1 May 2026Injectable drugsSource update: October 2024
Diazepam injectable
Injectable diazepam guidance for convulsive status epilepticus, tetanus-related muscle spasms, and severe adult agitation.
Prescription under medical supervision
This guide page is for structured reference only and does not replace a clinician, pharmacist, or emergency review. Dose choice, route choice, interactions, and safety decisions still need professional judgment.
Therapeutic action
Antiseizure (anticonvulsant), muscle relaxant, sedative, anxiolytic.
Indications
- First-line treatment of convulsive status epilepticus.
- Muscle spasms due to tetanus.
- Severe agitation in adults.
Forms and strengths, route of administration
The injectable solution may be used rectally.
- 10 mg in 2 ml ampoule, 5 mg/ml, for IM injection, slow IV injection, or IV infusion in 0.9% sodium chloride or 5% glucose.
Dose and duration
During and after administration, have ventilation equipment and solutions for fluid replacement ready for use.
For seizures, preferably use the rectal route in children.
| Age | Weight | 10 mg/2 ml solution | |
|---|---|---|---|
| Rectal route | IV injection | ||
| 1 to < 4 months | 3 to < 6 kg | 0.4 ml | 0.25 ml |
| 4 to < 12 months | 6 to < 10 kg | 0.7 ml | 0.4 ml |
| 1 to < 3 years | 10 to < 15 kg | 1.2 ml | 0.6 ml |
| 3 to < 5 years | 15 to < 20 kg | 1.5 ml | 1 ml |
| 5 to < 9 years | 20 to < 30 kg | 2 ml | 1.2 ml |
| 9 to < 12 years | 30 to < 40 kg | 2 ml | 2 ml |
Convulsive status epilepticus
- Child 1 month to 11 years: rectal route, one dose of 0.5 mg/kg, maximum 10 mg; slow IV injection, one dose of 0.2 to 0.3 mg/kg, maximum 10 mg.
- Child 12 years and over and adult: rectal route, one dose of 10 to 20 mg; slow IV injection, one dose of 10 mg.
- If seizures do not stop 5 minutes after the first dose, readminister the same dose regardless of route. Do not administer more than 2 doses in total.
Muscle spasms due to tetanus
- Child 1 month and over and adult: 0.1 to 0.3 mg/kg by slow IV injection every 1 to 4 hours or 0.1 to 0.5 mg/kg/hour by IV infusion over 24 hours.
Severe agitation
- Adult: 10 mg by IM injection, to be repeated once after 30 to 60 minutes if necessary.
Contra-indications, adverse effects, precautions
- Do not administer to neonates because the formulation contains benzyl alcohol, nor to patients with severe respiratory insufficiency or severe hepatic impairment.
- Administer with caution to older patients, patients with renal or hepatic impairment, and patients with history of substance abuse or mental disorders.
- May cause pain at injection site, hypotension, muscle weakness, ataxia, hypotonia, drowsiness, lethargy, confusional state, respiratory depression, and coma in overdose.
- Avoid or monitor combination with opioid analgesics, antipsychotics, first-generation antihistamines, antidepressants, other antiseizure medications, enzyme inducers, omeprazole, macrolides, ritonavir, isoniazid, fluconazole, itraconazole, and phenytoin.
- Pregnancy and breast-feeding: avoid, except if vital.
- Diazepam is subject to international controls: follow national regulations.
- Do not mix with other drugs in the same syringe or infusion.
Source
MSF Essential drugs practical guidelines (January 2026)
This page reproduces the structured reference information for this batch while leaving out the Storage and Remarks sections.
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