Diazepam dosing should be adjusted in hepatic or renal dysfunction by using which approach?

• A. Avoid entirely
• B. No adjustment needed
• C. Use small doses
• D. Use large doses

Answer: (C)

Diazepam is primarily processed by the liver into active metabolites, and those metabolites are excreted by the kidneys. In hepatic dysfunction, clearance of diazepam and its active metabolites is reduced, leading to longer and stronger effects. In renal dysfunction, the metabolites can accumulate, further prolonging sedation and risk of toxicity. Because of these pharmacokinetic changes, giving usual doses can easily cause oversedation, delirium, or respiratory depression. The safer approach is to start with smaller doses and titrate slowly based on response and tolerance. That’s why using small doses is the best choice.