Diazepam Dosing for Sedation in Intubated ICU Patients

Initial Dosing and Administration

For sedation of intubated ICU patients, the American College of Gastroenterology recommends starting with 5-10 mg IV bolus of diazepam, followed by additional 5 mg doses every 5 minutes as needed, with a typical maximum of 10-20 mg for most procedures 1
The initial induction dose of diazepam should be 5-10 mg IV over 1 minute, with additional 5 mg doses administered at 5-minute intervals until adequate sedation is achieved 1
The typical total dose of diazepam is 10 mg IV, though up to 20 mg may be necessary if not coadministered with an opioid 1

The dose of diazepam should be reduced by 20% or more in elderly or debilitated patients due to reduced clearance, as recommended by the American Geriatrics Society 1, 2
Lower doses of diazepam are required in patients with hepatic or renal impairment, as stated by the National Kidney Foundation 2
The dose of diazepam should be reduced by 50% or more when combined with opioids due to synergistic respiratory depression, as warned by the American Society of Anesthesiologists 1

Respiratory depression is a dose-dependent risk of diazepam, resulting from depression of central ventilatory response to hypoxia and hypercapnea, as reported by the American Thoracic Society 1
The risk of respiratory depression is substantially higher when diazepam is combined with opioids, and patients with underlying respiratory disease are at increased risk, as noted by the American College of Chest Physicians 1, 2
Patients receiving diazepam should be monitored continuously for oxygen saturation and respiratory effort, and be prepared to provide respiratory support, as recommended by the Society of Critical Care Medicine 2

Flumazenil should be available for reversal of diazepam, at a dose of 0.01-0.02 mg/kg IV, repeatable at 1-minute intervals to maximum cumulative dose of 0.05 mg/kg or 1 mg, as recommended by the American Academy of Clinical Toxicology 2
Diazepam may cause brief myoclonic activity, coughing, and dyspnea, and can paradoxically worsen delirium or agitation in some patients, as reported by the American Psychiatric Association 1, 2, 3