Benzodiazepine | Oral dose*¶ | Initial parenteral dose*¶ | Onset (minutes) |
Alprazolam | 0.5 mg | Not available | Oral: 15 to 30 (delayed with high fat meal) |
Diazepam | 2 to 10 mg | 0.03 to 0.1 mg/kg intravenous (2 to 10 mg per dose)Δ | Oral: 15 Intravenous: 2 to 5 |
Lorazepam | 1 to 2 mg | 0.02 to 0.04 mg/kg intravenous (1 to 4 mg per dose) | Oral: 15 to 30 Intravenous: ≤10 to 15 |
Midazolam | 7.5 mg◊[1,2] (intranasal dosing is provided in footnote§) | 0.01 to 0.02 mg/kg intravenous (0.5 to 2 mg per dose) | Oral: 10 to 20 Intranasal: ≤5 Intravenous: 1 to 3 |
Oxazepam | 15 to 30 mg | Not available | Oral: 60 to 120 |
Temazepam | 15 to 30 mg | Not available | Oral: 30 to 60 |
* Individualization of dose: In most adults, a standard (non-weight based) dose at the lower end to middle of dose range shown in table is appropriate. However, patients with regular benzodiazepine or alcohol use leading to tolerance may need a dose in the upper end of the range. Approximately 50% reduction of dose is needed for older (>60 years) or debilitated adults, patients with low cardiac output, or those premedicated with opioid analgesics. If intravenous administration is used, a slow rate of administration (eg over 2 to 5 minutes or more) with frequent assessments of cardiorespiratory and sedative effects is recommended. In patients with obesity, standard, non-weight-based initial dosing is preferred. Standard adult doses are shown in parentheses following intravenous weight-based doses.
¶ Repeated dose(s) usually equal to one-half of initial dose may be needed 30 to 60 minutes after oral administration or 5 to 30 minutes after intravenous administration, based upon response and duration of procedure.
Δ Administer by slow intravenous push in a relatively large vein.
◊ In the United States, oral midazolam is available as a syrup approved for use in pediatric patients; use in adult patients is off-label. Oral tablets are available elsewhere in the world; refer to local product information for approved uses.
§ Midazolam injection solution (5 mg/mL) may be administered intranasally at a dose of 1 to 4 mg[3]. The injection solution is irritating to nasal passages.Courtesy of the authors.
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