Table 3. Pediatric Benzodiazepine Maximum Recommended Dosages

Drug Name Treatment Indication Maximum Recommended Dosage
chlordiazepoxide anxiety Greater than or equal to  6 years: 30 mg daily in divided doses
clobazam seizures associated with Lennox-Gastaut syndrome
  • 2 years and older, adolescents less than or equal to 30 kg:
    • 20 mg/day in two divided doses
  • 2 years and older, adolescents greater than 30 kg:
    • 40 mg/day in two divided doses
clonazepam seizures
  • Less than 10 years or less than or equal to 30 kg:
    • 0.2 mg/kg daily in divided doses
  • Greater than or equal to 10 years or greater than  30 kg:
    • 20 mg daily in divided doses
clorazepate seizures
  • 9-12 years: 60 mg daily in divided doses
  • Greater than 12 years: 90 mg daily in divided doses
diazepam (nasal) seizures
  • 6-11 years of age:
    • 10-18 kg: 5 mg as one spray in one nostril (equates to 0.3 mg/kg dose)^
    • 19-37 kg: 10 mg as one spray in one nostril (equates to 0.3 mg/kg dose)^
    • 38-55 kg: 15 mg as 2 x 7.5 mg devices with one spray in each nostril (equates to 0.3 mg/kg dose) ^
    • 56-74 kg: 20 mg as 2 x 10 mg devices with one spray in each nostril (equates to 0.3 mg/kg dose) ^
  • Greater than or equal to 12 years of age:
    • 14-27 kg: 5 mg as one spray in one nostril (equates to 0.2 mg/kg dose)^
    • 28-50 kg: 10 mg as one spray in one nostril (equates to 0.2 mg/kg dose)^
    • 51-75 kg: 15 mg as 2 x 7.5 mg devices with one spray in each nostril (equates to 0.2 mg/kg dose) ^
    • Greater than or equal to 76 kg: 20 mg as 2 x 10 mg devices with one spray in each nostril (equates to 0.2 mg/kg dose) ^
diazepam (oral) musculoskeletal conditions Greater than or equal to 6 months of age: 10 mg/day in divided doses have been used; dose may be increased as needed and tolerated – no maximum dose documented
diazepam (oral) seizures Greater than or equal to 6 months of age: 10 mg/day in divided doses have been used; dose may be increased as needed and tolerated – no maximum dose documented
diazepam (rectal) seizures+
  • 2-5 years: 0.5 mg/kg/dose^
  • 6-11 years: 0.3 mg/kg/dose^
  • Greater than or equal to 12 years: 0.2 mg/kg/dose^
lorazepam anxiety Greater than or equal to 12 years: 10 mg daily in divided doses (maximum, 2 mg/dose)
  insomnia due to anxiety or situational stress Greater than or equal to 12 years: 4 mg at bedtime
midazolam (nasal) seizures Greater than or equal to 12 years: 5 mg as one spray in one nostril!
oxazepam anxiety
  • 6-12 years: dose not established;
    • 1 mg/kg/day in divided doses has been adequate
  • Greater than 12 years:
    • mild, moderate: 60 mg daily, in divided doses
    • severe: 120 mg daily, in divided doses

Legend:

  • ^ May give second diazepam nasal or rectal dose at least 4 hours after first dose, if necessary; may not use more than 2 doses to treat single episode; may not treat more than 1 episode/5 days or more than 5 episodes/month
  • + Dose rounded up to nearest commercially available unit dose (in multiples of 2.5 mg); should not be administered by caregivers outside the hospital more frequently than one course every 5 days with a maximum of 5 courses per month; not for chronic administration to minimize potential for development of tolerance
  • ! May give second midazolam nasal dose 10 minutes after first dose, if necessary; may not use more than 2 doses to treat a single episode. Nasal midazolam should be used to treat no more than one episode every three days and no more than 5 episodes per month