Diazepam (Oral)

Diazepam works to reduce anxiety symptoms, symptoms of alcohol withdrawal, and muscle spasms, and it is occasionally used to treat IBS or panic attacks.

Overview

Diazepam works on the central nervous system (CNS) to relieve anxiety, symptoms of alcohol withdrawal, and muscle spasms. It is commonly prescribed to people with certain seizure disorders to help relax the muscles, but in these instances, it usually prescribed along with other medicines. Sometimes diazepam is also used to treat panic attacks or irritable bowel syndrome.

This drug belongs to a family called benzodiazepines. Medicines in this category slow down the nervous system in order to produce a variety of effects. One of the biggest risks associated with drugs of this nature is respiratory depression, in which breathing slows down and, in the very worst cases, stops and leads to unconsciousness or death. It is also a habit-forming drug and can lead to dependency if taken for long periods. For this reason, diazepam is only available with a doctor's prescription.

Diazepam is known under the brand name Valium in the US, and when taken orally it is available in the following dosage forms:

  • Tablet
  • Solution
  • Extended release capsule

Conditions Treated?

Type Of Medicine?

  • Benzodiazepine

Side Effects

Diazepam can cause a wide range of side effects, some of which are severe and need urgent medical attention, while others are minor and do not cause serious harm. If you're unsure whether a side effect warrants medical attention, call your doctor just in case.

If you notice any of the following more common side effects, check with your doctor immediately:

  • Shakiness
  • Unsteady walk
  • Trembling
  • Problems with coordination or muscle control

The following are potential side effects which happen so infrequently that their incidence is unknown, but they require immediate medical attention if they do occur:

  • Pain in stomach or abdomen
  • Pain in lower back or side
  • Increased muscle spasms or tone
  • Seizures
  • Shakiness or trembling in arms, hands, legs or feet
  • Tremors
  • Mood or mental changes
  • Agitation
  • Anxiety
  • Confusion
  • Irritability
  • Discouragement
  • Sadness or emptiness
  • Nervousness
  • Difficulty concentration
  • Memory problems
  • Sudden angry outbursts
  • False beliefs or delusions
  • Seeing, hearing or feeling things that aren't there (hallucinations)
  • Feeling that others are watching or controlling you
  • Feeling that others can hear your thoughts
  • Unusual or out of character behavior
  • Hyperexcitability
  • Restlessness
  • Faintness, dizziness or lightheadedness when getting up from seated or lying positions
  • Chills
  • Fever
  • Headache
  • Cough
  • Sore throat
  • Vomiting blood
  • Black, tarry stools
  • Dark urine
  • Increased frequency of urination
  • Decreased urine output
  • Difficulty in passing urine or dribbling urine flow
  • Painful urination
  • Loss of bladder control
  • Pale skin
  • Peeling, flaking or blistering skin
  • Itching
  • Rash
  • Sores, ulcers or white spots in the mouth
  • Yellows eyes or skin
  • Abnormal bruising or bleeding
  • Unpleasant breath odor
  • Blurred vision
  • Changes in speech pattern or rhythm
  • Slurred speech
  • Fast heartbeat
  • Fast or irregular breathing
  • Shortness of breath
  • Loss or lack or appetite
  • Nausea
  • Sleeplessness or trouble sleeping
  • Nightmares
  • Abnormal weakness or tiredness
  • Sweating

The following are side effects which are relatively minor and do not usually require medical attention unless they become persistent or very severe. They may dissipate once your body gets used to diazepam. If you find them particularly bothersome you could contact your doctor for advice.

  • Constipation
  • Diarrhea
  • Difficulty swallowing
  • Dry mouth
  • Increased watering of mouth
  • Double vision
  • Reduced sex drive
  • Inability to achieve or maintain an erection
  • Increased sex drive or sexual ability
  • Feeling that self or surroundings are moving or sensation of spinning
  • Indigestion
  • Increase passing of gas

If you notice any other side effects not listed here, report them to your doctor as soon as possible. You could also report new side effects to the FDA.

Overdose

An overdose of diazepam could be life-threatening. If you think you may have taken too much of this medicine, call your doctor immediately. If someone becomes unconscious as a result of taking an overdose of diazepam, call 911. The following are symptoms of overdose and require immediate medical attention:

  • Loss of consciousness
  • Loss of energy or strength
  • Muscle pain or weakness
  • Troubled, labored or difficult breathing
  • Irregular, fast, slow or shallow breathing
  • Lack of coordination
  • Unusual drowsiness, tiredness or sluggishness
  • Pale or blue lips, nails or skin

Dosage

For anxiety:

  • Adults ' between 2 and 10 mg, taken two to four times each day.
  • Elderly adults' between 2 and 2.5 mg, taken once or twice a day, with dose gradually increased as required.
  • Children aged 6 months and over ' between 1 and 2.5 mg, taken three to four times a day, with dose gradually increased as required.

For alcohol withdrawal:

  • Adults ' 10 mg taken three or four times on the first day, then 5 mg taken three or four times per day as required.
  • Elderly adults' between 2 and 2.5 mg taken once or twice each day, with dose gradually increased as required.

