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Benzodiazepine — Status Epilepticus / Febrile Convulsions (Community) Pregnancy: Avoid — neonatal withdrawal syndrome; neonatal floppy infant syndrome; use only if seizure control absolutely necessary

Diazepam (Paediatric)

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

Adult dose

Dose: Status epilepticus: 5–10 mg IV; anxiety/muscle spasm: 2–10 mg orally
Route: IV, oral, rectal
Frequency: As needed
Max: 30 mg IV per episode
Adult reference — see paediatric dose section

Paediatric dose

Dose: Status epilepticus: IV 0.1–0.3 mg/kg; Rectal: <5 years: 5 mg, ≥5 years: 10 mg mg/kg
Route: Intravenous (hospital) or rectal tube (community)
Frequency: Single dose; may repeat once after 10 minutes if seizure continues
Max: IV max: 10 mg per dose; rectal: 10 mg
BNFc: community febrile convulsions — rectal diazepam (Stesolid) prescribed for home use by parents (5 mg <15 kg, 10 mg ≥15 kg); buccal midazolam now preferred in hospital/community as first-line per APLS guidelines — faster, more reliable, less stigmatised. IV diazepam: give slowly over 3–5 minutes (respiratory depression risk); avoid IM (erratic absorption).

Dose adjustments

Renal

No dose adjustment required

Hepatic

Use with caution — prolonged sedation in hepatic impairment

Paediatric weight-based calculator

BNFc: community febrile convulsions — rectal diazepam (Stesolid) prescribed for home use by parents (5 mg <15 kg, 10 mg ≥15 kg); buccal midazolam now preferred in hospital/community as first-line per APLS guidelines — faster, more reliable, less stigmatised. IV diazepam: give slowly over 3–5 minutes (respiratory depression risk); avoid IM (erratic absorption).

Clinical pearls

  • Buccal midazolam vs rectal diazepam: APLS now recommends buccal midazolam as first-line for paediatric seizures in community and hospital — faster absorption, less invasive, evidence of similar or better efficacy; rectal diazepam retained as alternative when midazolam unavailable
  • Paradoxical excitation: can occur in children and young adults — increased agitation, aggression, disinhibition; if occurs, switch to alternative (e.g., phenobarbital) not additional diazepam
  • Febrile convulsion management: diazepam/midazolam to stop seizure; paracetamol/ibuprofen for fever comfort; most febrile convulsions are benign and self-limiting — prophylactic diazepam not recommended (NICE)
  • Antidote: flumazenil 10 micrograms/kg IV (max 200 micrograms) — reverses benzodiazepine sedation; short half-life, may need repeat doses

Contraindications

  • Respiratory depression without ventilatory support
  • Acute narrow-angle glaucoma
  • Myasthenia gravis
  • Sleep apnoea

Side effects

  • Respiratory depression
  • Sedation
  • Hypotension
  • Paradoxical excitation (especially young children and elderly)
  • Thrombophlebitis (IV)
  • Pain on IM injection

Interactions

  • CNS depressants — additive respiratory depression
  • Opioids — MHRA/FDA warning: fatal respiratory depression
  • Antiepileptics — enhanced CNS depression

Monitoring

  • Respiratory rate and SpO2 (continuous IV use)
  • Sedation level
  • Blood pressure
  • Duration of seizure and response

Reference: BNF for Children; APLS UK Algorithm 2021; NICE CG137 (Febrile Seizures); RCPCH Seizure Management Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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