For treatment of seizures:
a) For cluster seizures or status epilepticus (for client treatment at home): 0.5 mg/kg rectally; if on phenobarbital, use diazepam at 2 mg/kg (using diazepam parenteral solution) per rectum. Administer at the onset of seizure and up to 3 times in a 24-hour period, but should not be given within 10 minutes of the prior dose. Owners should stay with dog for one hour after administration. (Podell 2000), (Podell 2006), (Podell 2009)
b) For cluster seizures (for client treatment at home): 1 mg/kg administered rectally at the onset of seizures; can be given up to 3 times over a 24 hour period. Dogs receiving phenobarbital should receive 2 mg/kg. Because diazepam is inactivated by light and adheres to plastic, it is best to dispense the drug in the original glass vial and instruct the owner to draw the required amount into a syringe when needed. A rubber catheter or teat cannula is then placed on the syringe for rectal administration. (Munana 2010)
c) For refractory status epilepticus using constant rate IV infusion: 0.1– 0.5 mg/kg diluted in D5W. Rate administered per hour should be equal to the maintenance fluid requirement for the patient. Use with caution as diazepam can crystallize in solution and adsorb to PVC tubing. For status or cluster seizure treatment at home: 0.5–2 mg/kg per rectum (Platt & McDonnell 2000)
d) For status epilepticus: Rule out hypoglycemia, electrolyte abnormalities as primary cause. Stop seizure with diazepam or midazolam 0.5–1 mg/kg IV, 1–2 mg/kg rectally or IV if patient on phenobarbital. Place IV catheter and initiate active cooling if necessary. If another seizure occurs, repeat IV diazepam or midazolam. Administer a long-acting anticonvulsant (e.g., phenobarbital at 5–8 mg/kg IV every 4– 6h until seizures are under control regardless of additional therapy). If patient still has seizure activity, consider one or more of the following: 1) continuous rate infusion of diazepam or midazolam, 2) propofol or other means of anesthesia. (Knipe 2006), (Knipe 2009)
e) For status epilepticus: 0.5 mg/kg IV, intranasally or rectally. Dose may be repeated twice, if necessary. Anticonvulsant activity lasts only 15–30 minutes so a longer acting therapy is required if seizures stop. For at home therapy for cluster seizures, diazepam may be given rectally or intranasally at 0.5 mg/kg. Dogs who are on chronic phenobarbital therapy, may require higher doses (1–2 mg/kg). (Mariani 2010b)
Functional urethral obstruction/urethral sphincter hypertonus:
a) 2–10 mg q8h (Polzin and Osborne 1985); (Lane 2000)
b) 2–10 mg PO three times a day; 0.5 mg/kg IV (Chew et al. 1986)
c) 0.2 mg/kg PO q8h or 2–10 mg (total dose) PO q8h (Bartges 2003)
As a psychotherapeutic agent (e.g., situational anxiety):
a) 0.55–2.2 mg/kg PO q8-12h (Haug 2008)
b) 0.5–2.2 mg/kg prn for storms (Sherman & Mills 2008)
c) As a fast-acting anxiolytic: 0.5–2 mg/kg PO prn (Neilson 2009)
For adjunctive treatment of metronidazole toxicity (CNS):
a) Doses of diazepam averaged 0.43 mg/kg in the study and were given as
an IV bolus once, and then PO q8h for 3 days. (Evans et al. 2002)