CFT CONSULTA DIAZEPAM Nº 16.pdf

7/29/2019 CFT CONSULTA DIAZEPAM N 16.pdf

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Gobierno de la Provincia de Crdoba

Ministerio de Salud

Hospital de Nios de la Santsima Trinidad

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Comit de FarmacoteraputicaNmero N 16

Hospital de Nios de la Santsima Trinidad - Comit de Farmacoteraputica

TE: 0351-4586400 int. 606 - email: [email protected]

Datos del Solicitante

Solicitante: UTI Consulta N: 16

rea: Servicio de Enfermera Fecha: 04/05/2012

Tema de la consulta

Uso prolongado de diazepam en ttanos

Respuesta

Esta consulta se deriv al CIME, por lo que se agradece especialmente a la Facultad de CienciasQumicas de la Universidad Nacional de Crdoba, y a su excelente equipo de profesionales. En estecaso a las farmacuticas Mariana Cafaratti y Liliana Bessone, que elaboraron el presente informe queaqu se transcribe:

DIAZEPAMGold Standard/Elsevier Clinical Pharmacology [en lnea]. EEUU (Acceso restringido). Acceso: 3/05/12 Disponible en

http://www.clinicalpharmacology.com

Indications/Dosage

For the treatment of muscle spasm due to local pathology such as muscle or joint inflammation or trauma;athetosis; stiff-man syndrome; tetanus; or spasticity due to upper motor neuron diseases such as cerebral

palsy:

Oral dosage (oral solution or regular tablets):Adults: 210 mg PO three to four times per day.Geriatric: 22.5 mg PO one to two times per day, increasing the dose according to response and patienttolerability.Infants >= 6 months, Children, and Adolescents: Initially, 12.5 mg PO three to four times per day. The

dose may be increased as needed and tolerated.[28712]Neonates and Infants < 6 months: Safety and efficacy have not been established.Intravenous and Intramuscular dosage:Adults : 510 mg IM or IV initially, repeated every 34 hours as needed. For tetanus, larger doses may berequired.Children >= 5 years and Adolescents: 510 mg IM or IV every 34 hours as needed.[43931]Infants and Children < 5 years: 12 mg IM or IV every 34 hours as needed.[43931]

Neonates: Safety and efficacy have not been established.

DIAZEPAMMinisterio de Sanidad y Consumo. Informacin de Medicamentos para el Profesional Sanitario. USP-DI. 2da Edicin Espaola. Madrid. Espaa.1995
http://www.clinicalpharmacology.com/http://www.clinicalpharmacology.com/http://www.clinicalpharmacology.com/


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Dosis peditrica habitual

Coadyuvantes de relajantes del msculo esqueltico: Ttanos:

Nios de 5 aos en adelante: IM o IV, de 5 a 10 mg cada 3 4 hs, la dosificacin puede repetirse cada 3 o 4horas segn las necesidades.

DIAZEPAM

American Society of Health-System Pharmacists (ASHP) AHFS DI Monographs (on-line) EEUU Acceso: 3/05/12 Disponible en:http://www.drugs.com/monograph/Dosage

Pediatric Patients

Tetanus

IV or IMChildren >30 days to 5 years of age: 12 mg. May repeat dose every 34 hours as needed.Children >5 years of age: 510 mg. May repeat dose every 34 hours as needed.

Prescribing LimitsPediatric PatientsIVMaximum 0.25 mg/kg as a single initial dose, repeated at 15- to 30-minute intervals

to a maximum total dose of 0.75 mg/kg

_______________________________________________________________________________________

Sean C Sweetman, editor. The Complete Drug Reference. Martindale. 36th Edition. London-Chicago Pharmaceutical Press. 2009

Muscle spasm. Diazepam and other benzodiazepines may be used for the relief of

muscle spasm (p.1887) of various aetiologies including that secondary to muscle orjoint inflammation or trauma, such as in acute low back pain (p.7), or resulting from

spasticity (p.1887), dystonias (p.809), stiff-man syndrome (see below), cerebral palsy,

poisoning, or tetanus (p.1901). High doses are often required and treatment may be

limited by adverse effects or by risk of dependence.

