Diazepam



Diazepam 794
Photo by: Jasmin Merdan

Definition

Diazepam is a mild tranquilizer in the class of drugs known as benzodiazepines. It is most commonly sold in the United States under the brand name Valium. The generic form of this drug is also available.

Purpose

Diazepam is used on a short-term basis to treat patients with mild to moderate anxiety. It is also used to treat some types of seizures (epilepsy), muscle spasms, nervous tension, and symptoms relating to alcohol withdrawal.

Description

Diazepam is one of many chemically-related tranquilizers in the class of drugs called benzodiazepines. Benzodiazepines are sedative-hypnotic drugs that help to relieve nervousness, tension, and other anxiety symptoms by slowing the central nervous system. To do this, they block the effects of a specific chemical involved in the transmission of nerve impulses in the brain , decreasing the excitement level of the nerve cells. All benzodiazepines, including diazepam, cause sedation, drowsiness, and reduced mental and physical alertness.

Recommended dosage

The typical dose of diazepam used to treat anxiety or seizures in healthy adults ranges from a total of 6 milligrams (mg) to 40 mg per day given in three or four doses. Elderly people (over age 60) are usually given lower doses in the range of 4–10 mg per day to treat anxiety or nervous tension. For acute treatment of seizures, a higher dose of diazepam is given intravenously (directly into the vein) only in a controlled medical setting such as a hospital or emergency room. For alcohol withdrawal, the typical dose is a total of 30–40 mg per day given in three or four doses.

The typical dose for a child over age six months with anxiety or seizures is a total of 3–10 mg per divided into several doses. In general, children receive lower doses of diazepam even when they have a body weight equivalent to a small adult. Diazepam is usually taken as a pill, but an injectable form is sometimes used when a serious seizure is in progress or when muscle spasms are severe. There is also a liquid oral form of the drug available.

Precautions

The elderly, children, and those with significant health problems need to be carefully evaluated before receiving diazepam. Children under the age of six months should not take diazepam. In addition, people with a history of liver disease, kidney disease, or those with low levels of a protein in the blood called albumin need to be carefully assessed before starting this drug.

People taking diazepam should not drive, operate dangerous machinery, or engage in hazardous activities that require mental alertness, because diazepam can cause drowsiness. Alcohol and any drugs that treat mental illness should not be used when taking this medication. People who have previously had an allergic reaction to any dosage level of diazepam or any other benzodiazepine drug should not take diazepam. People with acute narrow-angle glaucoma should not take diazepam.

The prescribing physician should be consulted regularly if diazepam is taken consistently for more than two weeks. Diazepam and other drugs in this class can be habit-forming. Diazepam can become a drug of abuse and should be used with caution in patients with history of substance abuse. People taking diazepam should not stop taking the drug abruptly. This can lead to withdrawal effects such as shaking, stomach cramps, nervousness, and irritability.

Side effects

Anxiety, irregular heartbeat, forgetfulness, mental depression, and confusion are side effects that could require prompt medical attention. However, these side effects are not common when taking diazepam. Even less common, but serious events, are behavior changes, low blood pressure, muscle weakness, and the yellowing of the eyes or skin (jaundice). More common, but less serious side effects, include drowsiness, clumsiness, slurred speech, and dizziness. Rare among these less serious side effects are stomach cramps, headache, muscle spasm, nausea, vomiting, and dry mouth.

Once a person stops taking diazepam, the following side effects could occur from withdrawal: sleeping difficulties, nervousness, and irritability. Less common side effects from withdrawal include confusion, abdominal cramps, mental depression, sensitivity to light, nausea, shaking, and increased sweating. Rarely seen side effects include seizures, hallucinations , and feelings of distrust in the patient.

Interactions

Diazepam interacts with a long list of other medications. Anyone starting this drug should review the other medications they are taking with their physician and pharmacist for possible interactions. Patients should always inform all their health care providers, including dentists, that they are taking diazepam. Diazepam can add to the depressive effects of other central nervous system depressant drugs (for example, alcohol, other tranquilizers, or sleeping pills) when taken together. In severe cases, this can result in death.

Several drugs reduce the ability of diazepam to be broken down and cleared from the body. This results in higher levels of the drug in the blood and increases the probability that side effects will occur. These drugs include several antibiotics, such as erythromycin, anti-stomach acid drugs, such as cimetidine (Tagamet), and antifungal drugs, such as fluconazole. Alcohol should not be used when taking diazepam and other benzodiazepine drugs. Other drugs that are used to treat mental disorders should not be combined with diazepam unless the patient is under the careful supervision and monitoring of a doctor.

Resources

BOOKS

Consumer Reports Staff. Consumer Reports Complete Drug Reference 2002 ed. Denver: Micromedex Thomson Healthcare, 2001.

Ellsworth, Allan J. Mosby's Medical Drug Reference. 2001-2002. St. Louis: Mosby, 2001.

Hardman, Joel G., Lee E. Limbird, eds. Goodman & Gilman's The Pharmacological Basis of Therapeutics . 10th ed. New York: McGraw-Hill, 2001.

Mosby's GenRx Staff. Mosby's GenRx. 9th ed. St. Louis: Mosby, 1999.

Venes, Donald, and others. Taber's Cyclopedic Medical Dictionary. 19th ed. Philadelphia: F. A. Davis, 2001.

Mark Mitchell, M.D.



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