Diazepex: instructions for use. Diazpex: instructions for use Interaction with other medicinal products
Composition
active substance: diazepam;
2 ml of solution (1 ampoule), 10 mg of diazepam,
Excipients: benzoic acid (E 210), sodium benzoate (E 211), propylene glycol, benzyl alcohol, ethyl alcohol 96%, water for injection
Dosage form
Injection.
Basic physical and chemical properties: transparent liquid, color from transparent to light yellow with a green tinge.
Pharmacological group
Anxiolytics. Benzodiazepine derivatives. ATX code N05B A01.
Pharmacological properties
Pharmacological.
Diazepam is a psychotropic drug of the benzodiazepine class with a pronounced sedative, anti-anxiety, anticonvulsant and muscle relaxant effect; it also has a hypnotic effect.
In the central nervous system (CNS), diazepam acts on specific benzodiazepine receptors, which are functionally closely related to the receptors of gamma-aminobutyric acid (GABA), the main inhibitory mediator of the central nervous system, therefore, as a result of the action of diazepam, the inhibitory effect of GABA on the central nervous system is enhanced.
Diazepam acts on the receptors of the limbic system and the cerebral cortex, exhibiting sedative and anxiolytic effects. The muscle relaxant and anticonvulsant actions of diazepam are associated with its property to reduce the activity of the epileptogenic media of all parts of the brain, as well as its inhibitory effect on the reflexes of the spinal cord. Diazepam practically does not act on the receptors of the peripheral autonomic nervous system and does not cause extrapyramidal disorders.
Pharmacokinetics.
absorption
The absorption of diazepam depends on the route of administration. When administered, the drug is completely absorbed, however, diazepam is not always absorbed faster than when administered orally.
distribution
The level of binding of diazepam and its metabolites with blood plasma proteins is high (diazepam - 98%). It is known that diazepam dissolves well in lipids. Diazepam and its metabolites cross the blood-brain and placental barriers, and also penetrate into breast milk (approximately 1/10 of the concentration in the mother's blood plasma).
metabolism
Diazepam is metabolized mainly in the liver with the formation of pharmacologically active metabolites - N-desmethyldiazepam, temazepam, oxazepam.
output
Withdrawal of diazepam consists of two phases. The first phase indicates its early distribution in the body, the second phase - about a long withdrawal, which lasts 1-2 days.
The half-life of the drug can last 2-5 days, since its active metabolite, desmethyldiazepam (nordiazepam), circulates in the body.
With repeated administration of diazepam, the accumulation of diazepam and desmethyldiazepam is noted. It may take 2 weeks before equilibrium is reached, and the concentration of the metabolite may even exceed the level of diazepam.
Diazepam and its metabolites are excreted in the urine, mainly in the form of conjugates.
Diazepam clearance is 20-30 ml / min.
Pharmacokinetics in special clinical situations
The half-life of diazepam and its metabolites is increased in newborns, the elderly, and patients with liver disease. In renal failure, the elimination half-life is practically unchanged.
Intramuscular injections can cause an increase in plasma CPK activity when reaching a maximum level after 12-24 hours after administration. This must be taken into account in the differential diagnosis of myocardial infarction.
Absorption upon administration is variable (especially of the gluteal muscles). This method of administration should be used if oral or intravenous administration is not possible or recommended.
The relationship between the concentration of diazepam and its metabolites in blood plasma and the therapeutic effect of vidstunium.
Indications
States of anxiety and fear or their symptoms.
Alcohol withdrawal syndrome.
Convulsions of various etiologies, status epilepticus, febrile seizures.
The drug is also used for premedication before surgery.
Contraindications
- History of hypersensitivity to benzodiazepines.
- Acute attack of angle-closure glaucoma or open-angle glaucoma if the patient is not receiving proper therapy.
- Myasthenia gravis gravis .
- Respiratory depression, acute respiratory failure.
- Sleep apnea.
