Diazepam (Emulsion) Intravenous for Adults : First-line

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 25⁰C
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

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