Diazepam

Pronunciation

Generic Name: diazepam (dye AZ e pam)
Brand Names: Valium

What is diazepam?

Diazepam is a benzodiazepine (ben-zoe-dye-AZE-eh-peens). It affects chemicals in the brain that may become unbalanced and cause anxiety.

Diazepam is used to treat anxiety disorders, alcohol withdrawal symptoms, or muscle spasms. Diazepam is sometimes used with other medications to treat seizures.

Diazepam may also be used for purposes not listed in this medication guide.

Important information

You should not use this medication if you are allergic to diazepam or similar medicines (Ativan, Klonopin, Restoril, Xanax, and others), or if you have myasthenia gravis, severe liver disease, narrow-angle glaucoma, a severe breathing problem, or sleep apnea.

Do not use diazepam if you are pregnant. It could harm the unborn baby.

Slideshow: Flashback: FDA Drug Approvals 2013

Do not start or stop taking diazepam during pregnancy without your doctor's advice. Diazepam may cause harm to an unborn baby, but having a seizure during pregnancy could harm both the mother and the baby. Tell your doctor right away if you become pregnant while taking diazepam for seizures.

Before you take diazepam, tell your doctor if you have glaucoma, asthma or other breathing problems, kidney or liver disease, seizures, or a history of drug or alcohol addiction, mental illness, depression, or suicidal thoughts.

Do not drink alcohol while taking diazepam. This medication can increase the effects of alcohol.

Never take more of this medication than your doctor has prescribed. An overdose of diazepam can be fatal.

Diazepam may be habit forming. Never share this medicine with another person, especially someone with a history of drug abuse or addiction.

Before taking this medicine

You should not use this medication if you are allergic to diazepam or similar drugs (Ativan, Klonopin, Restoril, Xanax, and others), or if you have:

  • myasthenia gravis (a muscle weakness disorder);

  • severe liver disease;

  • narrow-angle glaucoma;

  • a severe breathing problem; or

  • sleep apnea (breathing stops during sleep).

To make sure diazepam is safe for you, tell your doctor if you have any of these conditions:

  • open-angle glaucoma;

  • asthma, emphysema, bronchitis, chronic obstructive pulmonary disorder (COPD), or other breathing problems;

  • kidney or liver disease;

  • epilepsy or other seizure disorder;

  • a history of mental illness, depression, or suicidal thoughts or behavior; or

  • a history of drug or alcohol addiction.

Diazepam may be habit forming. Never share diazepam with another person, especially someone with a history of drug abuse or addiction. Keep the medication in a place where others cannot get to it.

FDA pregnancy category D. If you take diazepam for anxiety, alcohol withdrawal, or muscle spasms, do not use this medicine if you are pregnant. It could harm the unborn baby. Use effective birth control, and tell your doctor if you become pregnant during treatment. Diazepam may cause low blood pressure, breathing problems, or addiction and withdrawal symptoms in a newborn if the mother takes the medication during pregnancy.

See also: Pregnancy and breastfeeding warnings (in more detail)

If you take diazepam for seizures, do not start or stop taking diazepam during pregnancy without your doctor's advice. Diazepam may cause harm to an unborn baby, but having a seizure during pregnancy could harm both the mother and the baby. Tell your doctor right away if you become pregnant while taking diazepam for seizures.

Diazepam can pass into breast milk and may harm a nursing baby. You should not breast-feed while using this medicine.

Do not give this medication to a child younger than 6 months old.

The sedative effects of diazepam may last longer in older adults. Accidental falls are common in elderly patients who take benzodiazepines. Use caution to avoid falling or accidental injury while you are taking this medicine.

How should I take diazepam?

Take diazepam exactly as prescribed by your doctor. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Measure liquid medicine with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.

Diazepam should be used for only a short time. Do not take this medication for longer than 12 weeks (3 months) without your doctor's advice.

Do not stop using diazepam suddenly, or you could have increased seizures or unpleasant withdrawal symptoms. Ask your doctor how to safely stop using diazepam.

Call your doctor at once if you feel that this medicine is not working as well as usual, or if you think you need to use more than usual.

While using diazepam, you may need frequent blood tests at your doctor's office.

Store at room temperature away from moisture, heat, and light.

Keep track of the amount of medicine used from each new bottle. Diazepam is a drug of abuse and you should be aware if anyone is using your medicine improperly or without a prescription.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of diazepam can be fatal.

Overdose symptoms may include extreme drowsiness, loss of balance or coordination, limp or weak muscles, or fainting.

What should I avoid?

This medication may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Do not drink alcohol while taking diazepam. This medication can increase the effects of alcohol.

