Makindo Medical Notes.com

Overdose accidental or otherwise. ABCs, monitor O₂ sats and give oxygen. Ensure ability to manage respiratory depression and airways issues. Respiratory and airway support. Flumazenil may be given with caution.

About: Always check the BNF link here

• Long acting Benzodiazepine
• Active metabolites have a half-life of 100 hours

Mode of action

• Binds to a receptor on the GABA(A) receptor-chloride ionophore complex.
• Does not bind to the active site where GABA itself binds
• Enhances the effect of GABA the main inhibitory neurotransmitter in CNS
• GABA(A) receptor are ligand-gated ion channels
• Increases the frequency of Cl- channel opening and potentiating GABA transmission

Indications

• Anticonvulsant, Anxiolytic, Muscle relaxant, Hypnotic for insomnia, Premedication
• Myoclonus, Amnesia - useful for unpleasant procedures, Alcohol withdrawal

Dose

• Anxiety/Sedation : Diazepam 2-5 mg tds up to 30 mg per day in divided doses
• Status Epilepticus: Diazepam 5-10 mg slow iv (Diazemuls is less irritating) which may be repeated. Up to 20 mg.

Contraindications

• Operating machinery, Sleep apnoea syndrome
• Use with other sedation/alcohol
• Respiratory depression, Respiratory muscle weakness
• Myasthenia gravis, muscle weakness

Cautions

• Driving/operating machinery due to sedation
• Reduce dose in elderly, renal or liver failure

Side effects

• Respiratory depression, sedation, drowsiness, amnesia
• Rebound insomnia on stopping, Amnesia, Tolerance, Withdrawal
• Drowsiness, Ataxia, reduced psychomotor performance
• Dependence after 4-6 weeks with a withdrawal syndrome
• Long-acting metabolites e.g. with Diazepam can give hangover effects

Interactions

• Effects are reversed by Flumazenil but risk of rebound seizure
• Caution with other sedative medications and olanzapine
• p450 enzyme inhibitors can increase diazepam levels - See BNF/Datasheet

References

• Diazepam in BNF