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## Overview
Mylotat is a brand name for diazepam, a benzodiazepine medication.
## Primary Indications
* Anxiety disorders
* Short-term relief of anxiety symptoms
* Seizures (adjunct therapy)
* Muscle spasms
* Alcohol withdrawal syndrome
## Adult Dosing
* **Anxiety:** 2-10 mg orally 2-4 times daily. Maximum: Generally 30 mg/day, but higher doses may be used short-term under medical supervision.
* **Seizures:** Rectal gel: 0.2 mg/kg.
* **Muscle Spasms:** 2-10 mg orally 2-4 times daily.
* **Alcohol Withdrawal:** 10 mg orally or IM initially, then 5-10 mg every 3-4 hours as needed.
## Pediatric Dosing
* **Anxiety:** Generally not recommended for children under 6 months. For children 6 months and older, doses vary widely based on indication and specific situation.
* **Seizures:** Rectal gel: Age 2-5 years: 0.5 mg/kg. Age 5-10 years: 0.3 mg/kg. Age 10-12 years: 0.2 mg/kg.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution and consider lower doses.
* **Renal Impairment:** Dose adjustments are generally not required unless severe.
## Contraindications
* Hypersensitivity to benzodiazepines
* Acute narrow-angle glaucoma
* Myasthenia gravis
* Severe respiratory insufficiency
* Severe hepatic insufficiency
* Sleep apnea syndrome
## Adverse Effects
* **Common:** Drowsiness, fatigue, dizziness, muscle weakness, ataxia.
* **Serious:** Respiratory depression, paradoxical reactions (agitation, hallucinations), dependence, withdrawal symptoms, anterograde amnesia.
## Key Drug Interactions
* **CNS Depressants (e.g., opioids, alcohol, other sedatives):** Increased risk of sedation, respiratory depression, and death.
* **CYP3A4 Inhibitors (e.g., ketoconazole, itraconazole):** May increase diazepam levels.
* **CYP3A4 Inducers (e.g., rifampin):** May decrease diazepam levels.
* **Theophylline/Aminophylline:** May antagonize sedative effects of diazepam.
## Monitoring
* Sedation, respiratory rate, and mental status.
* Signs of dependence and withdrawal if used long-term.
* Liver function tests in patients with hepatic impairment.
## Clinical Pearls
* Use the lowest effective dose for the shortest possible duration.
* Risk of dependence increases with duration of use and higher doses.
* Avoid abrupt discontinuation; taper dose gradually.
* Diazepam has a long half-life, which can lead to accumulation, especially in the elderly or those with hepatic impairment.
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*This information is intended for clinical use and does not replace the official prescribing information or professional judgment. Always verify current prescribing information with the manufacturer's approved labeling.*
