Per policy, these medications require cardiac and/or special monitoring. (KEY: "Y" = may be given as described on chart. "N" = may NOT be given except in Rapid Response/Code Blue situations or as otherwise described in Exceptions section of Policy.
generic (Brand) / Notes
CCU, OR, PACU, CCL, ED
PCU
2N (Tele)
1N (Tele), 3N (Tele)
Med/Surg (1N w/o Tele, 3N w/o Tele, 4N, 5N)
BirthPlace
SNF
ICS
OPS
diazePAM (Valium) IV Push not for sedation
Y
Y
Y
Y
Y
Y
Y
Y
Y
diazePAM (Valium) IV Push sedation / analgesia by non-ANES personnel Key: designated staff
Y
N
N
N
N
N
N
N
N
Available ED To-Go medications.
Description (Qty)
diazePAM (Valium) 5 mg tablets (#4)
Adult Extravasation Management
diazePAM (Diastat AcuDial, Valium)
Agent type:
Non-Chemotherapeutic
Vesicant/Irritant:
Vesicant
Local Care:
Cold or warm compress
Antidote:
No known antidote
Enteral Drug Administration notes.
Generic (Brand)
Comments and Considerations
Recommendations for Administration with Enteral Nutrition
diazePAM (Valium)
Commercially available solution has lower bioavailability due to binding with NG tubing
Suggest using diazepam tablets instead of solution.
2023 American Geriatrics Society Beers Criteria® for potentially inappropriate medication use in older adults.
Medication:
diazePAM (Valium)
Criteria 1: Potentially inappropriate medication use in older adults. (Table 2)
Drug(s)
benzodiazepines
Rationale
The use of benzodiazepines exposes users to risks of abuse, misuse, and addiction. Concomitant use of opioids may result in profound sedation, respiratory depression, coma, and death. Older adults have increased sensitivity to benzodiazepines and decreased metabolism of long-acting agents; the continued use of benzodiazepines may lead to clinically significant physical dependence. In general, all benzodiazepines increase the risk of cognitive impairment, delirium, falls, fractures, and motor vehicle crashes in older adults. May be appropriate for seizure disorders, rapid eye movement sleep behavior disorder, benzodiazepine withdrawal, ethanol withdrawal, severe generalized anxiety disorder, and periprocedural anesthesia.
Recommendation
Avoid
Quality of evidence: Moderate, Strength of Recommendation: Strong
Criteria 2: Potentially inappropriate medication use in older adults due to drug–disease or drug–syndrome interactions that may exacerbate the disease or syndrome. (Table 3)
Drug(s) ⇆ disease or syndrome
benzodiazepines ⇄ Delirium
Rationale
Avoid in older adults with or at high risk of delirium because of the potential of inducing or worsening delirium.
Recommendation
Avoid
Quality of evidence: Moderate, Strength of Recommendation: Strong
Drug(s) ⇆ disease or syndrome
benzodiazepines ⇄ Dementia or cognitive impairment
Rationale
Avoid because of adverse CNS effects.
Recommendation
Avoid
Quality of evidence: Moderate, Strength of Recommendation: Strong
Drug(s) ⇆ disease or syndrome
antiepileptics ⇄ History of falls or fractures
Rationale
May cause ataxia, impaired psychomotor function, syncope, or additional falls. If one of the drugs must be used, consider reducing the use of other CNS-active medications that increase the risk of falls and fractures. (i.e., anticholinergics, selected antidepressants, antiepileptics, antipsychotics, sedative/hypnotics including benzodiazepines and, Nonbenzodiazepine benzodiazepine receptor agonist hypnotics, opioids) and implement other strategies to reduce fall risk.
Recommendation
Avoid except for seizures and mood disorders.
Quality of evidence: High, Strength of Recommendation: Strong
Drug(s) ⇆ disease or syndrome
benzodiazepines ⇄ History of falls or fractures
Rationale
May cause ataxia, impaired psychomotor function, syncope, or additional falls. Benzodiazepines: shorter-acting ones are not safer than long-acting ones. If one of the drugs must be used, consider reducing the use of other CNS-active medications that increase the risk of falls and fractures. (i.e., anticholinergics, selected antidepressants, antiepileptics, antipsychotics, sedative/hypnotics including benzodiazepines and, Nonbenzodiazepine benzodiazepine receptor agonist hypnotics, opioids) and implement other strategies to reduce fall risk.
Recommendation
Avoid unless safer alternatives are not available.
Quality of evidence: High, Strength of Recommendation: Strong
Criteria 4: Potentially clinically important drug-drug interactions that should be avoided in older adults. (Table 5)
Interacting drug(s) or class(es)
skeletal muscle relaxants ⇄ CNS-active agents
Risk Rationale
Increased risk of falls and of fracture with the concurrent use of ≥3 CNS-active agents (antiepileptics including gabapentinoids, antidepressants, antipsychotics, benzodiazepines, Nonbenzodiazepine benzodiazepine receptor agonist hypnotics, opioids, and skeletal muscle relaxants).
Recommendation
Avoid concurrent use of ≥3 CNS-active drugs Click for list; minimize the number of CNS-active drugs.
Quality of evidence: High, Strength of Recommendation: Strong
Interacting drug(s) or class(es)
benzodiazepines ⇄ CNS-active agents
Risk Rationale
Increased risk of falls and of fracture with the concurrent use of ≥3 CNS-active agents (antiepileptics including gabapentinoids, antidepressants, antipsychotics, benzodiazepines, Nonbenzodiazepine benzodiazepine receptor agonist hypnotics, opioids, and skeletal muscle relaxants).
Recommendation
Avoid concurrent use of ≥3 CNS-active drugs Click for list; minimize the number of CNS-active drugs.
Quality of evidence: High, Strength of Recommendation: Strong
Increased risk of falls and of fracture with the concurrent use of ≥3 CNS-active agents (antiepileptics including gabapentinoids, antidepressants, antipsychotics, benzodiazepines, Nonbenzodiazepine benzodiazepine receptor agonist hypnotics, opioids, and skeletal muscle relaxants).
Recommendation
Avoid concurrent use of ≥3 CNS-active drugs Click for list; minimize the number of CNS-active drugs.
Quality of evidence: High, Strength of Recommendation: Strong
(KEY: "Y" = may be given as described on chart. "N" = may NOT be given except in Rapid Response/Code Blue situations or as otherwise described in Exceptions section of Policy.
IV Push not for sedation
IV Push sedation / analgesia by non-ANES personnel Key: designated staff
(Brand)
(Valium)
Older adults have increased sensitivity to benzodiazepines and decreased metabolism of long-acting agents; the continued use of benzodiazepines may lead to clinically significant physical dependence. In general, all benzodiazepines increase the risk of cognitive impairment, delirium, falls, fractures, and motor vehicle crashes in older adults.
May be appropriate for seizure disorders, rapid eye movement sleep behavior disorder, benzodiazepine withdrawal, ethanol withdrawal, severe generalized anxiety disorder, and periprocedural anesthesia.
Benzodiazepines: shorter-acting ones are not safer than long-acting ones.
If one of the drugs must be used, consider reducing the use of other CNS-active medications that increase the risk of falls and fractures. (i.e., anticholinergics, selected antidepressants, antiepileptics, antipsychotics, sedative/hypnotics including benzodiazepines and, Nonbenzodiazepine benzodiazepine receptor agonist hypnotics, opioids) and implement other strategies to reduce fall risk.