Category:

• Sedative

• Muscle relaxant

Description:

• Benzodiazapine

  Indications:

• Antianxiety

• Sedative

• Acute alcohol withdrawal

• Anticonvulsant

• Skeletal muscle relaxant

• Pre-surgery/procedure relaxation

  Contraindications:

• Psychoses

• Acute narrow-angle glaucoma

• Lactation

• Co-administration with ketoconazole or itraconazole (P450 enzyme inhibition)

  Precautions:

• Pregnancy category D

• Controlled Substance: Schedule IV

• Closely monitor patients with suicidal tendencies.

• Use with caution in psychiatric patients due to paradoxical reactions of excitement, over stimulation and acute rage.

• Use with caution in seizure disorder patients due to an increase in occurance of grand mal seizures.

• Will impair higher order motor function, therefore use caution when operating machinery or automobiles.

• Do not drink alcohol and use with caution when administering with other CNS depressive medications.

• When administering IV or IM to children, have respiratory assistance available.  Give slowly over 3 minutes in a dosage not to exceed 0.25mg/kg. After 15-30 minutes, if children is stable, may repeat initial dosage.  If no relief after three doses, commence adjunctive therapy.

• May take with food if gastrointestinal upset occurs.

  Adverse Reactions (Side Effects):

• Central nervous system: drowsiness, dizziness, fatigue, blurred vision, headache, nervousness

• Cardiovascular: bradycardia, tachycardia, hypertension, hypotension

• GI: constipation, diarrhea, dry mouth

Dosage:

Administered orally, rectally, intravenously

• Adult:

  • Anxiety/convulsive disorders: 

    • PO 2-10mg 3-4 times daily

  • Sedative-hypnotic, alcohol withdrawal: 

    • PO 10mg 3-4 times daily, tapered as needed

  • Skeletal muscle relaxant: 

    • PO 2-10mg 3-4 times daily

  • Status epilepticus: 

    • IV bolus 5-20mg infused at a rate of 2 mg/minute

    • may repeat every 5-10 minutes, not to exceed 60mg

    • may repeat in 30 minutes if seizures reappear

  • Adjunct for epilepsy: 

    • PR 0.2 mg/kg as needed

• Geriatric:  
  • 2-2.5mg 1-4 times daily
  • titrated as needed

• Child: 

  • IV bolus 0.1-0.3 mg/kg (over 3 minutes)

  • may repeat every 15 minutes for 2 doses

• Tetanic muscle spasms: 

  • Infants >30 days to <5years IM/IV 1-2mg to 5-10mg every 3-4 hours as needed

• Anxiety/convulsive disorders: 

  • > 6 months PO 1-2.5mg 3-4 times daily (0.04-0.2 mg/kg 3-4 times daily as needed)

• Adjunct for epilepsy: 

  • PR: age 2-5 years 0.5 mg/kg as needed

  • age 6-11 years 0.3 mg/kg as needed

  • age > 12 years 0.2 mg/kg as needed