Diazepam, Valium®

Brand name

  • Valium®

Drug Class

  • Benzodiazepines

Preparations

  1. Tablets 2, 5, 10 mg
  2. Injection: 10 mg

Indications

  1. Anxiolytic agent
  2. Sedative
  3. Anticonvulsant

Dosing

Anticonvulsant:

  1. 2 mg to 10 mg, 2 to 4 times daily

Anxiety:

  1. Depending upon severity of symptoms-2 mg to 10 mg, 2 to 4 times daily

Insomnia:

  1. a single daily dose of 2 to 4 mg may be given, usually at bedtime.

For elderly or debilitated patients:

  1. 2 mg to 2.5 mg, 1 or 2 times daily initially; increase gradually as needed and tolerated

Alcohol withdrawal symptoms:

  1. 10 mg, 3 or 4 times during the first 24 hours, reducing to 5 mg, 3 or 4 times daily as needed

Skeletal muscle spasm:

  1. 2 mg to 10 mg, 3 or 4 times daily

Drug Interactions

The effect of valium can be potentiated with

  1. Phenothiazines
  2. Antipsychotics
  3. Anxiolytics
  4. Sedatives hypnotics
  5. Anticonvulsants
  6. narcotic analgesics
  7. Anesthetics
  8. Sedative antihistamines
  9. Barbiturates
  10. MAO inhibitors
  11. Antidepressants

Alcohol

  1. Concomitant use with alcohol is not recommended due to enhancement of the sedative effect.

Hepatic Cytochrome P450 3A and 2C19 inhibitors:

  1. May lead to increased and prolonged sedation.
  2. Is known to occur with cimetidine, ketoconazole, fluvoxamine, fluoxetine, and omeprazole.

Phenytoin

  1. metabolic elimination of phenytoin is decreased by diazepam

Adverse Effects

General:

  1. paradoxical reaction (excitatory)
  2. may worsen depression or psychosis
  3. Fatigue
  4. Diplopia
  5. Blurred vision
  6. Hypersensitivity reactions,
  7. Anaphylactic reactions

Respiratory:

  1. Respiratory depression and partial airway obstruction, especially when combined with narcotics
  2. laryngospasm

Cardiovascular:

  1. Hypotension

CNS:

  1. Confusion
  2. Amnesia
  3. Stimulation
  4. Restlessness
  5. Aacute hyperexcited states
  6. anxiety
  7. Agitation
  8. Aggressiveness
  9. Irritability
  10. Rage
  11. Hallucinations
  12. Psychoses
  13. Delusions
  14. increased muscle spasticity
  15. insomnia
  16. sleep disturbances
  17. Nightmare

Urogenital:

  1. incontinence
  2. changes in libido
  3. urinary retention

Skin:

  1. Allergy

Blood:

  1. thrombophlebitis

Pregnancy and Breastfeeding

  1. Not recommended

Warning

Sign and symptoms of toxicity:

  1. Drowsiness
  2. Confusion
  3. Lethargy
  4. Ataxia
  5. Diminished reflexes
  6. Hypotonia
  7. Hypotension
  8. Respiratory depression
  9. Coma

Management:

  1. Gastric lavage
  2. Activated charcoal may limit drug absorption
  3. Dialysis has limited value
  4. Flumazeil
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