: Benzodiazepine
Therapeutic class: Anxiolytic, anticonvulsant, sedative-hypnotic, skeletal muscle relaxant (centrally acting)
Controlled substance schedule IV
Pregnancy risk category D
Produces anxiolytic effect and CNS depression by stimulating gamma-aminobutyric acid receptors. Relaxes skeletal muscles of spine by inhibiting polysynaptic afferent pathways. Controls seizures by enhancing presynaptic inhibition.
Injection: 5 mg/ml
Oral solution: 1 mg/ml, 5 mg/5 ml
Tablets: 2 mg, 5 mg, 10 mg
Indications and dosages
➣ Anxiety disorders
Adults: 2 to 10 mg P.O. two to four times daily, depending on symptom severity. Alternatively, for moderate anxiety, 2 to 5 mg I.V., repeated in 3 to 4 hours if needed. For severe anxiety, 5 to 10 mg I.V., repeated in 3 to 4 hours if needed.
Children age 6 months and older: 1 to 2.5 mg P.O. three to four times daily; may increase gradually as needed
➣ Before cardioversion
Adults: 5 to 15 mg I.V. 5 to 10 minutes before cardioversion
➣ Before endoscopy
Adults: Usually, 10 mg I.V. is sufficient; may be increased to 20 mg I.V. Alternatively, 5 to 10 mg I.M. 30 minutes before endoscopy.
➣ Status epilepticus and severe recurrent convulsive seizures
Adults: 5 to 10 mg I.V. slowly, repeated as needed q 10 to 15 minutes, to a maximum of 30 mg; may repeat regimen if needed in 2 to 4 hours. May give I.M. if I.V. delivery is impossible.
Children ages 5 and older: 1 mg I.V. slowly q 2 to 5 minutes, to a maximum of 10 mg; repeat in 2 to 4 hours if needed. May give I.M. if I.V. delivery is impossible.
Children over 1 month to 5 years: 0.2 to 0.5 mg I.V. slowly q 2 to 5 minutes, to a maximum of 5 mg I.V. May give I.M. if I.V. delivery is impossible.
➣ Muscle spasm associated with local pathology, cerebral palsy, athetosis, "stiff-man" syndrome, or tetanus
Adults: 2 to 10 mg P.O. three to four times daily. Or initially, 5 to 10 mg I.V. or I.M., repeated in 3 to 4 hours if needed. Tetanus may necessitate higher dosages.
Elderly or debilitated patients: Initially, 2 to 2.5 mg P.O. once or twice daily, increased gradually as needed and tolerated
Children ages 5 and older: 5 to 10 mg I.M. or I.V., repeated q 3 to 4 hours as needed to control tetanus spasm
Children over 1 month to 5 years: 1 to 2 mg I.M. or I.V. slowly, repeated q 3 to 4 hours as needed to control tetanus spasm
➣ Acute alcohol withdrawal
Adults: Initially, 10 mg P.O. three to four times during first 24 hours, decreased to 5 mg P.O. three to four times daily p.r.n. Or initially, 10 mg I.M. or I.V.; then 5 to 10 mg I.M. or I.V. in 3 to 4 hours p.r.n.
• Panic attacks
• Adjunct to general anesthesia
• Hypersensitivity to drug, other benzodiazepines, alcohol, or tartrazine
• Coma or CNS depression
• Narrow-angle glaucoma
Use cautiously in:
• hepatic dysfunction, severe renal impairment
• elderly patients
• pregnant or breastfeeding patients (use not recommended)
• Give P.O. dose with or without food.
☞ Administer I.V. infusion slowly into large vein, taking at least 1 minute for each 5 mg in adults or at least 3 minutes for each 0.25 mg/kg in children.
• Know that I.V. route is preferred over I.M. route because of slow or erratic I.M. absorption.
• Don't mix with other drugs or solutions in syringe or container.
• Enforce bed rest for at least 3 hours after I.V. injection.
• Give I.M. injection deeply and slowly into large muscle mass.
• If desired, mix oral solution with liquid or soft food.
CNS: dizziness, drowsiness, lethargy, depression, light-headedness, disorientation, anger, manic or hypomanic episodes, restlessness, paresthesia, headache, slurred speech, dysarthria, stupor, tremor, dystonia, vivid dreams, extrapyramidal reactions, mild paradoxical excitation
CV: bradycardia, tachycardia, hypertension, hypotension, palpitations, cardiovascular collapse
EENT: blurred vision, diplopia, nystagmus, nasal congestion
GI: nausea, vomiting, diarrhea, constipation, gastric disorders, difficulty swallowing, increased salivation
GU: urinary retention or incontinence, menstrual irregularities, gynecomastia, libido changes
Hematologic: blood dyscrasias including eosinophilia, leukopenia, agranulocytosis, and thrombocytopenia
Hepatic: hepatic dysfunction
Musculoskeletal: muscle rigidity, muscular disturbances
Respiratory: respiratory depression
Skin: dermatitis, rash, pruritus, urticaria, diaphoresis
Other: weight gain or loss, decreased appetite, edema, hiccups, fever, physical or psychological drug dependence or tolerance
Drug-drug. Antidepressants, antihistamines, barbiturates, opioids: additive CNS depression
Cimetidine, disulfiram, fluoxetine, hormonal contraceptives, isoniazid, ketoconazole, metoprolol, propoxyphene, propranolol, valproic acid: decreased metabolism and enhanced action of diazepam
Digoxin: increased digoxin blood level, possible toxicity
Levodopa: decreased levodopa efficacy
Rifampin: increased metabolism and decreased efficacy of diazepam
Theophylline: decreased sedative effect of diazepam
Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, lactate dehydrogenase: increased levels
Neutrophils, platelets: decreased counts
Drug-herbs. Chamomile, hops, kava, skullcap, valerian: increased CNS depression
Drug-behaviors. Alcohol use: increased CNS depression
• Monitor vital signs and respiratory and neurologic status.
• Supervise ambulation, especially in elderly patients.
• Monitor CBC and kidney and liver function test results.
☞ Avoid sudden drug withdrawal. Taper dosage gradually to termination of therapy.
• Inform patient he may take drug with or without food; recommend taking it with food if it causes stomach upset.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
☞ Tell patient to notify prescriber immediately if easy bruising or bleeding occurs.
• Instruct patient to move slowly when sitting up or standing, to avoid dizziness from blood pressure decrease. Advise him to dangle legs briefly before getting out of bed.
☞ Advise patient not to stop taking drug abruptly.
• Advise patient to avoid alcohol and other depressants such as sedatives while taking drug.
• Tell female patient not to take drug if she is pregnant or plans to breastfeed.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.
diazepam/di·az·e·pam/ (di-az´ĕ-pam) a benzodiazepine used as an antianxiety agent, sedative, antipanic agent, antitremor agent, skeletal muscle relaxant, anticonvulsant, and in the management of alcohol withdrawal symptoms.
Side effects Drowsiness, fatigue, muscle weakness, and ataxia