Grapefruit and grapefruit juice may interact with diazepam and lead to unwanted side effects. Discuss the use of grapefruit products with your doctor.

Diazepam side effects

Get emergency medical help if you have any of these signs of an allergic reaction to diazepam: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • confusion, hallucinations, unusual thoughts or behavior;

  • unusual risk-taking behavior, decreased inhibitions, no fear of danger;

  • depressed mood, thoughts of suicide or hurting yourself;

  • hyperactivity, agitation, aggression, hostility;

  • new or worsening seizures;

  • weak or shallow breathing;

  • a feeling like you might pass out;

  • muscle twitching, tremor;

  • loss of bladder control; or

  • little or no urinating.

Common diazepam side effects may include:

  • memory problems;

  • drowsiness, tired feeling;

  • dizziness, spinning sensation;

  • feeling restless or irritable;

  • muscle weakness;

  • nausea, constipation;

  • drooling or dry mouth, slurred speech;

  • blurred vision, double vision;

  • mild skin rash, itching; or

  • loss of interest in sex.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Diazepam Dosing Information

Usual Adult Dose of Diazepam for Anxiety:

Oral: 2 to 10 mg 2 to 4 times a day.
IM or IV: 2 to 5 mg (moderate anxiety) or 5 to 10 mg (severe anxiety) for one dose. May repeat in 3 to 4 hours, if necessary.

Usual Adult Dose of Diazepam for Alcohol Withdrawal:

Oral: 10 mg 3 to 4 times during the first 24 hours, then 5 mg 3 to 4 times a day as needed.
IM or IV: 5 to 10 mg one time. May repeat in 3 to 4 hours, if necessary.

Usual Adult Dose of Diazepam for ICU Agitation:

Initial dose: 0.02 to 0.08 mg/kg IV over 2 to 5 minutes every 0.5 to 2 hours to control acute agitation.
Maintenance dose: 0.4 to 0.2 mg/kg/hr by continuous IV infusion.

Usual Adult Dose of Diazepam for Muscle Spasm:

Oral: 2 to 10 mg 3 to 4 times a day.
IM or IV: 5 to 10 mg initially, then 5 to 10 mg in 3 to 4 hours, if necessary. For tetanus, larger doses may be required.

Usual Adult Dose of Diazepam for Seizures:

Oral: 2 to 10 mg 2 to 4 times a day.
Rectal gel: 0.2 mg/kg, rounded up to the nearest available unit dose. A supplemental dose of 2.5 mg may be added for more precise titration or if a portion of the first dose is expelled. May repeat in 4 to 12 hours. Maximum of 1 episode every 5 days, or 5 episodes per month.

Usual Adult Dose of Diazepam for Endoscopy or Radiology Premedication:

IV: 10 mg or less is usually adequate; however up to 20 mg may be necessary to produce the desired sedation in some patients.
IM: If IV cannot be used, 5 to 10 mg 30 minutes prior to the procedure.
Dosage of narcotics should be reduced by at least a third and in some cases may be omitted.

Usual Adult Dose of Diazepam for Status Epilepticus:

IV or IM: 5 to 10 mg initially (IV preferred).
May be repeated at 10 to 15 minute intervals up to a maximum dose of 30 mg.
If necessary, may be repeated again in 2 to 4 hours.

Usual Adult Dose of Diazepam for Light Anesthesia:

Premedication for Anesthesia:
10 mg, IM (preferred route), 1 to 2 hours before surgery.

Usual Pediatric Dose for Seizures:

Rectal gel:
Infants less than 6 months old: Not recommended; product contains benzoic acid, benzyl alcohol, ethanol 10%, propylene glycol, and sodium benzoate. Prolonged CNS depression has been reported in neonates receiving diazepam.
Infants and Children 6 months to 2 years: Dose not established
2 to 5 years: 0.5 mg/kg, rounded up to the nearest available unit dose.
6 to 11 years: 0.3 mg/kg, rounded up to the nearest available unit dose.
12 years or greater: 0.2 mg/kg, rounded up to the nearest available unit dose.
A supplemental dose of 2.5 mg may be added in 10 minutes for more precise titration or if a portion of the first dose is expelled. May repeat in 4 to 12 hours. Maximum of 1 episode every 5 days, or 5 episodes per month.

Usual Pediatric Dose for Status Epilepticus:

Neonates: IV: (This is not recommended as a first line agent because the injection contains benzoic acid, benzyl alcohol, and sodium benzoate): 0.1 to 0.3 mg/kg/dose given over 3 to 5 minutes, every 15 to 30 minutes to a maximum total dose of 2 mg.

