Diazepam 10mg/2ml Inj, 2ml
Overview
What is this medicine?
How to Use This Medicine
If you need to store this medication at home, consult with your doctor, nurse, or pharmacist to determine the proper storage method.
If you miss a dose, contact your doctor immediately to receive guidance on the next steps to take.
Lifestyle & Tips
- Avoid alcohol and other medications that cause drowsiness (e.g., opioids, antihistamines, sleeping pills) while taking diazepam, as this can lead to dangerous breathing problems or extreme sedation.
- Do not drive or operate heavy machinery until you know how this medication affects you, as it can cause dizziness and drowsiness.
- If you have been taking diazepam regularly, do not stop taking it suddenly without consulting your doctor, as this can lead to withdrawal symptoms (e.g., seizures, anxiety, tremors).
- Inform your doctor about all other medications you are taking, including over-the-counter drugs, supplements, and herbal products.
Available Forms & Alternatives
Available Strengths:
- Diazepam 2mg Tablets
- Diazepam 5mg Tablets
- Diazepam 10mg Tablets
- Diazepam 5mg/5ml (1mg/1ml) Oral Sol
- Diazepam 5mg/1ml Oral Concentrate
- Diazepam 5mg/ml Inj, 2ml
- Diazepam 5mg/ml Inj, 10ml
- Diazepam 20mg Rectal Gel
- Diazepam 10mg Rectal Gel( 2 Pack)
- Diazepam 2.5mg Rectal Gel (2 Pack)
- Diazepam 5mg/ml Inj, 2ml
- Diazepam 10mg Rectal Gel (2 Pack)
- Diazepam 20mg Rectal Gel
- Diazepam 10mg/2ml Inj, 2ml
Dosing & Administration
Adult Dosing
Condition-Specific Dosing:
Pediatric Dosing
Dose Adjustments
Renal Impairment:
Hepatic Impairment:
Pharmacology
Mechanism of Action
Pharmacokinetics
Absorption:
Distribution:
Elimination:
Pharmacodynamics
Safety & Warnings
BLACK BOX WARNING
Side Effects
Although rare, this medication can cause severe and potentially life-threatening side effects. If you experience any of the following symptoms, contact your doctor or seek medical help right away:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Shortness of breath
Change in balance
Feeling confused
Hallucinations (seeing or hearing things that are not there)
Memory problems or loss
Severe dizziness or fainting
Muscle spasms
Twitching
Trouble sleeping
Changes in eyesight
Slurred speech
Severe upset stomach, vomiting, or loss of appetite that persists
Suicidal thoughts or actions (see below for more information)
Like other medications used to treat seizures, this drug may increase the risk of suicidal thoughts or actions, particularly in people who have had suicidal thoughts or actions in the past. If you experience any new or worsening symptoms, such as:
Depression
Feeling nervous, restless, or irritable
Panic attacks
Other changes in mood or behavior
Suicidal thoughts or actions
contact your doctor immediately.
Injection (I.V.)-Specific Side Effects
If you receive this medication through injection, it may cause tissue damage if the drug leaks from the vein. Inform your nurse if you experience:
Redness
Burning
Pain
Swelling
Blisters
Skin sores
Leaking of fluid at the injection site
Other Side Effects
Most people who take this medication do not experience severe side effects. However, some people may experience:
Drowsiness
Fatigue or weakness
Muscle weakness
Irritation at the injection site
If any of these side effects or other symptoms bother you or persist, contact your doctor for advice.
Reporting Side Effects
If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Severe drowsiness or difficulty waking up
- Slow, shallow, or difficult breathing
- Unusual confusion or disorientation
- Slurred speech
- Extreme dizziness or lightheadedness
- Unusual mood changes, agitation, or aggression (paradoxical reactions)
- Yellowing of the skin or eyes (jaundice)
- Signs of an allergic reaction (e.g., rash, itching, swelling of face/tongue/throat, severe dizziness, trouble breathing)
Before Using This Medicine
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
Certain health conditions, including:
+ Breathing problems
+ Glaucoma
+ Liver disease
+ Myasthenia gravis
+ Sleep apnea
If you have a history of psychosis
Recent consumption of large amounts of alcohol or use of medications that may cause drowsiness, such as phenobarbital or certain pain medications like oxycodone
If you are breastfeeding or plan to breastfeed, as you may need to avoid doing so while taking this medication
If the patient is a child, as this medication may not be suitable for all ages
This list is not exhaustive, and it is crucial to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health problems with your doctor and pharmacist. They will help determine if it is safe to take this medication with your other medications and health conditions. Never start, stop, or change the dose of any medication without first consulting your doctor.
