Drug Information Table Benzodiazepines – diazepam (Valium), alprazolam (Xanax) Therapeutic Use Administration • Anxiety and anxiety disorders • Give alprazolam orally. (alprazolam, diazepam) • Take oral benzodiazepines • Skeletal muscle spasm and with food if gastrointestinal spasticity (diazepam) symptoms develop. • Seizure disorders—treats • Give diazepam orally, rectally, status epilepticus (diazepam) IM, or IV. • Acute alcohol withdrawal • Administer IV diazepam symptoms (diazepam) slowly and have emergency • Induction of anesthesia resuscitation equipment nearby. (diazepam) • Take care to avoid intra-arterial IV diazepam administration or extravasation into tissue. • Be aware that IV diazepam precipitates in solution with some diluents and drugs. • Do not give the emulsion form IM (IV only). • Avoid IM diazepam due to inconsistent absorption; if necessary, inject slowly into a large muscle. Side/Adverse Effects Interventions Patient Instructions • Drowsiness, slurred speech • Monitor patients to prevent • Instruct patients to use care falls and other injury following with ambulation and when administration. driving or using hazardous equipment. • Impaired recall of events • Assess patient’s memory • Advise patients that amnesia (anterograde amnesia), following administration. may occur. • Paradoxical reaction • Monitor patients, especially • Instruct patients to stop (confusion, anxiety) older adults, for a paradoxical taking the drug and inform reaction. the provider if a paradoxical reaction occurs. • Hypotension, tachycardia, • Monitor vital signs, especially • Instruct patients to avoid respiratory depression with IV administration. increasing the prescribed dose. • Instruct patients to change positions slowly to prevent falls. • Tolerance and physical • Monitor patients for signs of • Instruct patients that tolerance dependence (especially with tolerance and dependence. to benzodiazepines occurs with alprazolam) time. • Withdrawal symptoms – • Taper over 1 to 2 weeks to • Instruct patients to taper Insomnia, anxiety, tremors, prevent or minimize withdrawal. the drug slowly to prevent diaphoresis, dizziness, panic, • Monitor for signs of withdrawal. withdrawal symptoms. hypertension, seizures • Overdose/toxicity • Reverse sedation with IV • Instruct patients to take the ◦◦Oral—sedation, confusion flumazenil. drug as prescribed and avoid ◦◦Parenteral—possibly life- • Manage oral overdose with the use of other depressants. threatening sedation, gastric lavage, activated hypotension, respiratory charcoal, saline cathartics, and depression, cardiac arrest dialysis. • Provide airway and blood pressure support as needed for parenteral overdose. Contraindications Precautions Interactions • Pregnancy Category D, • Older adults, children under 18 • The risk of severe sedation and lactation (alprazolam); respiratory depression increase • Schedule IV controlled • Renal or hepatic impairment when taken concurrently substances • Mental health disorders, with other CNS depressants • Glaucoma suicidal ideation, addiction risk (alcohol, opioids, other • Coma, shock, neonates, labor/ • Chronic respiratory disorders benzodiazepines). delivery (IV diazepam) • Neuromuscular disorders • Cimetidine (Tagamet) increases benzodiazepine levels. • Smoking decreases the effects of benzodiazepines. • Kava kava and valerian increase the risk for sedation. • Disulfiram (Antabuse) and fluoxetine (Prozac) increase alprazolam levels.