Diazepam

Diazepam (brand names: Valium, Dialar, Diazemuls, Diazepam Desitin, Diazepam RecTubes, Stesolid and Tensium) is a benzodiazepine which has a relatively long half-life. It is mostly used to treat anxiety[1], certain forms of epilepsy[1], muscle spasms (seizures[1]), fits[1], and sleeping problems. It can also be taken to help people relax before an operation or other medical or dental treatments. This is known as a pre-med.[1]

Diazepam
Clinical data
Pronunciation/daɪˈæzɪpæm/ dy-AZ-ip-am
Trade namesValium, Vazepam, Valtoco, others[2]
AHFS/Drugs.comMonograph
MedlinePlusa682047
License data
Pregnancy
category
Dependence
liability		High[4]
Addiction
liability		Moderate[5][6]
Routes of
administration		oral, intramuscular, intravenous, rectal, nasal,[7] buccal film
Drug classBenzodiazepine
ATC code
Legal status
Legal status
  • AU: S4 (Prescription only) [3]
  • BR: Class B1 (Psychoactive drugs)
  • CA: Schedule IV
  • DE: Prescription only (Anlage III for higher doses)
  • NZ: Class C
  • UK: POM (Prescription only) [8][9]
  • US: Schedule IV [10][11]
  • UN: Psychotropic Schedule IV
  • In general: ℞ (Prescription only)
Pharmacokinetic data
Bioavailability76% (64–97%) oral, 81% (62–98%) rectal[12]
MetabolismLiver – CYP2B6 (minor route) to desmethyldiazepam, CYP2C19 (major route) to inactive metabolites, CYP3A4 (major route) to temazepam
Metabolites
  • Nordiazepam
  • Temazepam[13]
Elimination half-life(50 h); 20–100 h (32–200 h for main active metabolite desmethyldiazepam)[10][8][9]
ExcretionKidney
Identifiers
CAS Number
PubChem CID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
ECHA InfoCard100.006.476
 ☒NcheckY (what is this?)  (verify)


This medicine can cause serious allergic reactions that require emergency treatment. Make sure the signs of these reactions are known: read allergic reaction symptoms of drugs.

It works by increasing the levels of a calming chemical in the brain called gamma-aminobutyric acid (GABA). Like with other benzodiazepines, there is a risk of addiction if it is used for long periods of time. For this reason the drug is used to treat acute cases (2-4 weeks maximum) to avoid dependence.[1]

Pregnancy category: US:[14] D, AU:[15] C, UK:[1] 'You can take diazepam during pregnancy, but taking it for a long time, particularly towards the end of pregnancy, may make your baby drowsy after they are born'.

According to the World Health Organization diazepam is an essential drug. It has been the most prescribed medicine in the United States many times.

It is sometimes used recreationally to cause a calming effect. Diazepam has caused huge problems in Scotland in the past[16].

Taking diazepam

Most adults aged 18 years and over can take diazepam tablets and liquid. People aged over 65 might need to take a lower dose. Children aged 1 month and older can take it for muscle spasms. Diazepam rectal tubes can be used by adults and children.[1]

Conflicts (conditions)

Diazepam is not suitable for some people. To make sure that it is safe, report new, current, or past issues, such as:[1]

Conflicts with other medications

Some medicines affect the way diazepam works and increase the chances of side effects happening. Before taking diazepam, report other medications like:[1]

Do not take herbal remedies for anxiety or insomnia, such as valerian or passionflower, with diazepam. They can increase the drowsy effects of diazepam and may also have other side effects.[1]

There is not enough information to say that other herbal remedies and complementary medicines are safe to take with diazepam. They're not tested in the same way as pharmacy and prescription medicines. They generally are not tested for the effect they have on other medicines.[1]

Dose (amount, method, missed doses)

Dosage for a child goes according to weight, age and general health of mother and baby. The doses listed are for adults. Dosages for children and babies can vary.[1]

Dose might be lower for over 65s or those with kidney or liver problems or severe breathing problems.[1]

The usual dose for diazepam is:[1]

  • anxiety – 2mg, taken 3 times a day, this can be increased to 5mg to 10mg, taken 3 times a day
  • sleep problems (related to anxiety) – 5mg to 15mg, taken once a day at bedtime
  • muscle spasms in adults – 2mg to 15 mg a day. This can be taken as 1mg twice a day and can go up to 5mg taken 3 times a day. The dose can be increased to up to 20mg, taken 3 times a day if needed
  • muscle spasms in children (aged 1 month to 17 years) – the dose varies depending on age. It's usually taken twice a day, with 10 to 12 hours between each dose

How to take tablets and liquid

Diazepam tablets or liquid are taken with a drink of water. It can be taken with or without food.[1]

If it is in liquid form, the bottle should be shaken before taking. The medicine will come with a plastic syringe or spoon to help take the right amount. If there is no plastic syringe or spoon, the pharmacist should have one. A kitchen teaspoon will not work as it will not measure the right amount.[1]