For muscles spasm:

  • Adults ' between 2 and 10 mg taken three or four times each day.
  • Elderly adults ' between 2 and 2.5 mg taken one once or twice a day, with dose gradually increased as required.
  • Children aged 6 months and over ' between 1 and 2.5 mg taken three or four times a day, with dose gradually increased as required.

For seizures:

  • Adults '2 to 10 mg taken two to four times each day.
  • Elderly adults '2 to 2.5 mg taken once or twice each day, with dose gradually increased as needed.
  • Children aged 6 months and over 'between 1 and 2.5 mg taken three or four times a day, with dose gradually increase as required.

For children under 6 months old, the use and dose of diazepam should be determined by a doctor, regardless of the condition being treated.

How to use diazepam

Diazepam tablets or capsules should be swallowed whole. Do not crush, chew or break them. You can take them with or without food, but they may be easier to swallow if you take them with water.

Diazepam solution is provided in a concentrated liquid form which should be diluted before use. The medicine is provided with a marked dropper to help you measure the dose, and your doctor or pharmacist will be able to explain to you how to use it correctly. It is very important that you carefully measure out your doses so that you don't accidentally take too much; doing so could be harmful. You could mix the concentrate with water, juice or carbonated drinks, or with a semisolid food such as applesauce or pudding if you prefer. Make sure to consume the solution immediately after it is prepared.

Your doctor will probably tell you how often you can take the medicine. Try to take each dose at roughly the same times each day to avoid forgetting a dose or taking doses too close together. Only take diazepam as frequently as your doctor instructs; taking it more often could increase the risk of harmful side effects. If you feel that the medicine isn't as effective as you'd like, visit your doctor for advice.

Diazepam is a habit-forming drug, which means that you can develop physical and mental dependency on it. Furthermore, long term use can make the body more tolerant to the drug, which makes it less effective. The risk of dependency and tolerance increases the longer you take it, so only take the medicine for as long as your doctor instructs. Generally, the drug should not be taken for longer than four months at a time. However, you should not stop taking the drug suddenly without your doctor's instructions. Your doctor will may gradually decrease your dose in order to minimize physical and mental withdrawal effects.

Missed doses

If you miss a dose of diazepam and you are supposed to take multiple doses within one day, simply skip the missed dose and continue your usual dosing schedule. If you only take one dose of diazepam each day, take the dose as soon as you remember as long as it is on the same day. Do not double doses of diazepam to make up for missed doses as doing so could increase the risk of side effects.

Interactions

Diazepam can interact with a wide range of medicines and cause harmful effects. It is extremely important that your doctor knows about all prescription and OTC medicine that you take, including herbal supplements and multivitamins. It can be helpful to keep a list of your medicines which you can show to each doctor you see.

It is particularly important to tell your doctor if you take any of the following medicines:

  • Antihistamines
  • Antidepressants
  • Anti-anxiety medicines
  • Asthma medicines
  • Cold, flu or allergy medicines
  • Muscle relaxants
  • Oral contraceptives
  • Parkinson's disease medicines
  • Sedatives
  • Seizures medicines
  • Sleeping pills
  • Tranquilizers

Flumazenil (brand name Romazicon) should never be taken at the same time as diazepam because it reverses the drug's effects.

Many other medicines are not recommended for use with diazepam. Your doctor may try to prescribe alternative treatments where interactions occur, but if both medicines are absolutely necessary they may continue to prescribe both with dosage adjustments or changes to the frequency or times at which you take the medicines. Always follow your doctor's instructions carefully to minimize the risk of harmful side effects or interactions.

Antacids

If you regularly take antacids for relief of indigestion, heartburn or acid reflux, avoid taking them at the same time as diazepam. This is because antacids can affect the way diazepam is absorbed by the body and may make it less effective. Always take diazepam first and then take antacids at least an hour later.

Surgery

Some medicines used during surgery could interact with diazepam and cause harmful effects. Be sure to let your doctor, dentist or surgeon know that you are taking this medicine before you undergo surgery or dental surgery. They may advise you to stop taking the medicine before surgery.

Tobacco

Cigarette smoking may reduce the effectiveness of diazepam. Tell your doctor about all tobacco products you use before taking the drug.

Warnings

Risk of respiratory depression

Diazepam is a central nervous system (CNS) depressant, which means that it poses the risk of serious respiratory depression in which breathing can become slow or even stop. The risk of respiratory depression is increased if other CNS depressants are taken at the same time. Make sure your doctor knows about all medicines you currently take, including those purchased over the counter.

Pain medicines, cold, flu and allergy relief medicines, sleeping aids, muscle relaxants and antidepressants are examples of drugs which may contain CNS depressants. If in doubt, ask your doctor or pharmacist whether it is safe to take a medicine at the same time as diazepam. Alcohol is also a CNS depressant and should be avoided during treatment with diazepam, as should street drugs.