- Severe liver failure.
- Intoxication with drugs or psychotropic substances.
- Alcohol intoxication, acute intoxication with substances that depress the central nervous system.
- The first 30 days of life of newborns due to insufficient liver function.
- I and III trimesters of pregnancy.
- Breastfeeding period.
Not intended for the treatment of phobias, obsessions and chronic psychosis.
It should not be used as monotherapy for the treatment of depression or depression, which is accompanied by anxiety, fear, since such patients may experience suicidal tendencies.
Interaction with other medicinal products and other types of interactions
Simultaneous use of diazepam and centrally acting antihistamines, antipsychotics, muscle relaxants (baclofen, tizanidine), nabilone, lofexidine, phenothiazine or barbituric acid derivatives, narcotic drugs, antidepressants (MAO inhibitors, etc.) increase the sedative effect on the central nervous system. The risk of apnea increases, hypotension and muscle weakness are possible.
With the simultaneous use of diazepam with opiates, the depressing effect on respiration may increase. When used with other muscle relaxants, the consequences are unpredictable, there is a risk of respiratory arrest.
When used simultaneously with antihypertensive drugs, their hypotensive effect is enhanced; α-blockers can enhance the sedative effect of diazepam. Elderly patients need special supervision.
Isoniazid, ritonavir, amprenavir increase the concentration of benzodiazepines in the blood plasma.
If diazepam is administered concurrently with any narcotic pain reliever (eg in dentistry), it is recommended that the drug be administered after the administration of the anesthetic, the dose should be carefully adjusted according to the patient's needs.
In pharmacokinetic studies, conflicting data have been obtained on the interaction of diazepam with antiepileptic drugs.
Inhibitors of liver enzymes (for example, cimetidine, fluvoxamine, fluoxetine, omeprazole) have the ability to reduce the clearance of benzodiazepines, thereby enhancing their effect. In turn, inducers of liver enzymes (rifampicin) can increase the clearance of benzodiazepines.
There are reports that benzodiazepines affect the elimination of phenytoin.
With simultaneous use with levodopa, the effect of levodopa decreases.
When used simultaneously with digoxin, diazepam can reduce its renal excretion, thus increasing the toxicity of digoxin.
Isoniazid, disulfiram, antihistamines and contraceptives containing estrogens, increase, while rifampicin weakens the connection of diazepam and desmethyldiazepam with blood plasma proteins, thus increasing the concentration of the fraction of unbound diazepam in the blood plasma.
With simultaneous use with alcohol, pathological reactions are possible. The pathological effect of the interaction of diazepam and alcohol does not depend on the amount and type of alcohol consumed.
Alcohol can be taken no earlier than 36 hours after using diazepam.
Antifungal drugs (ketoconazole) also increase the plasma concentration of benzodiazepines.
Application features
Parenteral diazepam should not be used in patients with organic brain changes (especially atherosclerosis) or with chronic pulmonary insufficiency. However, in exceptional cases or when treating a patient in a hospital, diazepam can be administered parenterally in smaller doses. The drug is administered intravenously slowly, not exceeding the rate of 1 ml (5 mg) / min. Avoid getting the drug solution into the arteries or perivascular space. When injected, the drug should be injected deep into the muscle. Do not add other solutions or medications to the drug in a syringe or infusion system! After intravenous administration, the drug acts quickly, but for a short time, it is not recommended to use it for maintenance therapy.
The advisability of using diazepam in patients with respiratory impairment and reduced attention due to the danger of respiratory depression should be carefully weighed.
For patients with chronic pulmonary insufficiency or chronic liver disease, it may be necessary to reduce the dose and should be used with caution also in renal failure, although the elimination half-life of diazepam does not change.
Amnesia is possible with diazepam. This condition usually appears several hours after the drug is used, therefore, to reduce the risk, patients should be provided with 7-8 hours of uninterrupted sleep.