How to use rectal tubes

Diazepam rectal tubes (or rectal diazepam) can be used if an adult or child is having a seizure or fit.[1]

If the medicine has been prescribed to be used with rectal tubes, it's important that a family member, friend or carer knows how to give (administer) the medicine. This may vary between different brands. The instructions that come with the medicine carefully. For when a seizure is happening, they also need to know how long to wait before giving the rectal diazepam. This depends on the type of seizure and how long it lasts. Before prescribing diazepam rectal tubes, a doctor will talk to the patient and a family member or carer about how to recognise the type of seizure that should be treated with this medicine. They will also teach the family member or carer how to give the medicine.[1]

While diazepam regularly, and forgetting to take a dose is happening often, it may help to set an alarm to remind the person to take it. A pharmacist may also have some advice on other ways to remember to take medicine or medicines.[1]

take the missed dose as soon as it is remembered, unless it's nearly time for the next dose. In this case, just leave out the missed dose and take the next dose at the usual time. Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.[1]

Taking too much

Taking more than the prescribed dose of diazepam may cause symptoms including:[1]

  • poor co-ordination or trouble speaking
  • feeling sleepy
  • a slow or irregular heartbeat (arrhythmia )
  • uncontrolled eye movements
  • muscle weakness
  • feeling overexcited

And call an ambulance. If A&E is needed, do not drive, but instead have another person drive.[1]

Side effects

Diazepam can cause severe allergic reactions. A doctor's appointment should be made if memory loss (amnesia) starts happening.[1]

Common side effects

There are things which help cope with common side effects. These common side effects of diazepam happen in more than 1 in 100 people:[1]

Rare/Serious side effects

Call a doctor or ambulance/emergency services straight away if these side effects appear:[1]

  • skin turns yellow, or whites of the eyes turn yellow (although this may be less obvious on brown or black skin)
  • seeing or hearing things that are not there (hallucinations)
  • thinking things that are not true (delusions)
  • falling over more often
  • unusual mood changes such as talking more than usual or feeling overexcited, agitated, restless, irritable or aggressive. These side effects are more likely in children or in people over 65 years old.

Call an ambulance or go to A&E straight away if breathing becomes very slow or shallow.

These are not the complete list of side effects. For the complete list, see the leaflet inside of the medicine packet.[1]

Long term side effects

Diazepam can cause withdrawal symptoms if it is taken for a long time.[1]

If diazepam is prescribed for more than 4 weeks, the dose may be reduced gradually when it is time to stop taking it to prevent withdrawal symptoms.[1]

References
  1. "Diazepam: medicine for anxiety, muscle spasms and seizures". nhs.uk. 2022-02-07. Retrieved 2024-05-31.
  3. "Valium". NPS MedicineWise. 31 January 2020. Archived from the original on 29 July 2020. Retrieved 9 January 2023.
  4. Edmunds M, Mayhew M (2013). Pharmacology for the Primary Care Provider (4th ed.). Mosby. p. 545. ISBN 978-0-323-08790-2. Archived from the original on 14 January 2023. Retrieved 13 July 2020.
  5. Clinical Addiction Psychiatry. Cambridge University Press. 2010. p. 156. ISBN 978-1-139-49169-3. Archived from the original on 8 September 2017.
  6. Ries RK (2009). Principles of addiction medicine (4 ed.). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins. p. 106. ISBN 978-0-7817-7477-2. Archived from the original on 8 September 2017.
  7. "Valtoco – diazepam spray". DailyMed. 13 January 2020. Archived from the original on 1 August 2020. Retrieved 13 February 2020.
  8. "Diazepam Tablets BP 10 mg – Summary of Product Characteristics (SmPC)". (emc). 16 September 2019. Archived from the original on 25 July 2020. Retrieved 25 July 2020.
  9. "Diazepam Injection BP Summary of Product Characteristics (SmPC)". emc. 17 January 2022. Archived from the original on 25 January 2023. Retrieved 11 February 2024.
  11. "Libervant- diazepam film". DailyMed. 27 April 2024. Retrieved 18 May 2024.
  12. Dhillon S, Oxley J, Richens A (March 1982). "Bioavailability of diazepam after intravenous, oral and rectal administration in adult epileptic patients". British Journal of Clinical Pharmacology. 13 (3): 427–32. doi:10.1111/j.1365-2125.1982.tb01397.x. PMC 1402110. PMID 7059446.
  13. Goodkin HP (2010). "Diazepam". In Panayiotopoulos CP (ed.). Atlas of Epilepsies. London: Springer. doi:10.1007/978-1-84882-128-6_263. ISBN 978-1-84882-128-6.
  14. Armstrong, Carrie (2008-09-15). "ACOG Guidelines on Psychiatric Medication Use During Pregnancy and Lactation". American Family Physician. 78 (6): 772–778.
  15. "Australian Product Information - VALIUM (diazepam)".
  16. "Street valium blamed for 'unprecedented' spike in drugs deaths". BBC News. 2019-01-28. Retrieved 2024-06-01.


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