Precautions & Cautions
Before operating a vehicle or engaging in activities that require alertness and clear vision, wait until you understand how this medication affects you.
Refrain from consuming alcohol while taking this drug, as it may exacerbate its effects.
Prior to using marijuana, other cannabis products, or prescription and over-the-counter medications that may impair your reactions, consult with your doctor.
If you experience changes in the frequency or severity of seizures after initiating this medication, notify your doctor promptly.
This medication may cause drowsiness and reduced alertness, increasing the risk of falls, particularly in older adults. If you have concerns, discuss them with your doctor.
Do not alter the dosage or discontinue this medication without consulting your doctor, as this may trigger seizures.
If you are taking this medication long-term, your doctor may recommend regular blood tests to monitor your condition.
Prolonged use or high doses of this medication may lead to tolerance, reducing its effectiveness. If you suspect this is occurring, contact your doctor. Do not exceed the prescribed dose.
Certain formulations of this medication may contain benzyl alcohol. If possible, avoid products with benzyl alcohol in newborns and infants, as high doses can cause severe side effects, especially when combined with other medications containing benzyl alcohol. Consult your doctor to determine if this product contains benzyl alcohol.
If you are 65 or older, use this medication with caution, as you may be more susceptible to side effects.
When administering this medication to children, exercise caution, as they may be at a higher risk of experiencing certain side effects.
This medication may pose a risk to the unborn baby if taken during pregnancy. If you become pregnant or are already pregnant, notify your doctor immediately. Taking this medication late in pregnancy may increase the risk of respiratory or feeding problems, low body temperature, or withdrawal symptoms in the newborn. Discuss the potential risks with your doctor.
Overdose Information
Overdose Symptoms:
- Extreme drowsiness or sedation
- Confusion
- Muscle weakness
- Loss of coordination (ataxia)
- Slow or shallow breathing (respiratory depression)
- Hypotension (low blood pressure)
- Coma
What to Do:
Seek immediate medical attention. Call 911 or your local Poison Control Center (e.g., 1-800-222-1222 in the US). Overdose management is primarily supportive care (maintaining airway, breathing, circulation). Flumazenil, a benzodiazepine antagonist, can reverse effects but carries risks (e.g., precipitating withdrawal seizures) and is generally reserved for specific situations.
Drug Interactions
Contraindicated Interactions
- Opioids (unless alternative treatment options are inadequate and with extreme caution)
- Strong CYP3A4 inhibitors in patients with severe respiratory depression or acute narrow-angle glaucoma
Major Interactions
- Opioids (additive CNS depression, respiratory depression, profound sedation, coma, death)
- Other CNS depressants (e.g., alcohol, barbiturates, tricyclic antidepressants, antipsychotics, antihistamines, general anesthetics) - increased risk of sedation and respiratory depression
- Strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, ritonavir, clarithromycin) - increased diazepam levels
- Strong CYP2C19 inhibitors (e.g., fluvoxamine, fluoxetine, omeprazole) - increased diazepam levels
Moderate Interactions
- CYP3A4/2C19 inducers (e.g., rifampin, carbamazepine, phenytoin) - decreased diazepam levels
- Antacids (may delay absorption of oral forms, less relevant for injection)
- Digoxin (may increase digoxin levels)
Minor Interactions
- Not many specific minor interactions listed that are clinically significant for injection beyond general caution with other sedatives.