_______________________________________________________________________________________

NEONATAL TETANUS TREATED WITH HIGH DOSAGE DIAZEPAM

B. H. KHOO, E. L. LEE, K. L. LAM. Neonatal tetanus treated with high dosage diazepamArchives of Disease in Childhood, 1978, 53, 737-739
http://www.drugs.com/monograph/http://www.drugs.com/monograph/http://www.drugs.com/monograph/


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Sedation. Muscle relaxation and sedation were achieved by continuous IV infusion of high dose diazepam(20-40 mg/kg per day) and intragastric phenobarbitone (10-15 mg/kg per day in 4 divided doses). The initialtotal daily maintenance dose of diazepam was 20 mg/kg and this could be increased gradually to a maximumof 40 mg/kg until spasms were controlled. Additional bolus injections of diazepam (5-10 mg) wereadministered if spasms were severe and frequent; but these were not given more than 4 times in 24 hours.Once spontaneous spasms had ceased for at least 48 hours, the dose of diazepam was reduced every

third day by approximately 10% of the previous dose. If dosage reduction was attempted too rapidly,spontaneous spasms recurred and subsequent control was sometimes difficult. Diazepam was given via thenasogastric tube when the spasms were controlled and nasogastric feeding had been established; this was

usually achieved after 5 to 10 days of intravenous therapy. A few patients had hiccups but these wereeffectively controlled by 2 to 5 mg IV chlorpromazine.

Discussion

The main side effects encountered with this regimen were severe drowsiness, coma, and occasionally apnoeicepisodes which were reversible when the dose of the drug was reduced. These patients tended to haveexcessive pooling of secretions in the oropharynx because the swallowing reflex was depressed, and theyrequired frequent suction. Respiratory arrest is another potential hazard, but the continuous infusion ofdiazepam did not seriously depress respiration.Renal, hepatic, and haematological functions were also unaffected.

Although diazepam forms a white precipitate when diluted with dextrose saline solutions, this does not resultin any adverse reaction nor does it reduce the therapeutic potency (Smith and Masotti, 1971). However, thesolvent of diazepam contains 5 % sodium benzoate which competes with bilirubin for the binding sites inalbumin, thus increasing the risks of hyperbilirubinaemia (Schiff et al., 1971). Hyperbilirubinaemia was not a

problem as most of our patients were term infants and more than 7 days old at admission. In this series only 3developed neonatal jaundice; the maximum total bilirubin levels reached were 8*5, 10*8, and (Case 15) 18*2mg/ 100 ml respectively. Case 15 was treated with phototherapy and serum bilirubin fell to 10*8 mg/ 100 ml4 days later; unfortunately this patient was lost to follow-up. During intravenous diazepam treatment, carewas taken to ensure that the percutaneous intravenous needle was not dislodged as skin necrosis can resultfrom subcutaneous perfusion of the drug.

LISTA DE TODAS LAS REFERENCIAS CONSULTADAS1. Okoromah CN, Lesi FEA. Diazepam para el tratamiento del ttanos (Revisin Cochrane traducida). En: La Biblioteca Cochrane Plus, 2008

Nmero 4. Oxford: Update Software Ltd. Disponible en: http://www.update-software.com. (Traducida de The Cochrane Library, 2008 Issue

3. Chichester, UK: John Wiley & Sons, Ltd.)

2. B. H. KHOO, E. L. LEE, K. L. LAM. Neonatal tetanus treated with high dosage diazepam. Archives

of Disease in Childhood, 1978, 53, 737-739

3. Sean C Sweetman, editor. The Complete Drug Reference. Martindale. 36th Edition. London-Chicago Pharmaceutical Press. 2009

4. American Society of Health-System Pharmacists (ASHP) AHFS DI Monographs (on-line) EEUU Acceso: 3/05/12 Disponible en:

http://www.drugs.com/monograph/
http://www.drugs.com/monograph/http://www.drugs.com/monograph/http://www.drugs.com/monograph/


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5. Ministerio de Sanidad y Consumo. Informacin de Medicamentos para el Profesional Sanitario. USP-DI. 2da Edicin Espaola.

Madrid. Espaa. 1995

6. Gold Standard/Elsevier Clinical Pharmacology [en lnea]. EEUU (Acceso restringido). Acceso: 3/05/12 Disponible en

http://www.clinicalpharmacology.com

Para ampliar la informacin, pueden consultar la excelente Revisin Cochrane:

Diazepam para el tratamiento del ttanos

Okoromah CN, Lesi FEA. Diazepam para el tratamiento del ttanos (Revisin Cochrane traducida). En: LaBiblioteca Cochrane Plus, 2008 Nmero 4. Oxford: Update Software Ltd. Disponible en: http://www.update-software.com. (Traducida de The Cochrane Library, 2008 Issue 3. Chichester, UK: John Wiley & Sons, Ltd.)

Para cualquier consulta o inquietud, dirigirse al Area de Produccin Cientfica. Int. 606.

[email protected]@yahoo.com.ar. Alejandra de Guernica.
http://www.clinicalpharmacology.com/http://www.clinicalpharmacology.com/mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]://www.clinicalpharmacology.com/

CFT CONSULTA DIAZEPAM Nº 16.pdf

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