diazepam
Apo-Diazepam (CAN), Diastat,
Diazepam Intensol, Dizac,
Novo-Dipam (CAN), Valium, Vivol (CAN)
Nursing Considerations
• Use diazepam with extreme caution in
patients with a history of alcohol or drug
abuse because it can cause physical and
psychological dependence, and in patients
with hepatic disorders such as hepatic
fibrosis and hepatitis because of potentially
significant increase in drug’s half-life.
• Use diazepam cautiously in patients with
hepatic or renal impairment. Severe hepatic
impairment is a contraindication to use.
• Expect to give a lower diazepam dose to
patient with chronic respiratory insufficiency
because of the risk of respiratory
depression.
•Mix concentrated oral solution (Intensol)
with liquid or semisolid food. Use supplied
calibrated dropper to measure doses.
• Protect diazepam injection from light.
Don’t use solution that’s more than slightly
yellow or that contains precipitate.
• Give I.M. injection into deltoid muscle for
rapid, complete absorption. Using other
sites may cause slow, erratic absorption.
• Before administering emulsion form, ask if
patient is allergic to soybeans because this
form contains soybean oil.
• For an infant or a child, administer I.V.
injection slowly over 3 minutes in a dose
not to exceed 0.25 mg/kg.
• Give emulsion form within 6 hours of
opening ampule because it contains no
preservatives and allows rapid microbial
growth. Use polyethylene-lined or glass
infusion sets and polyethylene or
polypropylene plastic syringes for administration.
Don’t use a filter with a pore size
less than 5 microns because a smaller size
may break down the emulsion.
• Don’t mix emulsion form with anything
other than its emulsion base. Otherwise, it
may become unstable and increase the risk
of serious adverse reactions.
•Monitor patient for adverse reactions,
especially if she has hypoalbuminemia,
which increases the risk of sedation.
WARNING Watch for signs of physical and
psychological dependence (strong desire
or need to continue taking diazepam, need
to increase dose to maintain drug effects,
and posttherapy withdrawal symptoms,
such as abdominal cramps, insomnia, irritability,
nervousness, and tremor).
•Monitor patient closely for increase in frequency
or severity of grand mal seizures
when diazepam is used with standard anticonvulsant
therapy. Dosage of other anticonvulsants
may need to be increased.
• Avoid abrupt withdrawal of diazepam, as
ordered, when used as part of the patient’s
seizure control regimen because a transient
increase in frequency or severity of
seizures may occur.
•Monitor severely depressed patient or one
with depression-related anxiety for suicidal
tendencies, particularly when therapy
starts and dosage changes; depression may
worsen temporarily during these times.
•Watch for psychiatric and paradoxical
reactions to diazepam, especially in children
and the elderly. If reations occur,
notify prescriber and expect drug to be
discontinued.
•Monitor patient for decreased drug effectiveness,
especially with prolonged use.
• Check patient’s blood counts and liver
function periodically, as ordered, because
prolonged diazepam therapy rarely causes
neutropenia and jaundice.
PATIENT TEACHING
• Instruct patient not to take more drug,
more often, or for a longer time than prescribed.
Warn her that physical and psychological
dependence can occur, and
teach her to recognize the signs.
• Advise patient not to take drug to relieve
everyday stress.
• Advise patient to avoid hazardous activities
until drug’s CNS effects are known.
• Advise patient to avoid CNS depressants
and alcohol during therapy.
• Instruct patient not to stop taking drug
abruptly without prescriber’s supervision.
If patient has a history of seizures, warn
that abrupt withdrawal may trigger them.
• Instruct patient to mix Diazepam Intensol
with water, soda, or a similar beverage;
applesauce; or pudding just before taking
it. Caution her not to save the mixture for
later. Tell her to use calibrated dropper
that’s provided to measure each dose.
• Teach patient how to self-administer a rectal
form, if prescribed.
• Instruct female patient of childbearing age
to notify prescriber immediately if she is
or could be pregnant because diazepam
therapy will need to be discontinued.
• Urge family or caregiver to watch patient
closely for suicidal tendencies, especially
when therapy starts or dosage changes.
