Divial

Use Divial solution as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Divial solution is usually given as an injection at your doctor's office, hospital, or clinic. If you will be using Divial solution at home, a health care provider will teach you how to use it. Be sure you understand how to use Divial solution. Follow the procedures you are taught when you use a dose. Contact your health care provider if you have any questions.
• Do not use Divial solution if it contains particles, is cloudy or discolored, or if the vial is cracked or damaged.
• Divial solution should not be injected into an artery because serious side effects may occur.
• Keep this product, as well as syringes and needles, out of the reach of children and pets. Do not reuse needles, syringes, or other materials. Ask your health care provider how to dispose of these materials after use. Follow all local rules for disposal.
• If you miss a dose of Divial solution, use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not use 2 doses at once.

Ask your health care provider any questions you may have about how to use Divial solution.

Use: Labeled Indications

Anxiety (oral): Management of anxiety disorders or short-term (≤4 months) relief of anxiety.

Procedural anxiety, premedication (injection): Anesthesia premedication in adults to relieve anxiety or to produce amnesia (diminish recall) or sedation.

Status epilepticus (injection): Treatment of status epilepticus. May be used off label for acute seizures that have not yet progressed to status epilepticus.

Off Label Uses

Akathisia, antipsychotic-induced

Data from a limited number of open-label clinical trials suggest that Divial may be beneficial for the treatment of patients with antipsychotic-induced akathisia.

See also:
What other drugs will affect Divial?

Divial Injection, like other injectable benzodiazepines, produces additive depression of the central nervous system when administered with other CNS depressants such as ethyl alcohol, phenothiazines, barbiturates, MAO inhibitors, and other antidepressants.

When scopolamine is used concomitantly with injectable Divial, an increased incidence of sedation, hallucinations and irrational behavior has been observed.

There have been rare reports of significant respiratory depression, stupor and/or hypotension with the concomitant use of loxapine and Divial.

Marked sedation, excessive salivation, ataxia, and, rarely, death have been reported with the concomitant use of clozapine and Divial.

Apnea, coma, bradycardia, arrhythmia, heart arrest, and death have been reported with the concomitant use of haloperidol and Divial.

The risk of using Divial in combination with scopolamine, loxapine, clozapine, haloperidol, or other CNS-depressant drugs has not been systematically evaluated. Therefore, caution is advised if the concomitant administration of Divial and these drugs is required.

Concurrent administration of any of the following drugs with Divial had no effect on the pharmacokinetics of Divial: metoprolol, cimetidine, ranitidine, disulfiram, propranolol, metronidazole, and propoxyphene. No change in Divial dosage is necessary when concomitantly given with any of these drugs.

Divial-Valproate Interaction

Concurrent administration of Divial (2 mg intravenously) with valproate (250 mg twice daily orally for 3 days) to 6 healthy male subjects resulted in decreased total clearance of Divial by 40% and decreased formation rate of Divial glucuronide by 55%, as compared with Divial administered alone. Accordingly, Divial plasma concentrations were about two-fold higher for at least 12 hours post-dose administration during valproate treatment. Divial dosage should be reduced to 50% of the normal adult dose when this drug combination is prescribed in patients.

Divial-Oral Contraceptive Steroids Interaction

Coadministration of Divial (2 mg intravenously) with oral contraceptive steroids (norethindrone acetate, 1 mg, and ethinyl estradiol, 50 μg, for at least 6 months) to healthy females (n=7) was associated with a 55% decrease in half-life, a 50% increase in the volume of distribution, thereby resulting in an almost 3.7-fold increase in total clearance of Divial as compared with control healthy females (n=8). It may be necessary to increase the dose of Divial in female patients who are concomitantly taking oral contraceptives.

Divial-Probenecid Interaction

Concurrent administration of Divial (2 mg intravenously) with probenecid (500 mg orally every 6 hours) to 9 healthy volunteers resulted in a prolongation of Divial half-life by 130% and a decrease in its total clearance by 45%. No change in volume of distribution was noted during probenecid co-treatment. Divial dosage needs to be reduced by 50% when coadministered with probenecid.

Drug/Laboratory Test Interactions

No laboratory test abnormalities were identified when Divial was given alone or concomitantly with another drug, such as narcotic analgesics, inhalation anesthetics, scopolamine, atropine, and a variety of tranquilizing agents.