Inclusion of Valium on Code Cart and Guidelines: Q&A With Sheldon Sones of Sheldon S. Sones and Associates

Sheldon S. Sones, RPh, FASCP, is president of Sheldon S. Sones and Associates, a pharmacy and accreditation consulting firm based in Newington, Conn.

Q: Should we have Valium (diazepam) on the code cart and if so, what are the key guidelines?

Sheldon Sones: While most of my facilities have agreed that having diazepam on the code cart is a wise formulary addition, about one-third of the facilities do not maintain it as such.

While lorazepam is regarded as a drug of choice (due to its longer action) for status epilepticus, diazepam remains a wise choice (lorazepam has to be refrigerated and is usually not available in most facilities). We have seen two recent events calling for diazepam. I recommend it for review for inclusion at your medical staff meeting.

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Note: As with midazolam, last month this product was experiencing extremely short supply.

Some guidelines:

• Do not add a second drug to the same syringe
• Diazepam: Push at about 5 mg/ minute; Lorazepam: 2 mg/min
• Too rapid administration may lead to hypotension and respiratory depression
• Dose: Diazepam = 0.2 mg/kg
• Dose: Lorazepam = 0.1 mg/kg

Learn more about Sheldon S. Sones and Associates at www.sheldonsones.com.

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