When using benzodiazepines, paradoxical reactions can occur, such as anxiety, agitation, nervousness, aggressiveness, paranoia, anger, nightmares, hallucinations, psychosis, inappropriate behavior and other negative behavioral manifestations. If these symptoms appear, the drug should be discontinued. These symptoms are most common in children and the elderly.
With the use of benzodiazepines, dependence may develop. The risk is increased in patients who use the drug for a long time or use it in high doses in patients with a history of excessive alcohol and drug use. If there is a physical dependence on benzodiazepines, withdrawal symptoms will occur when therapy is discontinued. These include headache, muscle aches, increased anxiety, tension, confusion, and nervousness. In severe cases, the following symptoms may appear: loss of a sense of reality, depersonalization, numbness of the limbs, increased sensitivity to light, noise and physical contact, hallucinations or seizures of epilepsy. In case of termination of long-term intravenous therapy, a gradual dose reduction is necessary.
Special care should be taken when using the injectable form of diazepam in elderly patients, very debilitated patients and patients with cardiorespiratory failure, since there is a risk of apnea and / or cardiac arrest. The simultaneous use of barbiturates, alcohol and other CNS depressants increases the inhibitory effect of cardiorespiratory function, increases the risk of apnea.
The benzyl alcohol in the solution can cause irreparable harm to newborns, especially premature babies. In such cases, solution for injection is used only when there is no therapeutic alternative.
With long-term therapy, it is advisable to regularly check blood counts and liver function.
Benzodiazepines are prescribed to children only after a thorough assessment of the need for their use; the duration of treatment should be minimal.
In pediatric practice, minimum doses are used to avoid dangerous side effects (apnea or prolonged drowsiness).
It should be used with caution in porphyria.
Do not use diazepam in obstetrics.
Application during pregnancy or lactation.
There is no data on the safety of using the drug during pregnancy. Some studies indicate an increased congenital risk of abnormalities associated with the use of benzodiazepines in the first trimester of pregnancy, therefore, their use is contraindicated. The drug should not be used in the last trimester of pregnancy.
If diazepam is prescribed to a woman, she should know about the need to consult a doctor about stopping the use of the drug when planning a pregnancy or if pregnancy is suspected.
Diazepam is excreted in breast milk, so its use is prohibited during lactation.
The ability to influence the reaction rate when driving vehicles or other mechanisms.
Patients should be advised that diazepam, like other drugs in this group, may impair the patient's ability to perform tasks that require special dexterity. The sedative effect of the drug, amnesia, impaired ability to concentrate and excited muscle functions adversely affect the ability to drive vehicles and maintain mechanisms. During the use of diazepam, work associated with risk (work with technical devices, driving) should be avoided. In the case of insufficient sleep, attention is further weakened. Patients should be advised that alcohol can increase side effects and should therefore be discarded during treatment.
Method of administration and dosage
The dose is set individually, depending on the indications for use and the severity of the disease.
When administered, the drug is absorbed slowly. The recommended infusion rate is 0.5-1 ml / min or 2.5-5 mg / min.
In case of intense fear diazepam is administered intramuscularly or intravenously at a dose of up to 10 mg, if necessary, repeating the introduction every 4:00.
To provide sedation before small surgical or medical procedures, the drug is injected into large veins at 10-20 mg for 2-4 minutes for premedication - intravenously 100-200 μg / kg of body weight.
To prevent seizures in adults diazepam is administered intravenously at 10-20 mg at a rate of 5 mg / min. If necessary, the injection can be repeated after 30-60 minutes. Another scheme of use involves more frequent administration of smaller doses or intramuscular administration.
Doses for children with intravenous or intramuscular administration of the drug are 200-300 μg / kg of body weight or 1 mg for each year of life. The maximum daily dose for children should not exceed 3 mg / kg.
With muscle spasms diazepam is administered intramuscularly or slowly intravenously, 10 mg every 4:00.
