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Diazepam

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VOL: 100, ISSUE: 45, PAGE NO: 31

GENERIC/PROPRIETARY NAMES

- Generic: diazepam.

- Proprietary (NHS): Diazemuls (injection); Stesolid, Diazepam Rectubes (rectal tubes); Valclair (suppositories).

- Proprietary (non-NHS): Tensium, Rimapam (tablets); Dialar (oral sol).

CLASSIFICATION

- Functional: anxiolytic, hypnotic, anticonvulsant, muscle relaxant.

- Chemical: benzodiazepine.

- Legal: controlled drug (section 4), prescription only.

ACTION

- Depresses subcortical levels of central nervous system, including limbic system, recticular formation.

PHARMACOKINETICS

- Oral: onset 30 mins, peak 1-2 hrs.

- Intramuscular: onset 15-30 mins.

- Intravenous: onset 1-5 mins.

- Metabolised by liver, excreted by kidneys.

INDICATIONS

- Nurse prescriber: palliative care in chronic severe spasticity.

- Other: anxiety, insomnia, alcohol withdrawal, status epilepticus, febrile convulsions, premed sedation.

CONTRAINDICATIONS

- Respiratory depression.

- Acute pulmonary insufficiency.

- Sleep apnoea syndrome.

- Severe hepatic impairment.

- Chronic psychosis.

- Do not use alone with depression or for anxiety with depression.

CAUTIONS

- History of drug or alcohol abuse.

- Older or debilitated (reduce dose).

- Muscle weakness.

- Marked personality disorder.

- Psychosis.

- Pregnancy/breastfeeding.

- Renal impairment.

- Respiratory disease.

COMMON SIDE-EFFECTS

- Drowsiness and lightheadedness.

- Confusion, ataxia.

- Dependence.

- Increased aggression.

- Amnesia.

- Muscle weakness.

INTERACTIONS/INCOMPATIBILITY

- Isoniazid inhibits metabolism.

- Rifampicin increases metabolism.

- Vomeprazole and esomeprazole may inhibit metabolism.

- Ritonavir increases plasma levels - avoid concomitant use.

- Alters plasma levels of phenytoin.

- Raises plasma level of zotepine.

- May antagonise levodopa.

ADMINISTRATION

- Oral: tablets, capsules, solutions.

- Intramuscular injection - only if oral or IV route unavailable.

- Slow IV injection.

- IV infusion.

- Rectal (tubes and suppositories) if unable to take orally.

NURSING CONSIDERATIONS

- Assess baseline vital signs.

- Assess blood pressure, pulse and respiration if IV administration.

- Provide frequent sips of water for dry mouth.

- Provide fluids and fibre for constipation.

- Evaluate therapeutic response, mental state and physical dependency after long-term use.

PATIENT TEACHING

- Do not use for everyday stress.

- Do not use for more than four months unless directed by a clinician.

- Do not take more than the prescribed dose.

- Avoid non-prescribed medications unless approved by a clinician.

- May cause drowsiness - avoid driving or any other activities requiring alertness.

- Avoid other psychotropic medications unless prescribed.

- Avoid alcohol.

- Do not discontinue abruptly after long-term use - withdrawal symptoms may occur.

- Rise slowly as fainting may occur.

- Seek psychiatric help if depressed.

- Store securely.

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