Diazepam (Valium)
Classification: Benzodiazepine
Diazepam for moderate sedation has mostly given way to midazolam on most units, for the reasons the note under Special Considerations below states, but it remains in use where a longer duration of action or an oral route is wanted.
Dosage / Administration:
|
Route |
Onset of Action |
Peak Effect |
Duration of Action |
|---|---|---|---|
|
IV |
2-5 minutes |
3-5 minutes |
30-90 minutes |
|
Oral |
15-60 minutes |
60 minutes |
3-8 hours |
Adult Dose:
Administer in 1-2mg increments every 2 minutes IV until desired effect is achieved. (Slurred speech). Generally 10 to 20 mg in 60 minutes.
Pediatric Dose:
0.1 – 0.3 mg/kg.
Adverse Reactions:
- Respiratory effects – Respiratory depression, apnea
- Cardiovascular effects – Bradycardia, hypotension
- CNS effects – Agitation, confusion, diplopia
- GI effects – hiccups
- Special Considerations – Phlebitis at site of injection, rash, urticaria, avoid extravasation as drug is caustic to tissue.
- May be diluted with normal saline only. Do not mix with any other drug.
- Midazolam is generally preferable to Diazepam due to Midazolam’s decreased duration and easier titratability.
Reversal agent:
Flumazenil (Romazicon) will reverse the respiratory effects of diazepam overdose.
Diazepam in Moderate Sedation
Diazepam’s longer duration — 30 to 90 minutes IV, and hours by mouth — means recovery monitoring runs longer than it does with a shorter-acting benzodiazepine, and re-sedation after apparent recovery is a real risk to watch for, since flumazenil’s reversal effect wears off well before diazepam’s own effect does. Because it is caustic to tissue, IV administration uses a large vein and is watched for extravasation; it is never mixed with another drug in the same line. As with any medication given during moderate sedation, dosing and monitoring follow the facility’s sedation policy and the provider’s scope of practice.
Educational reference for sedation providers, relocated from the previous version of this site — not a substitute for the current package insert, your facility protocols, or clinical judgment. Verify all doses against current references before clinical use.