Large doses are needed for elimination of tetany... In this case, adults and children are prescribed intravenously at 100-300 mcg / kg of body weight every 1-4 hours.
For severe alcohol withdrawal syndrome 10 mg of diazepam is administered intramuscularly or intravenously, in some cases the dose can be increased.
Children.
Applied to children from 30 days of age.
Overdose
An overdose of benzodiazepines usually results in CNS depression, ranging from drowsiness to coma. In mild cases, symptoms include drowsiness, confusion, depressed reflexes, and apathy. In more severe cases, symptoms may include hypotension, arterial hypotension, respiratory depression, or (rarely) and death (very rarely).
If an overdose has occurred by the oral route, immediately carry out gastric lavage, stimulation of respiration, and administration of infusion solutions.
Dialysis applications are limited. Treatment is symptomatic, breathing, changes in pulse and leg pressure should be monitored. Arterial hypotension is eliminated with metaraminol or norepinephrine. To reduce the depression of the central nervous system, a specific antagonist of benzodiazepine receptors, flumazenil, can be used. Patients requiring such intervention should be closely monitored in a hospital setting. Caution should be exercised when using flumazenil in patients with epilepsy who are being treated with benzodiazepines.
Instructions for the medical use of the drugIndications for use
Anxiety, anxiety, tension, depression, depression; as a component of complex treatment it is also used for convulsive syndrome, arterial hypertension, rheumatoid arthritis, lumbago, malignant tumors, menopause, premenstrual syndrome, dysalgomenorrhea, gastric ulcer and duodenal ulcer, skeletal muscle spasticity, alcoholism, consequences of trauma.Release form
tablets 2 mg; blister 10, pack of cardboard 2;tablets 5 mg; blister 10, pack of cardboard 2;
1 tablet contains diazepam 2 or 5 mg; in a blister 10 pcs., in a cardboard box 2 blisters.
Pharmacodynamics
The calming and anti-anxiety effects are due to the influence on the benzodiazepine receptors of the limbic system; muscle relaxant and anticonvulsant - inhibition of spinal reflexes.Use during pregnancy
Contraindicated in the first trimester of pregnancy; during treatment, it is necessary to suspend breastfeeding.Contraindications for use
Hypersensitivity, glaucoma, myasthenia gravis.Side effects
Drowsiness, dizziness, weakness, ataxia, headache; rarely - visual impairment, euphoria, jaundice, dry mouth, nausea, constipation, shortness of breath, tachycardia, hypotension, leukopenia, granulocytopenia, allergic reactions.Method of administration and dosage
Inside. For states of anxiety and anxiety: 2–5 mg 2–4 times a day.For spastic conditions: 2-10 mg 3-4 times a day. The maximum daily dose for outpatients is 15 mg.
Children under 3 years old - 1-5 mg, 4-12 years old - 2-10 mg / day, usually for 1-3 doses.
Overdose
Symptoms: drowsiness, inhibition of reflexes, possibly coma.Treatment: symptomatic. The specific antidote is flumazenil.
Interaction with other drugs
The effect is enhanced by phenothiazine derivatives, barbiturates, MAO inhibitors, cimetidine, alcohol.Precautions for taking
It is prescribed with caution for violations of the functions of the heart, respiration, liver and kidneys, organic brain lesions, elderly patients, children. During the reception, it is recommended to avoid work associated with risk and speed of reactions.Storage conditions
In a dry place at room temperature.Shelf life
60 monthsBelonging to ATX classification:
N Nervous system
N05 Psycholeptics
N05B Anxiolytics
N05BA Benzodiazepine derivatives
Diazepex is a drug used for various anxiety, anxiety and depressive conditions. Has a pronounced calming effect.
It is currently used to treat many neurological conditions. Refers to anxiolytics. The active basis of the drug is Diazepam.
