Diazepam administration routes

If an i.v. line cannot be placed, the intraosseous drug administration route can be used for pediatric patients during, for example, cardiopulmonary resuscitation (CPR) because drug delivery by this route is similar to that for i.v. administration.If drug or fluid deliver by this route is sluggish, a saline flush can be used to clear the needle. Intraosseous administration is used to deliver medications such as epinephrine, atropine, sodium bicarbonate, dopamine, diazepam, isoproterenol, phenytoin, phenobarbital, dexametha-sone, and various antibiotics. ... 

Drug administration route Intranasal and intravenous diazepam have been compared [13 j. The tmax and half-life were similar after 5 and 10 mg intranasally and the systemic availability was 75%. There were no adverse events, although many subjects reported swallowing much of the preparation. All reported transient pain and watery eyes. 

Diazepam Being extremely lipophilic, diazepam penetrates quickly into the CNS, but can rapidly redistribute into body fat and muscle. This results in a faster decline in CNS levels and early recurrence of seizures. It is dosed at 5 to 10 mg (or 0.15 mg/kg) and infused no faster than 5 mg/minute. Repeated doses can be given every 5 minutes until seizure activity stops or toxicities are seen (e.g., respiratory depression). Diazepam can also be administered as a rectal suppository, making it possible for non-medical personnel to provide rapid therapy for seizures that develop at home or in public areas.11 The adult dose is 10 mg given rectally and this dose may be repeated once if necessary. Diazepam is erratically absorbed via the intramuscular route therefore, IM administration is not recommended. 

Benzodiazepines are the evidence-based treatment of choice for uncomplicated alcohol withdrawal.17 Barbiturates are not recommended because of their low therapeutic index due to respiratory depression. Some of the anticonvulsants have also been used to treat uncomplicated withdrawal (particularly car-bamazepine and sodium valproate). Although anticonvulsants provide an alternative to benzodiazepines, they are not as well studied and are less commonly used. The most commonly employed benzodiazepines are chlordiazepoxide, diazepam, lorazepam, and oxazepam. They differ in three major ways (1) their pharmacokinetic properties, (2) the available routes for their administration, and (3) the rapidity of their onset of action due to the rate of gastrointestinal absorption and rate of crossing the blood-brain barrier. 

Benzodiazepines are usually given orally and are well absorbed by this route. Since the benzodiazepines are weak bases, they are less ionized in the relatively alkaline environment of the small intestine, and therefore, most of their absorption takes place at this site. For emergency treatment of seizures or when used in anesthesia, the benzodiazepines also can be given parenter-ally. Diazepam and lorazepam are available for intravenous administration. 

Most BZs are completely absorbed from the gastrointestinal (GI) tract. The one exception is clorazepate, a pro-drug that undergoes acid hydrolysis in the stomach and is decarboxylated to form N-desmethyl-diazepam, which is then completely absorbed into the bloodstream (Bellantuono et ak, 1980 Hobbs et ak, 1996 Chouinard et ak, 1999). In contrast, most BZs, with the exception of lorazepam and midazolam, are not consistently absorbed from intramuscular injection (Chouinard et ak, 1999). Lorazepam is available as a sublingual form that reaches clinical effect at the same rate as an oral dose. In general, intravenous administration is used only for anesthesia or for the acute management of seizures. When BZs are given via this route, the onset of action is almost immediate (Chouinard et ak, 1999). 

Most muscle relaxants are absorbed fairly easily from the gastrointestinal tract, and the oral route is the most frequent method of drug administration. In cases of severe spasms, certain drugs such as methocarbamol and orphenadrine can be injected intramuscularly or intravenously to permit a more rapid effect. Likewise, diazepam and dantrolene can be injected to treat spasticity if the situation warrants a faster onset. As discussed earlier, continuous intrathecal baclofen administration may be used in certain patients with severe spasticity, and local injection of botulinum toxin is a possible strategy for treating focal dystonias and spasticity. Metabolism of muscle relaxants is usually accomplished by hepatic microsomal enzymes and the metabolite or intact drug is excreted through the kidneys. 

Although diazepam has a high bioavailability after oral administration (approaching 100%), it is administered in equine practice primarily by the i.v. route. Because of its low water solubility, diazepam is solubilized in propylene glycol for injection. The bioavailability of this formulation is poor after i.m. administration and diazepam is not recommended for i.m. use. When i.m. administration of a benzodiazepine is desired, the more water-soluble agent midazolam is recommended. In contrast to diazepam, midazolam has a poor oral bioavailability (42%) because of its high hepatic clearance and first-pass metabolism. Zolazepam, in combination with tiletamine, can also be administered i.m. 

The most common route of exposure to the benzodiazepines is ingestion of oral dosage forms. Several of these agents are also available for parenteral administration (intramuscular or intravenous). Diazepam may be administered through an... 

Diazepam. The side effects of diazepam for intravenous administration are similar to those of phenytoin when administered by this route, that is, cardiovascular collapse when administered too rapidly. 

Parenteral administration via the intramuscular route should be avoided with diazepam and chlordiazepoxide secondary to variability in the rate and extent of drug absorption. Intramuscular lorazepam provides rapid, reliable, and complete absorption however, the preparation requires refrigeration. 

The later phase of the treatment could be expected to take place in a hospital setting. The patient is, accordingly, under monitoring and the intravenous route and/or rectal route for administration would be available. This means that whenever symptoms such as restlessness, anxiety, seizures and/or convulsions appear, prompt treatment is easier to achieve. Diazepam and midazolam are still valid as good choices, but it may... 

Valium (diazepam) tablet (oral administration) and intramuscular (innovator products administered via two different extravascular routes)... 

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