Diazepam

• Valum®

1. Anxiolytic agent
2. Sedative
3. Anticonvulsant

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

1. Used for short-term management of symptoms of anxiety
2. 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.
3. 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.
4. Management of convulsive disorders
5. The effectiveness of Valium in long-term use, that is, more than 4 months, has not been assessed by systematic clinical studies

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:

2. 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

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

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. acute hyperexcited states
6. anxiety
7. Agitation
8. Aggressiveness
9. Irritability
10. Rage
11. Hallucinations
12. Psychoses
13. Delusions
14. increased muscle spasticity
15. insomnia and sleep disturbances
16. Nightmare

Urogenital:

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

Skin:

1. Allergy

Blood:

1. thrombophlebitis

1. Not recommended during pregnancy
2. Avoid using during nursing

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