Valpam

Composition: Ampoule:     Each ampoule (2ml) contains diazepam 10mg.
Syrup:         Each teaspoonful (5ml) contains diazepam 2mg.
Tablets:     Each tablet contains diazepam.2mg or 5mg.

Properties: Diazepam (Valpam®) is a Bezodiazepine with anti-convulsant, anxiolytic, sedative, muscle relaxant and amnestic properties. Diazepam is extensively metabolized in the liver into active metabolites such as desmethyldiazepam (nordazepam), oxazepam and temazepam.  Diazepam is excreted in the urine, mainly in the form of its metabolites, either free or in conjugated form.  The peak serum concentrations are attained after 25 minutes and 0.5-1.5 hours following I.V. and I.M. injections respectively. Diazepam, unlike major tranquilizers, has no demonstrable peripheral autonomic blocking action, nor does it produce extra-pyramidal side effects. Diazepam crosses the blood brain barrier and is highly lipid soluble.  These properties qualify it for intravenous use in short-term anesthetic procedures since it acts promptly on the brain and its initial effects decreases rapidly as it is redistributed into fat depots and tissues.

Indications: As an Anxiolytic:
-    Short-term relief to anxiety symptoms
-    Tension and agitations.
-    Cardiac disorders and myocardial infarction.

As a Pre-medication:
-    Anesthetic procedure
-    Minor gynecological and surgical operations
-    All sorts of endoscopy
-    Cardiac catheterization
-    Cardioversion

As a Short-Term Anesthetic:
-    Extraction of impacted wisdom tooth  
-    Closed reduction of fractures

As an Anticonvulsant and Muscle Relaxant:
-    Eclampsia and pre-eclampsia
-    Febrile seizure prophylaxis
-    Status epilepticus and severe recurrent convulsive seizures.
-    Muscle spasticity associated with cerebral palsy, athetosis or tetanus.

In Acute Alcohol or Drug Withdrawal.

Contra-Indictions: Hypersensitivity to the drug.

Adverse Effects:=    Like all other benzodiazepines, diazepam may cause drowsiness, fatigue, headache, blurring of vision or skin rash.
=    If injected rapidly, pain, venous thrombosis or phlebitis may occur at the site of injection.

N.B.
=    Diazepam should be injected slowly taking at least one minute for each 5mg given to reduce the possibility of venous thrombosis, phlebitis, local irritation and swelling.
=    Diazepam is not injected in the small veins such as those on the dorsum of the hand or wrist.
=    Diazepam should not be mixed with other drugs in syringe or infusion flask.

Dosage & Administration: Ampoules:
Infants Over 30 Days of Age Till 5 Years:
-    Status epilepticus: 0.2-0.5mg slowly every 2-5 minutes up to a maximum dose of 5mg.
-    Muscle spasm and tetanus: 1-2mg. slowly, repeated every 3-4 hours if necessary.

Children Over 5 Years:
-    Status epilepticus: 1mg. every 2-5 minutes up to a maximum dose of 10mg.
-    Muscle spasm and tetanus: 5-10mg repeated every 3-4 hours.

Older Children and Adults:
-    The usual recommended dose ranges from 2-20mg by slow I.m. or I.V. injection, depending on the indication and its severity.
-    For endoscopic and anesthetic procedures or status epilepticus: 10mg by slow I.M. or I.V. injection, up to 30mg.

Syrup:
Infants Over 30 Days of Age Till 5 Years:
-    Symptomatic relief of anxiety, sedation, muscle relaxant: 1/4 to 1/2 teaspoonful, 3 times daily; until the attacks are controlled.
-    Febrile Seizure prophylaxis: 1/2 -1 teaspoonful, 3 times daily for 2-3 days.

Children Over 5 Years:
-    Symptomatic relief of anxiety, sedation, and muscle relaxant: 1-11/2 teaspoonful, 3 times daily; until the seizures are controlled.
-    Febrile Seizure prophylaxis: 11/2 to 2 teaspoonfuls, 3 times daily for 2-3 days.

Tablets:
Adults:  2-10mg, 2-3 times daily.
Geriatric or debilitated patients: 2-2.5mg, 1-2 times daily.
Children: 1-5mg daily or as prescribed by the physician.

Withdrawal Protocol:
Diazepam can be withdrawn in steps of about one-eighth (range one-tenth to one-quarter) of the daily dose every fortnight.

A suggested withdrawal protocol for patients who have difficulty is as follows:
1.    Transfer patient to equivalent daily dose of diazepam preferably taken at night
2.    Reduce Diazepam dose in fortnightly steps of 2 or 2.5mg.  If withdrawal symptoms occur, maintain this dose until symptoms improve.
3.    Reduce dose further, if necessary in smaller fortnightly steps.  It is preferable to reduce slowly rather than too quickly.
4.    Stop completely.  Time needed for withdrawal can vary from about 4 weeks to a year or more.

How supplied: Ampoules:     Packs of 3 ampoules
Tablets:     Strips of 10 tablets 2mg or 5mg
Syrup:         Bottles of 120ml.

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