디아제팜
Diazepam
7-chloro-1-methyl-5-phenyl-1,3-dihydro-2H-1,4-benzodiazepin-2-one
다른 이름: Valium · Diastat · Diazepam Intensol · Diazedor · Diazemuls · Stesolid · Diazepam Rectubes · diazepamum · LA-III · NSC-77518 · Ro5-2807
VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료
감사 완료 v13 용량 근거
검토된 비계산 근거검토된 비계산 근거 (1)
근거 표시 전용 — 자동 계산 불가
Persistent seizures during an insulinoma hypoglycemic crisis despite IV dextrose
Diazepam if seizures persist despite IV dextrose
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
개요
디아제팜은 항불안, 근육 이완, 최면, 식욕 촉진 및 항경련 특성으로 수의학에서 널리 사용되는 고전적이고 지속 시간이 긴 벤조디아제핀계 유도체입니다.
임상 요점:
- 발작 관리: 디아제팜은 뇌전증 지속상태(status epilepticus) 및 군발 발작의 응급 치료를 위한 1차 선택약입니다. 그러나 작용 시간이 짧고 내성이 빠르게 발생하기 때문에 개에서 장기적인 유지 항경련제로는 일반적으로 효과적이지 않습니다.
- 고양이 주의사항: 고양이에서는 내성 문제가 덜하지만, 특이 체질에 의한 치명적인 전격성 간괴사 위험이 있어 경구 투여는 매우 논란이 많습니다.
- 제형 특징: 주사제에는 프로필렌 글리콜이 포함되어 있어 정맥으로 너무 빠르게 투여할 경우 저혈압, 서맥 및 심장 독성을 유발할 수 있습니다. 또한 PVC 플라스틱에 쉽게 흡착되므로 플라스틱 주사기에 보관하거나 표준 수액 백을 통한 장시간 투여에는 적합하지 않습니다.
작용 기전
Diazepam exerts its effects by binding to specific allosteric sites on GABA-A receptors in the central nervous system (primarily in the limbic system, thalamus, and hypothalamus).
- Binding to the benzodiazepine site → enhances the affinity of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) for its receptor.
- This facilitation → increases the frequency of chloride channel opening → influx of chloride ions → neuronal hyperpolarization.
- The resulting hyperpolarization leads to profound CNS depression, producing anxiolytic, sedative, muscle relaxant, and anticonvulsant effects.
안전성·주의사항
금기사항
- Known hypersensitivity to benzodiazepines
- Cats exposed to chlorpyrifos (potentiates organophosphate toxicity)
- Significant liver disease (especially in cats)
- Intra-carotid artery injections (must be strictly avoided)
- CNS depression
- Respiratory depression
- Severe muscle weakness
- Hepatic impairment (may worsen hepatic encephalopathy)
- Long-term treatment of behavioural disorders (due to risks of disinhibition and interference with memory/learning)
부작용
- Sedation and ataxia (most common)
- Dogs: Paradoxical CNS excitement/agitation (especially at doses >0.8 mg/kg)
- Dogs: Increased appetite
- Cats: Idiosyncratic hepatic failure (with oral use)
- Cats: Behavior changes (irritability, depression, aberrant demeanor)
- Horses: Muscle fasciculations, weakness, ataxia, recumbency (at doses >0.2 mg/kg)
- Hypotension and phlebitis (with rapid IV injection)
- Muscle weakness
- Paradoxical excitation and aggression (especially with rapid IV injection or oral overdose in dogs)
- Pain and erratic absorption (IM injection)
- Fulminant hepatic necrosis (cats, repeated oral dosing)
- Thrombophlebitis (associated with propylene glycol injectable formulations)
주의
Intravenous Administration: Inject IV slowly (over 1-3 minutes). Rapid injection, especially in small animals or neonates, may cause hypotension or cardiotoxicity secondary to the propylene glycol vehicle. Flush the IV catheter with fluids after administration to help prevent thrombophlebitis.
Feline Hepatotoxicity: Use in cats is controversial due to reports of serious, potentially fatal idiosyncratic hepatotoxicity associated with oral administration. Baseline and follow-up liver function tests are strongly recommended if used.
- Patient Selection: Use cautiously in patients with hepatic or renal disease, debilitated or geriatric patients, and those in coma, shock, or with significant respiratory depression.
- Behavioral Disinhibition: Use very cautiously in aggressive patients, as it may disinhibit anxiety that normally suppresses aggressive behavior.
- Working Animals: May impair the abilities of working animals.
- Toxicity Treatment: Do not use to treat paradoxical CNS stimulation caused by human sleep aids (zolpidem, eszopiclone); use phenothiazines or phenobarbital instead.
- Pregnancy: May be teratogenic (FDA Category D). Use during the first trimester only if benefits clearly outweigh risks.
