Diazepam Intramuscular (IM) Dosing for Adults and Children
Diazepam injection IM dosing for common indications is weight-independent and varies by indication and severity. [1] Repeat dosing is specified as fixed re-dosing intervals for several indications. [1] Maximum daily dose is not explicitly stated in the labeled IM dosing sections. [1]
Medication Selection Algorithm
Diazepam injection is dosed by indication. [1] Recommended adult IM dosing ranges are the labeled dose ranges below. [1] Diazepam injection in children is listed as dose ranges for specific indications and does not provide a single universal IM pediatric dose. [1]
Recommended Adult IM Dose and Repeat Dosing
Moderate anxiety disorders and symptoms of anxiety
- 2 mg to 5 mg IM (or IV). [1]
- Repeat in 3 to 4 hours if necessary. [1]
Severe anxiety disorders and symptoms of anxiety
- 5 mg to 10 mg IM (or IV). [1]
- Repeat in 3 to 4 hours if necessary. [1]
Acute alcohol withdrawal
- 10 mg IM (or IV) initially. [1]
- Then 5 mg to 10 mg in 3 to 4 hours if necessary. [1]
Muscle spasm (including local pathology, cerebral palsy, athetosis, stiff-man syndrome, or tetanus)
- 5 mg to 10 mg IM (or IV) initially. [1]
- Then 5 mg to 10 mg in 3 to 4 hours if necessary. [1]
Preoperative medication (relief of anxiety and tension)
- 10 mg IM (preferred route) before surgery. [1]
Recommended Pediatric IM Dose and Repeat Dosing
Tetanus in infants >30 days of age
- 1 mg to 2 mg IM (or IV), slowly. [1]
- Repeat every 3 to 4 hours as necessary. [1]
Tetanus in children ≥5 years
- 5 mg to 10 mg IM repeated every 3 to 4 hours as necessary. [1]
Status epilepticus in children when IV is impossible
- The label states that if intravenous administration is impossible, the intramuscular route may be used. [1]
- The same labeled adult IM option for status epilepticus is described as 5 mg to 10 mg initially, with repeat dosing at 10 to 15 minute intervals up to a maximum dose of 30 mg. [1]
Maximum Dose Specification
Status epilepticus (adult or when IM is used because IV is impossible)
- Diazepam injection may be repeated at 10 to 15 minute intervals up to a maximum dose of 30 mg. [1]
Maximum daily dose
- A maximum daily dose for IM administration is not explicitly specified in the labeled IM dosing for the non-status-epilepticus indications. [1]
Precautions for IM Administration and Ongoing Safety Monitoring
Injection technique and drug handling
- Diazepam injection should be injected deeply into the muscle. [1]
- Diazepam injection should not be mixed or diluted with other solutions or drugs in syringe or infusion container. [1]
- Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. [1]
Respiratory and cardiovascular risk
- Extreme care is required in elderly patients, very ill patients, and those with limited pulmonary reserve because of the possibility of apnea and/or cardiac arrest. [1]
- Resuscitative equipment, including equipment necessary to support respiration, should be readily available. [1]
Concomitant depressant drugs
- Concomitant use of barbiturates, alcohol, or other central nervous system depressants increases depression and increases the risk of apnea. [1]
Dependence and withdrawal risk
- If diazepam is used more frequently than recommended, abrupt discontinuation or rapid dosage reduction can precipitate acute withdrawal reactions that can be life-threatening. [1]
Status epilepticus and severe clinical illness
- Extreme caution is advised for individuals with chronic lung disease or unstable cardiovascular status. [1]
Pediatric support needs
- Respiratory assistance should be available for tetanus dosing in infants and children. [1]