Benzodiazepine — Status Epilepticus / Febrile Convulsions (Community) Pregnancy: The safety of diazepam in human pregnancy has not been established; it should not be used in the first and third trimesters, and pregnancy and planning a pregnancy are listed as contraindications unless there are compelling reasons. There may be a small increase in the risk of congenital malformation, particularly oral cleft, with benzodiazepine use in the first trimester, though causality is not established. If administered in the late phase of pregnancy or during labour at high doses, effects on the neonate such as hypothermia, hypotonia (floppy infant syndrome), irregularities in heart rate, poor suckling and moderate respiratory depression can be expected; infants of mothers taking benzodiazepines chronically in later pregnancy may develop physical dependency and be at risk of withdrawal symptoms postnatally. Lactation: benzodiazepines are found in breast milk with milk:plasma ratios between 0.2 and 2.7, so there is a risk of accumulation in the breast-fed child - benzodiazepines should not be given to breast-feeding mothers.

Diazepam (Paediatric)

Brand names: Stesolid (rectal), Valium (oral/IV)

Diazepam is a benzodiazepine used in children for the acute treatment of prolonged or repeated seizures including status epilepticus, and for febrile convulsions, available by oral, rectal and parenteral routes.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Anxiety states, obsessive-compulsive neuroses and other psychiatric disorders: 5 to 30 mg daily in divided doses

Route: Oral (Diazepam 10 mg Tablet)

Frequency: Daily in divided doses

PAEDIATRIC REGIMEN AS STATED IN THE SPC - LIMITED, ORAL ONLY, NOT PER-KG. Verbatim section 4.2 'Children': 'Alternative presentations of diazepam are recommended for paediatric usage in order to obtain suitable doses of less than 5mg. Spastic children with minimal brain damage: 5-40mg daily in divided doses. Oral Premedication before surgery (see section 4.4): 2mg-10mg.' That is the entire paediatric posology in this source. paedDose is null because no mg/kg figure is stated anywhere in the SPC and no per-kg dose has been derived. ROUTE AND INDICATION CAVEAT: this source is a 10 mg ORAL TABLET. It gives NO rectal, intravenous or buccal regimen and NO regimen for acute seizures or status epilepticus, which is the common paediatric emergency use of diazepam - that regimen must be sourced from the relevant rectal or injection SPC and verified against a children's formulary before use. The SPC's own note that alternative presentations are recommended in children in order to obtain doses of less than 5 mg means this tablet is not a suitable paediatric formulation for small doses. FULL ADULT INDICATION LIST (section 4.2): anxiety states, obsessive-compulsive neuroses and other psychiatric disorders 5 to 30 mg daily in divided doses; alcohol withdrawal 5 to 20 mg, repeated if necessary in 2 to 4 hours; insomnia associated with anxiety 5 to 15 mg before bedtime; cerebral palsy 5 to 60 mg daily in divided doses; upper motor neuronic spasticity 5 to 60 mg daily in divided doses; muscle spasm of varied aetiology, fibrositis, cervical spondylosis 5 to 15 mg daily in divided doses; adjunct to the management of some types of epilepsy 2 to 60 mg daily in divided doses, treatment to be used for as long as the prescriber considers it necessary; oral premedication in dental patients 5 mg the night before, 5 mg on waking and 5 mg two hours before the appointment; oral premedication before surgery 5 to 20 mg. GENERAL: 'As an anxiolytic, the lowest dose which can control symptoms should be used. It should not be continued beyond 4 weeks. Long-term chronic use is not recommended. Treatment should always be tapered off gradually.' Prior to starting treatment a strategy for ending treatment should be agreed with the patient to minimise the risk of dependence, addiction and drug withdrawal syndrome. ELDERLY AND DEBILITATED: doses should be half the above recommended doses. HEPATIC: use in hepatic impairment may precipitate coma, therefore the dose should be reduced or an alternative drug considered. US LABELLING (openFDA, diazepam tablets, A-S Medication Solutions, 2025-10-27) is NOT the basis of the fields above and differs; quoted only for cross-check: 'PEDIATRIC PATIENTS: Because of varied responses to CNS-acting drugs, initiate therapy with lowest dose and increase as required. Not for use in pediatric patients under 6 months. 1 mg to 2.5 mg, 3 or 4 times daily initially; increase gradually as needed and tolerated.' SOURCE COMPLETENESS: eMC section 4.5 (interactions) was NOT captured in this bundle, and sections 4.4 and 4.8 were truncated at the source-fetch limit.