약물 상호작용
May increase diazepam levels
May decrease oral diazepam absorption
May increase diazepam levels by inhibiting metabolism
May decrease metabolism of benzodiazepines
Additive CNS depression effects may occur
May decrease diazepam levels
Diazepam may increase digoxin levels
May decrease the metabolism of benzodiazepines
May decrease oral diazepam absorption
May inhibit the metabolism of diazepam and increase levels
May decrease diazepam concentrations
May decrease diazepam concentrations
May increase diazepam levels
May induce hepatic microsomal enzymes and decrease the pharmacologic effects of benzodiazepines
Enhanced sedative effect
Enhanced sedative effect
Diazepam reduces the dose requirement of other anaesthetic agents
Can be used in combination for management of severe behavioural responses
Reverses the effects of diazepam (benzodiazepine antagonist)
모니터링
- Horses should be observed carefully after receiving this drug.
- Cats receiving oral diazepam must have baseline liver function tests. Repeat and discontinue drug if emesis, lethargy, inappetence, or ataxia develop.
- When used for seizure control in cats, obtain serum levels 5 days after beginning therapy (therapeutic goal: 200-700 ng/mL or 2500-700 nmol/L).
- Hepatic function (especially in cats)
- Respiratory rate and effort
- Level of CNS depression / sedation
- Seizure activity
약동학
반감기
흡수
Rapidly absorbed following oral administration (peak plasma levels within 30 mins to 2 hours). Slowly and incompletely absorbed following IM administration. Rectal bioavailability in dogs is <10% for parent drug, but ~80% when factoring in active metabolites. Intranasal bioavailability in dogs is ~80%.
분포
Highly lipid soluble and widely distributed throughout the body. Readily crosses the blood-brain barrier. Highly bound to plasma proteins (87% in horses, 98-99% in humans).
대사
Metabolized in the liver to several pharmacologically active metabolites, including desmethyldiazepam (nordiazepam), temazepam, and oxazepam.
배설
Metabolites are conjugated with glucuronide and eliminated primarily in the urine.
과다투여
When administered alone, diazepam overdoses are generally limited to significant CNS depression (confusion, coma, decreased reflexes, etc.). Hypotension, respiratory depression, and cardiac arrest have been reported in human patients, but are quite rare.
Treatment:
- Standard protocols for removing and/or binding the drug in the gut if taken orally (e.g., emesis, activated charcoal).
- Supportive systemic measures (fluids, respiratory support if needed).
- The use of analeptic agents (CNS stimulants like caffeine) is generally not recommended.
- Flumazenil (a specific benzodiazepine antagonist) may be considered for adjunctive treatment of severe overdoses.
제품
제형
- Oral tablets
- Oral solution
- Injectable solution
- Rectal gel
- Injectable: 5 mg/ml emulsion (e.g., Diazemuls)
- Oral: 2 mg, 5 mg, 10 mg tablets
- Oral: 2 mg/5 ml solution
- Rectal: 2 mg/ml and 4 mg/ml solutions
- Rectal: 10 mg suppositories
동물용의약품
- None (No veterinary-labeled products available)
- Diazedor
- Diazemuls
- Diazepam Rectubes
인용의약품
- Diazepam Oral Tablets: 2 mg, 5 mg, & 10 mg (Valium, generic)
- Diazepam Oral Solution: 1 mg/mL and 5 mg/mL (Diazepam Intensol)
- Diazepam Injection: 5 mg/mL
- Diazepam Rectal Gel: 2.5 mg, 10 mg, & 20 mg (Diastat)
- Stesolid
규제 현황
POM-V, POM
POM-V, POM
규제 데이터 없음: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
보관·안정성
Store all products at room temperature (15°-30°C). Protect injection from freezing and light. Protect oral forms from light. Important: Diazepam adsorbs to plastic; do not store drawn up in plastic syringes or administer through PVC IV bags/tubing for prolonged periods.
보호자 정보
- 보관: 어린이와 다른 반려동물의 손이 닿지 않는 곳에 보관하십시오. 단단히 닫힌 용기에 보관하십시오. 이 약물은 향정신성의약품(통제 약물)입니다.
- 투여: 처방된 대로 정확하게 투여하십시오. 집에서 발작을 위해 직장으로 투여하는 경우, 수의사의 안전한 투여 방법 지시를 주의 깊게 따르십시오.
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고양이에 대한 중요 경고: 고양이가 이 약을 복용하는 동안 식욕 부진, 구토를 보이거나 눈의 흰자위나 잇몸이 노랗게 변하는(황달) 증상이 나타나면 즉시 투약을 중단하고 즉시 수의사에게 연락하십시오. 이는 심각한 간 손상의 징후일 수 있습니다.
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