Pharmacology and mechanism of action
The drug has anxiolytic, hypnotic, sedative and muscle-relaxing effects. Causes a moderate decrease in blood pressure due to the expansion of the coronary vessels. Helps to increase the threshold of sensitivity to pain. Suppresses paroxysms. Leads to a decrease in the production of gastric juice.
When taking the drug, the action begins in half an hour. The maximum plasma concentration is after 1 hour. Binds to plasma proteins. It is destroyed in the liver, the half-life is 2 days (in the elderly - up to 100 hours).
The basis of the mechanism of action of the drug is that it acts on benzodiazepine receptors. This affects the conduction of the interneurons of the spinal cord. There is an increase in the inhibitory effect of GABA (a mediator of inhibition of all parts of the central nervous system).
These processes lead to inhibition of the subcortical parts of the brain. Thanks to the influence on the limbic system, it reduces fear, emotional stress, anxiety. The effect on the brain stem determines the sedative effect of the drug.
Inhibition of the spinal nerve pathways gives the anticonvulsant effect of Diazepex.
Indications and contraindications for use
Diazeppex is used in the following cases:
The use of Diazepex is contraindicated in the following conditions:
- hypersensitivity;
- shock state;
- acute alcohol poisoning, which caused a weakening of all vital functions of the body;
- the use of narcotic pain medications;
- angle-closure glaucoma;
- chronic obstructive pulmonary disease;
- pregnancy;
- age up to 6 months.
Dosages and dosage regimens
The drug is taken orally. In any case, when calculating the dose, only an individual approach is used. The approximate dosages of Diazpex are as follows:
Overdose and side effects
In case of an overdose, the following reactions occur:
- severe drowsiness and confusion;
- areflexia;
- violation of visual function;
- difficulty breathing up to apnea;
- depression of consciousness (up to the development of a coma).
Elimination of these symptoms is carried out by gastric lavage and forced diuresis. Antidote - Flumazenil.
Taking Diazepex can manifest with the following side effects:
special instructions
The drug is addictive and addictive. With withdrawal syndrome, irritability, anxiety, insomnia, tremors, fear, nausea, hallucinations, and very rarely psychosis may appear.
Influences driving and machine control. Use with caution in case of liver and kidney damage.
During pregnancy and lactation, the drug is used only for health reasons. Diazepex has a severe effect on the fetus (it depresses the baby's nervous system).
Interaction with other medications
Enhances the effect of sedatives. Reception with antidepressants enhances the effect of the latter. Enhances the action.
Contraceptive use (oral) increases the risk of bleeding. Caffeine reduces the sedative effect of Diazepex.
Strengthens the excretion of the drug. Paracetamol, on the contrary, slows down this process.
From the practical experience of doctors and patients
Numerous reviews indicate the effectiveness of the use of Diazepex, but there are nuances, more on that below.
Andrey Pavlovich, neurologist
Composition
1 tablet contains 5 mg of diazepam.
Excipients: lactose monohydrate, hydroxypropyl starch, microcrystalline cellulose, silicon dioxide, talc, magnesium stearate.
Description
Round white tablets with flat surfaces, beveled and scored on one side.
pharmachologic effect
DIAZEPEX® contains diazepam, a psychotropic drug of the benzodiazepine class with a pronounced sedative, anti-anxiety, anticonvulsant and muscle relaxant effect; it also has a hypnotic effect.
In the central nervous system (CNS), diazepam acts on specific benzodiazepine receptors, which are functionally closely related to the receptors for γ-aminobutyric acid (GABA), the main inhibitory mediator of the central nervous system, therefore, as a result of the action of diazepam, the inhibitory effect of GABA on the central nervous system is enhanced. Diazepam acts on receptors in the limbic system and cerebral cortex, exhibiting sedative and anxiolytic effects.
The muscle relaxant and anticonvulsant effects of diazepam are associated with its ability to reduce the activity of epileptogenic foci in all parts of the brain, as well as its inhibitory effect on the reflexes of the spinal cord.
