Thrombophlebitis After Intravenous Diazepam???Can It Be Prevented?

Abstract

Although pain and subsequent thrombophlebitis are complications in patients receiving intravenous (IV) diazepam, the mechanism and accompanying histology are unknown. To further elucidate the pathogenesis for this and determine whether it can be minimized, adult female rats received IV diazepam, diazepam vehicle, lidocaine, a combination of lidocaine and diazepam, or N saline solution, and underwent subsequent tissue light microscopy. Vascular tissue from animals receiving IV diazepam alone revealed marked inflammation with inflammatory edema and intramural polymorphonuclear-cell infiltration. Intravascular thrombosis and complete vein-wall destruction were also present in some animals as early as 48 hours after IV diazepam. Diazepam vehicle and diluted diazepam produced similar morphologic alterations. Lidocaine or saline IV resulted in no histologic alterations, while lidocaine added to diazepam did not reduce the inflammatory response. These results represent the first systematic morphologic evaluation of vein response to intravascular diazepam and suggest that it produces rapid and detrimental morphologic alterations. The dilution of diazepam or combination with lidocaine does not appear to alter these findings, and diazepam vehicle appears to assume a role in the production of the vascular injury.

Fat Emulsion as a Vechicle for Diazepam. A Study of 9492 Patients

“…These complications have been attributed to the solvent. Graham, Pagano and Katz (1977) demonstrated in histological studies that the lesions produced in the blood vessels by aqueous solutions of diazepam have the same appearance as those which occur after injection of the solvent used alone. The cause of the pain is not known, and there is no clear correlation between pain and thrombophlebitis (Langdon, Harlan and Bailey, 1973;Siebke, Ellertsen and Lind, 1976).…”

Histopathology of veins after intravenous lorazepam and ro 21-3981

“…1 To help elucidate this, we recently reported the histological effects of intravenous diazepam using a rat vein model. 2 The present study extends this model to the evaluation of Iorazepam and RO 21-3981, two new benzodiazepines ( Figure 1).…”

Comparison of I. M. Diazepam and Hydroxyzine as Premedicants

“…Diazepam is known to be irritating when given i.v., an effect of the drug itself and of the vehicle necessary to make it soluble (Graham, Pagano and Katz, 1977). It also causes pain on i.m.…”