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Diazepam (Emulsion) Intravenous for Adults

Who can administer

Administration RESTRICTED - see Appendix 1

Important information

DO NOT CONFUSE WITH DIAZEPAM SOLUTION for injection

Diazepam injection is available in two different formulations - one as an emulsion, and one as a solution

  • The emulsion version is preferable as it causes less venous irritation (ref 1)
  • Due to supply issues, occasionally the solution version is the only one which is available- in this case- use the Diazepam Solution monograph
  • It is ESSENTIAL to choose the correct one
  • This monograph refers to the EMULSION version

Available preparations

Diazepam Lipuro 10mg per 2ml ampoule - EMULSION

Reconstitution

  • Already in solution
  • Shake ampoule before use
  • Draw up into the syringe immediately prior to administration
  • Use a 5 micron filter needle when drawing up contents of ampoule

Infusion fluids

Glucose 5%

Methods of intravenous administration

Slow intravenous injection

  • Do not dilute (precipitation may occur) (see further information)
  • Administer into a large vein, no faster than 5mg per minute (ref 1)

Continuous intravenous infusion (administer using an electronically controlled infusion device)

  • Final diazepam concentration must be between 0.1 and 0.4mg/ml. (i.e. 10mg to 40mg diazepam per 100ml glucose 5%) (ref 1)
  • Rate is variable - see under 'Dose'
  • Incompatible with PVC. Non-PVC infusion container (e.g.Braun Ecoflac, Baxter Viaflo or Technopharm Macoflex are all suitable) and a low adsorption giving set (e.g. Baxter Ref VMC 9606, or Braun 8700110SP ) must be used. (available from pharmacy)
  • Fresh infusions must be made every 6 hours (ref 1)

Dose in adults

IMPORTANT: Elderly and debilitated patients should be given doses at the lower end of the dose ranges, due to increased sensitivity to the drug

Status epilepticus

  • Initial dose: Give 5 or 10mg as a slow intravenous injection
  • Repeat after thirty to sixty minutes as required (may be repeated every 10 to 15 minutes if needed- this should be only done after calling for specialist intervention)
  • Follow if necessary by an intravenous infusion of up to 3 mg/kg over 24 hours - see below for calculation

Tetanus (ref 2,3)

  • Give 0.1 to 0.3 mg/kg by slow intravenous injection every one to four hours as required
  • Alternatively, a continuous infusion of 3 to 10mg per kg over twenty four hours may be used
  • Example of calculations for continuous infusion 
  • Patient weighs 65kg 
    • Dose is 2mg per kg in 24 hours =  130mg in 24 hours = 5.4mg per hour 
    • A new infusion must be prepared every six hours - suggest preparing 40mg in 100ml Glucose 5% = 0.4mg per ml i.e. 5.4mg in 13.5ml per hour
    • This will only use 81ml of infusion bag, but at six hours, the infusion must be replaced with a freshly prepared one 

Renal impairment 

  • Start with small doses, titrate to response

Hepatic impairment

  • Avoid if possible as may precipitate encephalopathy 
  • Contraindicated in severe liver disease

Chronic respiratory insufficiency

  • Increased risk of respiratory depression 
  • Very slow intravenous administration is recommended
  • Contraindicated in severe respiratory insufficiency

Monitoring

  • It is advisable to keep the patient in a supine position, and monitor for at least one hour post dose (ref 1)
  • Monitor cardiorespiratory function

Further information

  • When being given by intravenous injection, the solution cannot be diluted further.
  • When being given by intravenous infusion, it can be added to infusion fluid.
  • The apparent contradiction is because when it is diluted in a large volume the stability is protected.  If diluted in a small volume of fluid, the drug will precipitate out.

Storage

  • Store below 25° C
  • Do not freeze

References

Diazepam Lipuro 10mg/2ml Braun- translated SPC 04/2014

1: Injectable medicines information Medusa, downloaded 08/06/2022

2: Martindale, The complete Drug Reference accessed online 08/06/2022

3:  BNF accessed online 08/06/2022

 

Therapeutic classification

Benzodiazepine