Diazepam practically does not act on the receptors of the peripheral autonomic nervous system and does not cause extrapyramidal disturbances.
Pharmacokinetics
Diazepam is rapidly absorbed from the gastrointestinal tract, reaching its maximum plasma concentration within about 30 to 90 minutes. The absorption rate is high (75%).
The degree of binding of the drug to blood plasma proteins is high and Diazepam dissolves well in lipids, easily penetrates the hematoplacental barriers.
In the liver, an intensive metabolic conversion of diazepam occurs with the formation of metabolites of desmethyldiazepam, oxazepam and temazepam.
Diazepam is characterized by two-phase elimination. The half-life of elimination of diazepam from plasma is up to 24 hours, the half-period of elimination of the main metabolite of diazepam, desmethyldiazepam, can reach 100 hours, and therefore the therapeutic effect of the drug is lengthened.
Diazepam and its metabolites are excreted mainly in the urine, mainly in the form of conjugates. Diazepam clearance is 20-30 ml per minute. It is excreted in mother's milk.
With repeated use, diazepam accumulates in the body.
Elderly patients, children, adolescents, as well as patients with hepatic and renal insufficiency: dose adjustment (reduction) is required, since the half-life of elimination in these groups of patients is lengthened.
Indications for use
In the treatment of anxiety conditions to quickly relieve the symptom of anxiety. Anxiety or tension associated with daily stress usually does not require treatment with anxiolytics, including Diazepex;
With acute alcohol withdrawal (anxiety, tension, and / or vegetative equivalents of these disorders);
As part of the complex therapy of musculoskeletal spasms associated with local pathology (cerebral palsy, athetosis, constrained person syndrome);
As part of the complex therapy of convulsive diseases.
Contraindications
|
Hypersensitivity to diazepam or other derivatives Acute angle-closure glaucoma. Acute respiratory failure. Respiratory depression. Sleep apnea. Severe liver failure. Phobias or obsessive disorders, chronic psychosis. Myasthenia gravis. Alcohol dependence (except in acute cases of discontinuation Poisoning with drugs or psychotropic substances. First trimester of pregnancy. Breastfeeding. Children under 6 years of age. Rare congenital galactose intolerance, Lapp-ligtase deficiency, or The drug should not be used in monotherapy for depression or in the treatment of anxiety, |
Pregnancy and lactation
During pregnancy, Diazepex should be prescribed only in the presence of urgent indications, if the expected therapeutic effect justifies the risk of a possible toxic effect on the fetus.
In clinical studies, it was found that diazepam crosses the placental barrier. The results of individual studies indicate that the use of so-called "small tranquilizers" (chlordiazepoxide, diazepam, meprobamate) in the first trimester of pregnancy increases the risk of organogenesis disorders. Regular use of benzodiazepines during pregnancy can lead to the development of withdrawal syndrome in newborns (anxiety, tremor, increased muscle tone), and use in the last weeks of pregnancy - depression of the central nervous system
Method of administration and dosage
Diazepex is administered orally. Doses are selected individually for each patient.
Adults are recommended to prescribe the drug, starting with a dose of 2.5-5 mg (½-1 tablet) 1-2 times a day, then gradually increasing it. Usually, a single dose for adults is 5-10 mg (1-2 tablets). In some cases (with increased agitation, fear, anxiety), a single dose can be increased to 20 mg. The daily therapeutic dose is given in 2-3 doses. The maximum daily dose is 60 mg.
For sleep disorders, adults are prescribed 5-10 mg at bedtime.
Weakened and elderly patients, as well as patients with impaired liver and kidney function, treatment should be started with half the usual dose for adults, gradually increasing it, depending on the achieved effect and tolerance.
Children from 7 years of age and older are prescribed 2.5-5 mg. The daily dose is 5-10 mg.
The duration of a continuous course of treatment should not exceed 1 month. Before a second course of treatment, a break should be at least 3 weeks.