Risk of dependency

Diazepam is a habit-forming drug. The risk of dependency is heightened in individuals who have, or have a history of, alcohol or drug abuse or dependency. Your doctor may choose not to prescribe diazepam if they believe you are at a very high risk of dependency.

To minimize the risk of dependency, only take diazepam as directed by your doctor. Do not take it more frequently than instructed, and only take it for the length of time advised by your doctor. Usually, the drug should not be taken for more than four months at a time.

Your doctor may gradually reduce your dose to reduce the risk of withdrawal effects when you are ready to stop taking the medicine. Follow their instructions closely. If you notice any of the following symptoms of withdrawal, contact your doctor as soon as possible:

  • Extreme anxiety
  • Sensitivity to light, noise, taste and smell
  • Insomnia
  • Paranoia
  • Muscle cramps
  • Tremors
  • Seizures
  • Restlessness

Contraindicated for patients with some medical conditions

Individuals with the following medical conditions should not take diazepam due to risk of serious complications:

Risk of mental depression

Diazepam can cause severe mental depression and the risk of it occurring is higher in patients who already have depression or a history of depression. Doctors will use caution when prescribing this drug to patients with a history of mental illness. If you have thoughts of suicide or of harming yourself while taking diazepam, contact your doctor immediately.

Decreased kidney or liver function

Patients with kidney disease or liver disease may not be able to take diazepam. This is because their condition will cause slower removal of the drug from their body. If the drug remains in the body for longer, its effects may be more potent and the risk of side effects increased. Depending on the severity of your kidney or liver disease, you may either be prescribed lower doses or unable to take the drug altogether.

Allergic reaction

Your doctor should know about all the allergies you suffer from in case there are any ingredients in diazepam which could trigger an allergic reaction. This includes food, chemical, drug, animal and dye allergies. If you have had a reaction to any other benzodiazepines in the past, you may not be able to take diazepam.

Drowsiness

Diazepam can cause dizziness and drowsiness. Do not drive or operate machinery until you know how the drug affects you. You should also avoid alcohol, which can increase drowsiness and dizziness.

Pregnancy and breastfeeding

The FDA have defined diazepam as a pregnancy category D drug, which means it should not be used during pregnancy due to potentially harmful effects to the fetus. Newborns which are exposed to the drug during labor could experience irregular heart rate, hypothermia, hypotonia (reduced muscle tone) and respiratory depression. They may also experience withdrawal symptoms. It is incredibly important to tell your doctor if you become pregnant while taking diazepam.

Do not suddenly stop taking diazepam if you become pregnant while taking it, particularly if you are taking it for seizures. Seizures during pregnancy can cause serious harm to both you and the fetus. Speak to your doctor immediately in order that they can prescribe a suitable alternative treatment, but only stop taking diazepam when they instruct you to do so.

Breastfeeding is not recommended while diazepam is being taken. The drug is excreted in human breast milk and it could accumulate in nursing infants and cause harmful effects, such as sedation, weight loss and feeding problems. Your doctor will advise that you either avoid taking diazepam or stop breastfeeding while taking the drug.

Elderly patients

Patients aged 65 or older tend to be more sensitive to the effects of diazepam. Usually, alternative medicines are prescribed which can treat symptoms without causing severe side effects, but in some instances the drug may still be prescribed in much lower doses than in younger adults. Doses may gradually be increased following careful monitoring of the patient.

Storage

Diazepam should be stored in a closed container 'the one it came in is best ' at room temperature. It should be kept away from heat, direct light or moisture, so avoid storing it in the bathroom.

Keep diazepam well away from children and pets. Keep the container lid tightly closed at all times and store the medicine up and away from the ground so that it is not within easy reach.

If you have unused or expired medicine, do not hold onto it. Ask your healthcare provider or pharmacist how to correctly dispose of unused medicine. There may be a local medicine take-back program in your area; these are often provided by garbage or recycling departments, healthcare providers like hospitals, or pharmacies.

Summary

Diazepam is a benzodiazepine which acts on the central nervous system to relieve anxiety, alcohol withdrawal symptoms and muscle spasms. Sometimes it is prescribed to relieve panic attacks and the symptoms of irritable bowel syndrome. In the US, it is only available with a doctor's prescription and is known as Valium.

Since diazepam depresses the central nervous system, it can cause serious respiratory depression. It should not be taken by people with preexisting breathing problems like COPD, asthma and sleep apnea. Other CNS depressants, like some antidepressants, antihistamines, sleeping aids and narcotic painkillers, should be avoided while taking diazepam. Alcohol and street drugs should also be avoided.

When diazepam is taken orally, it is administered in tablet, capsule or solution form, the latter of which should be mixed with a beverage or semisolid food. If the patient also takes antacids, they should do so at least an hour after taking diazepam.

Diazepam is not recommended for use during pregnancy or while breastfeeding. It can be taken by children over the age of 6 months in smaller doses. In elderly patients, its effects tend to be more potent and alternative treatments are usually recommended, but if diazepam is necessary it is given in incredibly small doses initially.