EAS Publisher | High-Dose Use of Parenteral Diazepam in Tetanus: A Clinical Pharmacology Perspective

High-Dose Use of Parenteral Diazepam in Tetanus: A Clinical Pharmacology Perspective

DOI : https://doi.org/10.36349/easjpp.2026.v08i03.002

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Tetanus, a vaccine-preventable disease, remains a life-threatening condition in low- and middle-income countries. It is characterised by muscle spasms and rigidity, driven by the tetanospasmin toxin, and is associated with a high mortality. Benzodiazepines, particularly diazepam, are the cornerstone of spasm control due to their GABA-A receptor agonism, which counteracts the toxin’s disinhibition of motor neurons. Diazepam can be administered at higher doses than those typically used in the average patient population. We report the successful clinical management of a 67-year-old male with severe generalised tetanus using high-dose intravenous diazepam (up to 210 mg/day initially as boluses and short infusions), highlighting pharmacokinetic and pharmacodynamic considerations, propylene glycol toxicity risks, and the need for careful titration. From a clinical pharmacology perspective, high-dose parenteral diazepam provides rapid spasm control but requires monitoring for accumulation of the active metabolite (N-desmethyldiazepam) and solvent-related complications. This case underscores the balance between therapeutic efficacy and safety in the management of tetanus.

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