Side effect
Drowsiness (especially severe in the first few days), slight dizziness, sometimes unsteady gait. Concentration of attention is reduced; neuromuscular response is slowed down
Rarely - ataxia, pruritus, nausea, constipation
With prolonged use, it is possible to develop drug dependence, impaired memory, menstrual cycle, decreased sex drive
In some cases, excitement may be observed at the beginning of treatment.
Hypoprothrombinemia
In elderly and childhood, there is an increase in the incidence of sedative side effects
Overdose
Symptoms: prolonged confusion, decreased reflexes, severe drowsiness, tremors, slow heartbeat, shortness of breath or shortness of breath, prolonged blurred speech, imbalance, severe weakness.
Treatment consists of supportive therapy and includes induction of vomiting and the administration of activated charcoal by mouth, gastric lavage, oxygen administration, administration of infusion solutions with the administration of effective diuretics (forced diuresis), intravenous administration of vasoconstrictors (dopamine, norepinephrine), administration of flumazenil (benzodiazepine receptor antagonist).
Interaction with other medicinal products
When using Diazepex together with other drugs, the following interactions can be observed: monoamine oxidase inhibitors, strychnine and corazole are antagonists of Diazepex; substances that depress the central nervous system (alcohol, hypnotics, anticonvulsants, analgesics, etc.), sharply increase the effect of Diazepex; antacids can delay but do not decrease the absorption of diazepam; premedication with Diazepex can reduce the dose of fentanyl required to induce induction of anesthesia and shorten the time of loss of consciousness; isoniazid can slow down the excretion of diazepam, which leads to an increase in its concentration in the blood plasma; rifampicin can increase the excretion of diazepam and, as a result, lower its concentration in blood plasma.
Application features
The risk of developing addiction
If patients take tranquilizers of the benzodiazepine group for a long time or in excessively high doses, sometimes physical or mental dependence on the drug may develop. With a rapid dose reduction or sudden discontinuation of Diazepex, withdrawal syndrome may develop, which is characterized by the following symptoms: anxiety, trembling, insomnia, and in severe cases - nausea, delirium, seizures. To prevent the development of withdrawal symptoms, the drug should be discontinued by gradually decreasing the dose.
To ensure the effective and safe use of Diazepex, patients should be warned about the inadmissibility of unauthorized dose increases or discontinuation of the drug without the permission of the doctor.
Inside, i / m, i / v, rectally. The dose is calculated individually depending on the patient's condition, clinical picture of the disease, sensitivity to the drug.
As an anxiolytic drug, it is prescribed orally, 2.5-10 mg 2-4 times a day.
Psychiatry: with neuroses, hysterical or hypochondriac reactions, states of dysphoria of various origins, phobias - 5-10 mg 2-3 times a day. If necessary, the dose can be increased to 60 mg / day. With alcohol withdrawal syndrome - 10 mg 3-4 times a day in the first 24 hours, followed by a decrease to 5 mg 3-4 times a day. Elderly, weakened patients, as well as patients with atherosclerosis at the beginning of treatment - by mouth, 2 mg 2 times a day, if necessary, increase to obtain the optimal effect. Working patients are recommended to take 2.5 mg 1-2 times a day or 5 mg (main dose) in the evening.
Neurology: spastic conditions of central origin in degenerative neurological diseases - by mouth, 5-10 mg 2-3 times a day.
Cardiology and rheumatology: angina pectoris - 2-5 mg 2-3 times a day; arterial hypertension - 2-5 mg 2-3 times a day, vertebral syndrome with bed rest - 10 mg 4 times a day; as an additional drug in physiotherapy for rheumatic pelvispondyloarthritis, progressive chronic polyarthritis, arthrosis - 5 mg 1-4 times a day. As part of the complex therapy of myocardial infarction: initial dose - 10 mg / m, then inside, 5-10 mg 1-3 times a day; premedication in case of defibrillation - 10-30 mg IV slowly (in separate doses); spastic conditions of rheumatic origin, vertebral syndrome - an initial dose of 10 mg IM, then inside, 5 mg 1-4 times a day.