Dose adjustments

Renal

In severe renal impairment the dose should be reduced (section 4.2). No numeric adjustment is stated.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance, other benzodiazepines or to any of the excipients
Phobic or obsessional states; chronic psychosis; hyperkinesis (paradoxical reactions may occur)
Acute pulmonary insufficiency; respiratory depression; acute or chronic severe respiratory insufficiency (ventilatory failure may be exacerbated); sleep apnoea
Myasthenia gravis (condition may be exacerbated)
Severe hepatic insufficiency (elimination half-life of diazepam may be prolonged); acute porphyria
Should not be used as monotherapy in patients with depression or with anxiety and depression, as suicide may be precipitated
Planning a pregnancy; pregnancy (unless there are compelling reasons)

Side effects

Drowsiness (very common); ataxia, impaired motor ability, tremor (common); confusion (common) - these predominantly occur at the start of therapy and usually disappear with repeated administration
Anterograde amnesia (uncommon), which may occur at therapeutic dosages with the risk increasing at higher dosages and may be associated with inappropriate behaviour
Respiratory depression (uncommon); respiratory arrest and increased bronchial secretion (rare); apnoea (not known). Increased salivary and bronchial secretion has been reported, in particular in children
Psychiatric and paradoxical reactions such as excitation, restlessness, agitation, irritability, aggressiveness, delusion, rages, hallucinations, psychoses, memory loss, nightmares and inappropriate behaviour (rare)
Drug dependence (frequency not known) - chronic use even at therapeutic doses may lead to physical and psychic dependence, and discontinuation may result in withdrawal or rebound phenomena
Hypotension and syncope, bradycardia and heart failure including cardiac arrest (rare); increased risk of falls and associated fractures in elderly patients

Interactions

US label (openFDA) drug interactions section, cross-check only: concomitant benzodiazepines and opioids increase the risk of respiratory depression - limit dosage and duration and monitor closely for respiratory depression and sedation
US label (openFDA), cross-check only: careful consideration is required when combining with other centrally acting agents that may potentiate or be potentiated by diazepam, such as phenothiazines, antipsychotics, anxiolytics/sedatives, hypnotics, anticonvulsants, narcotic analgesics, anaesthetics, sedative antihistamines, narcotics, barbiturates, MAO inhibitors and other antidepressants
US label (openFDA), cross-check only: concomitant alcohol is not recommended due to enhancement of the sedative effect; antacids lower diazepam peak concentrations by about 30 percent without affecting the extent of absorption
NOTE: eMC SPC section 4.5 was NOT captured in this bundle. The UK interaction section has therefore NOT been reviewed and must be checked in full against the UK SPC before use

Clinical monograph

How it works

It enhances the inhibitory action of GABA at GABA-A receptors, increasing chloride conductance and reducing neuronal excitability.

Prescribing in practice

The principal risk is respiratory depression and sedation, which is greater with intravenous use and when combined with other CNS depressants, so resuscitation facilities must be available.
Rectal solution provides a practical route for seizures in the community when intravenous access is unavailable; a defined maximum number of doses should not be exceeded before seeking emergency help.
Dose by weight using a children's formulary and reduce in hepatic impairment as accumulation can occur.

Monitoring

During and after administration monitor respiratory rate, oxygen saturation, conscious level and blood pressure.

Counselling the patient

Carers should be shown how to give rectal diazepam and when to call emergency services.
Expect drowsiness afterwards and ensure the child is supervised.
Seek immediate help if breathing becomes slow or the seizure does not stop.

Evidence & guidelines

Diazepam is an established option for terminating acute seizures in children, with buccal midazolam and intravenous lorazepam as alternatives per UK status epilepticus protocols.

Reference: APLS UK Algorithm 2021; NICE CG137 (Febrile Seizures); RCPCH Seizure Management Guidelines; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways