Brand name
- Valum®
Drug Class
- Anxiolytic agent
- Sedative
- Anticonvulsant
Preparations
- Tablets 2, 5, 10 mg
- Injection: 10 mg
Indications
- Used for short-term management of symptoms of anxiety
- In acute alcohol withdrawal, Valium (diazepam tablets) may be useful in the symptomatic relief of acute agitation, tremor, impending or acute delirium tremens and hallucinosis.
- As adjunct for the relief of skeletal muscle spasm due to reflex spasm to local pathology (such as inflammation of the muscles or joints, or secondary to trauma), spasticity caused by upper motor neuron disorders (such as cerebral palsy and paraplegia), athetosis, and stiff-man syndrome.
- Management of convulsive disorders
- The effectiveness of Valium in long-term use, that is, more than 4 months, has not been assessed by systematic clinical studies
Dosing
Anticonvulsant:
- 2 mg to 10 mg, 2 to 4 times daily
Anxiety:
- Depending upon severity of symptoms-2 mg to 10 mg, 2 to 4 times daily
Insomnia:
- a single daily dose of 2 to 4 mg may be given, usually at bedtime.
For elderly or debilitated patients:
- 2 mg to 2.5 mg, 1 or 2 times daily initially; increase gradually as needed and tolerated
Alcohol withdrawal symptoms:
- 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:
- 2 mg to 10 mg, 3 or 4 times daily
Drug Interactions
The effect of valium can be potentiated with:
- Phenothiazines
- Antipsychotics
- Anxiolytics
- Sedatives hypnotics
- Anticonvulsants
- Narcotic analgesics
- Anesthetics
- Sedative antihistamines
- Barbiturates
- MAO inhibitors
- Antidepressants
Alcohol
- Concomitant use with alcohol is not recommended due to enhancement of the sedative effect.
Hepatic Cytochrome P450 3A and 2C19 inhibitors:
- May lead to increased and prolonged sedation.
- Is known to occur with cimetidine, ketoconazole, fluvoxamine, fluoxetine, and omeprazole.
Phenytoin
- metabolic elimination of phenytoin is decreased by diazepam
Adverse Effects
General:
- paradoxical reaction (excitatory)
- may worsen depression or psychosis
- Fatigue
- Diplopia
- Blurred vision
- Hypersensitivity reactions,
- Anaphylactic reactions
Respiratory:
- Respiratory depression and partial airway obstruction, especially when combined with narcotics
- laryngospasm
Cardiovascular:
- Hypotension
CNS:
- Confusion
- Amnesia
- Stimulation
- Restlessness
- acute hyperexcited states
- anxiety
- Agitation
- Aggressiveness
- Irritability
- Rage
- Hallucinations
- Psychoses
- Delusions
- increased muscle spasticity
- insomnia and sleep disturbances
- Nightmare
Urogenital:
- incontinence
- changes in libido
- urinary retention
Skin:
- Allergy
Blood:
- thrombophlebitis
Pregnancy and Breastfeeding
- Not recommended during pregnancy
- Avoid using during nursing
Warning
Sign and symptoms of toxicity:
- Drowsiness
- Confusion
- lethargy
- Ataxia
- diminished reflexes
- hypotonia
- hypotension
- respiratory depression
- coma
Management:
- Gastric lavage
- Activated charcoal may limit drug absorption
- Dialysis has limited value
- Flumazeil
Section
This document is prepared by the “Mental Health for All” team. This document is provided for information purposes only and does not necessarily represent endorsement by or an official position of the Essentials of Medicine. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient’s medical history.