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Benzodiazepines - Coggle Diagram

- - - - Absorption
        
        Oral: Well absorbed (>90%); delayed and decreased when administered with a moderate fat meal
        Rectal: Well absorbed
      - Distribution
        
        Vd: Intranasal: 0.8 to 1 L/kg; IV: 1.2 L/kg (range: 0.6 to 2 L/kg) (Greenblatt 1989a); Oral: 1.1 L/kg (range: 0.6 to 1.8 L/kg (Greenblatt 1989b); Rectal: 1 L/kg.
    - - Hepatic; diazepam is N-demethylated by CYP3A4 and 2C19 to the active metabolite N-desmethyldiazepam, and is hydroxylated by CYP3A4 to the active metabolite temazepam. N-desmethyldiazepam and temazepam are both further metabolized to oxazepam. Temazepam and oxazepam are largely eliminated by glucuronidation.
    - - Urine (predominantly as glucuronide conjugates)
    - - Premature neonates (GA: 28 to 34 weeks): 54 hours.
        
        Infants: ~30 hours (Morselli 1973).
        
        Children 3 to 8 years: 18 hours (Morselli 1973).
        
        Adults: Parent: ~60 to 72 hours; Desmethyldiazepam: ~152 to 174 hours (Lamson 2011).
        
        Intranasal: ~49 hours.
        
        IV: Parent: 33 to 45 hours; Desmethyldiazepam: 87 hours (Cloyd 1998; Greenblatt 1989a).
        
        Oral: Parent: 44 to 48 hours; Desmethyldiazepam: 100 hours (Greenblatt 1989b).
        
        Rectal: Parent: 45 to 46 hours; Desmethyldiazepam: 71 to 99 hours (Cloyd 1998).
  - - - • It is used to relax muscles.
        • It is used to treat alcohol withdrawal.
        • It is used to treat anxiety.
        • It is used to help control certain kinds of seizures.
        •Avoid drinking alcohol while taking this drug.
        
        Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
        •take a missed dose as soon as you remember.
        •If it is close to the time for the next dose, skip the missed dose and go back to normal time.
        May cause dependence; risks/symptoms of misuse and abuse
- - - - Debilitated patients: Use with caution in debilitated patients; initial doses should be at the lower end of dosing range.
      - Elderly patients: Elderly patients may be at an increased risk of death with use; risk has been found highest within the first 4 months of use in elderly dementia patients.
      - Fall risk: Use with extreme caution in patients who are at risk of falls; benzodiazepines have been associated with falls and traumatic injury.