Obstetrics and gynecology: psychosomatic disorders, climacteric and menstrual disorders, preeclampsia - 2-5 mg 2-3 times a day. Preeclampsia - the initial dose is 10-20 mg IV, then 5-10 mg orally 3 times a day; eclampsia - during a crisis - intravenous 10-20 mg, then, if necessary, intravenous stream or drip, no more than 100 mg / day. In order to facilitate labor during the opening of the cervix by 2-3 fingers - i / m 20 mg; in case of premature birth and premature placental abruption - intramuscularly at an initial dose of 20 mg, after 1 hour, the administration of the same dose is repeated; maintenance doses - from 10 mg 4 times to 20 mg 3 times a day. With premature placental abruption, treatment is carried out without interruption - until the fetus ripens.
Anesthesiology, surgery: premedication - on the eve of the operation, in the evening - 10-20 mg orally; preparation for surgery - 1 hour before the start of anesthesia in / m adults - 10-20 mg, children - 2.5-10 mg; introduction to anesthesia - intravenous 0.2-0.5 mg / kg; for short-term narcotic sleep in complex diagnostic and therapeutic interventions in therapy and surgery - IV for adults - 10-30 mg, for children - 0.1-0.2 mg / kg.
Pediatrics: psychosomatic and reactive disorders, spastic states of central origin - prescribed with a gradual increase in the dose (starting with low doses and slowly increasing them to the optimal dose well tolerated by the patient), the daily dose (can be divided into 2-3 doses, with the main one, the largest dose, taken in the evening): inside, it is not recommended to use it for up to 6 months, from 6 months and older - 1-2.5 mg, or 40-200 μg / kg, or 1.17-6 mg / m2, 3- 4 times a day.
Inside, from 1 year to 3 years - 1 mg, from 3 to 7 years - 2 mg, from 7 years and older - 3-5 mg. Daily doses are 2, 6 and 8-10 mg, respectively.
Parenteral, status epilepticus and severe recurrent seizures: children from 30 days to 5 years - IV (slowly) 0.2-0.5 mg every 2-5 minutes up to a maximum dose of 5 mg, from 5 years and older - 1 mg every 2- 5 minutes to a maximum dose of 10 mg; if necessary, the treatment can be repeated after 2-4 hours. Muscle relaxation, tetanus: children from 30 days to 5 years old - i / m or i / v 1-2 mg, from 5 years and older - 5-10 mg, if necessary, a dose can be repeated every 3-4 hours.
For elderly and senile patients, treatment should be started with half the usual dose for adults, gradually increasing it, depending on the achieved effect and tolerance. Parenterally in case of anxiety, it is administered intravenously at an initial dose of 0.1-0.2 mg / kg, injections are repeated every 8 hours until the symptoms disappear, then they switch to oral administration.
With motor excitement, the drug is administered intramuscularly or intravenously 10-20 mg 3 times a day. With traumatic lesions of the spinal cord, accompanied by paraplegia or hemiplegia, chorea - in / m adults at an initial dose of 10-20 mg, children - 2-10 mg.
In case of status epilepticus - i / v at an initial dose of 10-20 mg, subsequently, if necessary, 20 mg i / m or i / v drip. If necessary, intravenous drip (no more than 4 ml) is diluted in 5-10% dextrose solution or 0.9% NaCl solution. To avoid precipitation of the drug, use at least 250 ml of infusion solution, quickly and thoroughly mix the resulting solution.
To relieve severe muscle spasm - intravenous once, or twice 10 mg. Tetanus: the initial dose is 0.1-0.3 mg / kg IV at intervals of 1-4 hours or as an IV infusion of 4-10 mg / kg / day