Monitoring
Baseline Monitoring
Rationale: To assess baseline respiratory function and risk of depression
Timing: Prior to administration
Rationale: To assess cardiovascular stability and risk of hypotension
Timing: Prior to administration
Rationale: To establish baseline mental status and guide titration
Timing: Prior to administration
Rationale: To assess organ function, especially if prolonged use or impairment suspected, as metabolism is hepatic and excretion is renal
Timing: Prior to initiation of therapy, if clinically indicated
Routine Monitoring
Frequency: Every 5-15 minutes initially, then as clinically indicated based on patient stability
Target: Respiratory rate >10 breaths/min, SpO2 >92%
Action Threshold: Respiratory rate <10 breaths/min or SpO2 <90% (or significant drop from baseline) - intervene immediately
Frequency: Every 5-15 minutes initially, then as clinically indicated
Target: Within patient's normal range
Action Threshold: Significant hypotension or bradycardia - intervene
Frequency: Every 5-15 minutes initially, then as clinically indicated
Target: Desired level of sedation (e.g., RASS -2 to 0)
Action Threshold: Excessive sedation (e.g., RASS -4 or -5) or paradoxical reaction - reduce dose or hold
Frequency: Regularly during and after IV administration
Target: No redness, swelling, or pain
Action Threshold: Signs of phlebitis - discontinue infusion at site, apply warm compress
Symptom Monitoring
- Respiratory depression (slow, shallow breathing)
- Excessive sedation or somnolence
- Hypotension
- Dizziness or lightheadedness
- Confusion or disorientation
- Slurred speech
- Ataxia or loss of coordination
- Paradoxical reactions (e.g., agitation, anxiety, hallucinations, aggression, insomnia)
- Injection site pain, redness, or swelling
Special Patient Groups
Pregnancy
Category D. Should be avoided during pregnancy, especially during the first trimester due to potential risk of congenital malformations (e.g., cleft lip/palate). Use in late pregnancy can lead to 'floppy infant syndrome' (hypotonia, lethargy, feeding difficulties) and neonatal withdrawal symptoms.
Trimester-Specific Risks:
Lactation
Excreted into breast milk. Can cause sedation, poor feeding, and weight loss in the infant. Use with caution, monitor infant for adverse effects, or consider alternative agents with shorter half-lives or lower excretion into milk.
Pediatric Use
Increased sensitivity to CNS depressant effects, especially in neonates and infants. Careful titration and close monitoring for respiratory depression and sedation are essential. Paradoxical reactions (e.g., excitement, agitation) can occur. Not recommended for routine use in neonates due to risk of gasping syndrome from benzyl alcohol preservative (if present).
Geriatric Use
Increased sensitivity to sedative and respiratory depressant effects. Start with lower doses and titrate slowly. Increased risk of falls, cognitive impairment, and paradoxical reactions. Monitor closely for over-sedation and respiratory depression.
Clinical Information
Clinical Pearls
- IV administration should be slow (e.g., 1 mL/min) into a large vein to minimize venous irritation, phlebitis, and local pain. Rapid IV injection can cause apnea or cardiac arrest.
- IM administration is generally not recommended due to erratic and incomplete absorption, but may be used if IV access is not possible (e.g., acute seizure outside hospital).
- Tolerance and physical dependence can develop with prolonged use. Abrupt discontinuation after chronic use can lead to severe withdrawal symptoms, including seizures.
- Paradoxical reactions (e.g., excitement, agitation, aggression) can occur, especially in children, elderly, and patients with psychiatric disorders.
- Diazepam is highly lipid-soluble, leading to rapid onset of action but also rapid redistribution out of the CNS, which explains its relatively short duration of acute effect despite a long elimination half-life.
- Due to its long half-life and active metabolites, accumulation can occur with repeated dosing, particularly in patients with hepatic impairment or in the elderly.
Alternative Therapies
- For Acute Anxiety: Lorazepam (IV), Midazolam (IV), Alprazolam (oral), Buspirone (oral, for chronic anxiety), SSRIs/SNRIs (for chronic anxiety).
- For Status Epilepticus: Lorazepam (IV, often preferred due to longer duration of action), Midazolam (IV, IM, intranasal, buccal), Phenytoin (IV), Fosphenytoin (IV), Levetiracetam (IV), Valproic Acid (IV).
- For Muscle Spasm: Cyclobenzaprine, Tizanidine, Baclofen, Methocarbamol (oral or IV).
- For Alcohol Withdrawal: Lorazepam (IV/oral), Oxazepam (oral), Chlordiazepoxide (oral/IM/IV).
Cost & Coverage
General Drug Facts
This medication is accompanied by a Medication Guide, a patient fact sheet that provides important information about its use. It is crucial to read this guide carefully and review it again each time your prescription is refilled. If you have any questions or concerns about this medication, discuss them with your doctor, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately contact your local poison control center or seek emergency medical attention. Be prepared to provide information about the medication taken, the amount, and the time it was taken, as this will help healthcare professionals provide appropriate treatment.