Benzodiazepines and information for nurses and pharmacy students.

1. BENZODIAZEPINES Diazepam, Midazolam,
Temazepam etc.

2. WHY ?
The most common substance present in drug-induced deaths in
2018 were benzodiazepines, identified in 883 deaths (51%).
The rate of drug-induced deaths in 2018 was higher in Regional and
remote areas (7.2 per 100,000 population) compared with Major
cities (6.8 per 100,000 population).
Reference:
https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-
drugs-australia/contents/impacts/health-impacts

3. MECHANISM AND USE
Benzodiazepines potentiate the inhibitory effects of GABA throughout
the CNS, resulting in:
1) anxiolytic
2) sedative
3) hypnotic
4) muscle relaxant
5) antiepileptic effects.

4. Reference: Australian Medicines Handbook

5. DIAZEPAM
Indications
Short-term management of anxiety, agitation
Acute alcohol withdrawal
Muscle spasm or spasticity
Premedication
Procedural sedation (see Practice points below)
Status epilepticus
Accepted
Benzodiazepine withdrawal
Acute behavioural disturbance

6. diazepam 20 mg orally, every 2 hours until
symptoms subside. A cumulative dose of 60 mg
daily is usually adequate.
Do not exceed 100 mg daily without seeking specialist advice.
Acute alcohol withdrawal
Anxiety, agitation
Oral, 2–5 mg as a single dose. Dose may be
repeated, if necessary, up to a maximum of 10 mg
daily. (Maximum 30mg for acute severe anxiety,
agitation, behaviour disturbance)
Dosage – Diazepam

7. MIDAZOLAM
Indications
Procedural sedation
Induction of anaesthesia
Sedation during ventilation
Premedication
Accepted
Status epilepticus

8. Dosage – Midazolam
Conscious sedation. Endoscopic or cardiovascular procedures. the initial dose is approximately 2.5 mg,
Total doses greater than 3.5 mg are not usually necessary.
Induction of anaesthesia. 0.15-0.2 mg/kg (10-15 mg), administered at a rate of approximately 2.5 mg/10 se
Intravenous sedation in intensive care units (ICU). the recommended infusion rate is 0.03-0.2 mg/kg/hour.
Dilution and admixture. Hypnovel may be mixed in
the same syringe with frequently used premedicants:
morphine sulphate, pethidine, atropine sulphate or
scopolamine. Hypnovel is compatible with normal
saline, glucose 5% and 10% in water, fructose IV
infusion (levulose 5%), potassium chloride, sodium
chloride and calcium chloride IV infusion (Ringer's
solution) and compound sodium lactate IV infusion
(Hartmann's solution).
Onset of clinical effect may be delayed; there is a danger of
overdosage if midazolam is given rapidly without waiting to
assess its effects.
Reference: Australian Medicines Handbook

9. TEMAZEPAM
Indications
Short-term treatment of insomnia
Dosage – Temazepam
Adult: Oral, 10–20 mg at night.
Elderly: Oral, 5–10 mg at night.
Reference: Australian Medicines Handbook

10. PRACTICE POINTS
Reserve for short-term (2–4 weeks) or intermittent use only; they
should be part of a broader treatment plan, not a first or sole
treatment
Benzodiazepines are occasionally used short term (up to 2 weeks) to
manage agitation or insomnia when starting antidepressants (eg in
panic disorder)
Benzodiazepines are sometimes misused for their euphoric and
sedative effects, both alone and with other drugs
Some data suggest that cognitive dysfunction associated with long-
term use may not be fully reversible
Reference: Australian Medicines Handbook

11. WITHDRAWAL SYMPTOMS
Suddenly stopping treatment (or reducing or tapering the dose too
quickly) in dependent people may produce withdrawal symptoms,
including anxiety, dysphoria, irritability, insomnia, nightmares,
sweating, memory impairment, hallucinations, hypertension,
tachycardia, psychosis, tremors and seizures
After stopping short-acting benzodiazepines, eg alprazolam, these
may occur within a few hours; for those that are longer acting, eg
diazepam, they may take days or weeks; they can last for several
weeks or longer after prolonged use
Reference: Australian Medicines Handbook