Infants greater than 30 days old and Children: IV: 0.1 to 0.3 mg/kg dose given over 3 to 5 minutes, every 5 to 10 minutes (maximum of 10 mg/dose).

Manufacturer recommendation:

Infants greater than 30 days old and Children less than 5 years: IV: 0.2 to 0.5 mg slow IV every 2 to 5 minutes up to a maximum total dose of 5 mg. Repeat in 2 to 4 hours if needed.

Children greater than or equal to 5 years: IV: 1 mg slow IV every 2 to 5 minutes up to a maximum of 10 mg. Repeat in 2 to 4 hours if needed.

Usual Pediatric Dose for Anxiety:

1 to 12 years:
Oral: 0.12 to 0.8 mg/kg/day in divided doses every 6 to 8 hours as needed.

IM: 0.04 to 0.3 mg/kg every 2 to 4 hours as needed, up to a maximum of 0.6 mg/kg in 8 hours.

Febrile seizure prophylaxis in children: Oral: 1 mg/kg/day orally in divided doses every 8 hours. Initiate therapy at first sign of fever and continue for 24 hours after fever resolves.

Usual Pediatric Dose for Muscle Spasm:

1 to 12 years:
Oral: 0.12 to 0.8 mg/kg/day in divided doses every 6 to 8 hours as needed.

IM: 0.04 to 0.3 mg/kg every 2 to 4 hours as needed, up to a maximum of 0.6 mg/kg in 8 hours.

Febrile seizure prophylaxis in children: Oral: 1 mg/kg/day orally in divided doses every 8 hours. Initiate therapy at first sign of fever and continue for 24 hours after fever resolves.

Usual Pediatric Dose of Diazepam for Seizure Prophylaxis:

1 to 12 years:
Oral: 0.12 to 0.8 mg/kg/day in divided doses every 6 to 8 hours as needed.

IM: 0.04 to 0.3 mg/kg every 2 to 4 hours as needed, up to a maximum of 0.6 mg/kg in 8 hours.

Febrile seizure prophylaxis in children: Oral: 1 mg/kg/day orally in divided doses every 8 hours. Initiate therapy at first sign of fever and continue for 24 hours after fever resolves.

Usual Pediatric Dose for Light Sedation:

Conscious sedation for procedures:
Oral:
1 to 12 years: 0.2 to 0.3 mg/kg orally 45 to 60 minutes before procedure, up to a maximum of 10 mg
13 to 18 years: 5 mg orally 45 to 60 minutes before procedure, may repeat with 2.5 mg dose.

Sedation:
1 to 12 years:
Oral: 0.02 to 0.3 mg/kg every 6 to 8 hours as needed.
IM: 0.04 to 0.3 mg/kg IM every 2 to 4 hours as needed, up to a maximum of 0.6 mg/kg in 8 hours.

13 to 18 years:
Oral: 2 to 10 mg 2 to 4 times a day as needed.
IM or IV: 2 to 10 mg 2 to 4 times a day as needed.

Usual Pediatric Dose for Tetanus:

Less than 1 month: 0.83 to 1.67 mg/kg/hour by continuous IV infusion, or 1.67 to 3.33 mg/kg IV, slowly, every 2 hours (20 to 40 mg/kg/day). Diazepam injection is not recommended as the drug of choice for neonates due to its benzyl alcohol and propylene glycol content.

1 month to 5 years: 1 to 2 mg IM or IV, slowly, repeated every 3 to 4 hours as necessary, or 15 mg/kg/day in divided doses every 2 hours.

Greater than 5 years: 5 to 10 mg IM or IV, slowly, repeated every 3 to 4 hours as necessary.

What other drugs will affect diazepam?

Taking diazepam with other drugs that make you sleepy or slow your breathing can cause dangerous or life-threatening side effects. Ask your doctor before taking diazepam with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.

Tell your doctor about all medicines you use, and those you start or stop using during your treatment with diazepam, especially:

  • cimetidine;

  • omeprazole;

  • phenytoin;

  • an antibiotic--clarithromycin, erythromycin, telithromycin;

  • an antidepressant such as fluoxetine, fluoxetine, and others;

  • antifungal medicine--itraconazole, ketoconazole, voriconazole;

  • heart or blood pressure medication such as diltiazem, nicardipine, quinidine, verapamil, and others; or

  • HIV/AIDS medicine--atazanavir, delavirdine, fosamprenavir, indinavir, nelfinavir, saquinavir, or ritonavir.

This list is not complete. Other drugs may interact with diazepam, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Where can I get more information?

  • Your pharmacist can provide more information about diazepam.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use diazepam only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2014 Cerner Multum, Inc. Version: 12.02. Revision Date: 2013-04-03, 10:02:16 AM.

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