Valium Side Effects

Generic Name: diazepam

Note: This page contains side effects data for the generic drug diazepam. It is possible that some of the dosage forms included below may not apply to the brand name Valium.

It is possible that some side effects of Valium may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.

For the Consumer

Applies to diazepam: oral capsule extended release, oral solution, oral tablet

As well as its needed effects, diazepam (the active ingredient contained in Valium) may cause unwanted side effects that require medical attention.

If any of the following side effects occur while taking diazepam, check with your doctor immediately:

More common
  • Shakiness and unsteady walk
  • unsteadiness, trembling, or other problems with muscle control or coordination
Incidence not known
  • Abdominal or stomach pain
  • agitation
  • anxiety
  • black, tarry stools
  • blistering, flaking, or peeling of skin
  • blurred vision
  • changes in patterns and rhythms of speech
  • chills
  • confusion
  • cough
  • dark urine
  • decrease in frequency of urination
  • decrease in urine volume
  • difficulty in passing urine (dribbling)
  • discouragement
  • dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly
  • false beliefs that cannot be changed by facts
  • fast heartbeat
  • fast or irregular breathing
  • feeling sad or empty
  • feeling that others are watching you or controlling your behavior
  • feeling that others can hear your thoughts
  • feeling, seeing, or hearing things that are not there
  • fever
  • headache
  • hyperexcitability
  • increased muscle spasms or tone
  • irritability
  • itching
  • lack of appetite
  • lack of memory of what takes place after a certain event
  • loss of appetite
  • loss of bladder control
  • loss of interest or pleasure
  • lower back or side pain
  • mood or other mental changes
  • nausea
  • nervousness
  • nightmares
  • outbursts of anger
  • painful or difficult urination
  • pale skin
  • rash
  • restlessness
  • seizures
  • shakiness in the legs, arms, hands, or feet
  • shortness of breath
  • sleeplessness
  • slurred speech
  • sore throat
  • sweating
  • trembling or shaking of the hands or feet
  • tremor
  • trouble concentrating
  • trouble in speaking
  • trouble sleeping
  • ulcers, sores, or white spots in the mouth
  • unable to sleep
  • unpleasant breath odor
  • unusual behavior
  • unusual bleeding or bruising
  • unusual feeling of excitement
  • unusual tiredness or weakness
  • vomiting of blood
  • yellow eyes or skin

If any of the following symptoms of overdose occur while taking diazepam, get emergency help immediately:

Symptoms of overdose
  • Change in consciousness
  • difficult or troubled breathing
  • irregular, fast or slow, or shallow breathing
  • lack of coordination
  • loss of consciousness
  • loss of strength or energy
  • muscle pain or weakness
  • pale or blue lips, fingernails, or skin
  • sleepiness
  • unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness

Some diazepam side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:

Incidence not known
  • Constipation
  • decreased interest in sexual intercourse
  • diarrhea
  • difficulty in swallowing
  • double vision
  • dry mouth
  • feeling of constant movement of self or surroundings
  • inability to have or keep an erection
  • increase in sexual ability, desire, drive, or performance
  • increased interest in sexual intercourse
  • increased watering of mouth
  • indigestion
  • loss of sexual ability, desire, drive, or performance
  • passing of gas
  • seeing double
  • sensation of spinning

For Healthcare Professionals

Applies to diazepam: injectable solution, intravenous suspension, oral capsule extended release, oral concentrate, oral solution, oral tablet, rectal kit

Nervous system

One study has suggested that the acute pharmacodynamic profile of diazepam (the active ingredient contained in Valium) with respect to euphoria and subject liking is similar to barbiturates.

Another study has suggested that long-term benzodiazepine therapy may be associated with significant cognitive impairments which may persist following benzodiazepine withdrawal.

Cases of paradoxical reactions to diazepam (increased agitation and hyperactivity) have been reported rarely.[Ref]

Nervous system side effects are common and include drowsiness, fatigue, confusion, depression, psychomotor impairment, cognitive impairment, headache, syncope, slurred speech, tremor, vertigo, dysarthria, dizziness, and ataxia. Acute dystonic reactions and coma have been rarely reported.[Ref]

Local

One recent study has reported that a palpable venous cord was present in as many as 23% of patients treated with intravenous diazepam (the active ingredient contained in Valium) [Ref]

Local reactions at the site of injection (such as venous thrombosis, phlebitis, local irritation and swelling) occur in about 8% of patients. Rarely, vascular impairment has occurred, sometimes with severe consequences. Diazepam emulsified injection (Dizac) has been associated with a lower frequency of thrombophlebitis and pain on injection. (Diazepam emulsified injection has been approved for intravenous use only.)[Ref]

Psychiatric

Psychiatric side effects have included stimulation, restlessness, acute hyperexcited states, anxiety, agitation, aggressiveness, irritability, rage, hallucinations, psychoses, delusions, insomnia, sleep disturbances, and nightmares. Inappropriate behavior and other adverse behavioral effects have been reported when using benzodiazepines.

Should these occur, use of the drug should be discontinued. These side effects are more likely to occur in children and in the elderly.

Respiratory

Diazepam (the active ingredient contained in Valium) particularly when given by parenteral routes of administration may decrease the sensitivity of upper airway reflexes and thereby increase the risk of aspiration.[Ref]

Respiratory arrest may occur, especially with parenteral administration of diazepam. Equipment for resuscitation should be immediately available when parenteral diazepam is used.[Ref]

Other

Some investigators have also suggested that the presence of psychosensory symptoms such as depersonalization, derealization, and perceptual distortion are a unique feature of the withdrawal syndrome. A recent study which confirmed that an increase in symptoms often accompanies withdrawal, concluded that withdrawal symptoms were neither intense nor excessively difficult for patients following discontinuation of low-dose diazepam (the active ingredient contained in Valium) [Ref]

Withdrawal symptoms after abrupt cessation of diazepam may include convulsions, tremor, abdominal cramps, panic attacks, depression, vomiting, anxiety, agitation, insomnia and sweating. Catatonia following benzodiazepine withdrawal has been reported in five patients, two of whom withdrew from diazepam.[Ref]

Gastrointestinal

Gastrointestinal effects include constipation, gastrointestinal disturbances, and nausea. Changes in salivation have also been reported including dry mouth and hypersalivation.[Ref]

Genitourinary

Genitourinary effects such as sexual dysfunction, incontinence, changes in libido, and urinary retention have been reported.[Ref]

Hypersensitivity

Hypersensitivity side effects including rash, pruritus, and severe bronchospasm have been rarely reported.[Ref]

Hepatic

Hepatic effects including granulomatous hepatitis have been reported. Elevated liver function tests have been rarely reported. Periodic monitoring of liver function tests is recommended for patients on long-term diazepam (the active ingredient contained in Valium) therapy, particularly for patients with preexisting liver disease.[Ref]

Hematologic

Neutropenia has been rarely reported. Periodic monitoring of blood counts may be useful in patients on long term diazepam (the active ingredient contained in Valium) therapy.[Ref]

Endocrine

Endocrine side effects including a single case of gynecomastia has been reported in association with diazepam (the active ingredient contained in Valium) therapy.[Ref]

Musculoskeletal

Musculoskeletal side effects have included increased muscle spasticity. One case report has suggested that diazepam (the active ingredient contained in Valium) may contribute to rhabdomyolysis in patients with hyponatremia. There are postmarketing reports of falls and fractures in benzodiazepine users. The risk is increased in those taking concomitant sedatives (including alcoholic beverages) and in the elderly.[Ref]

Cardiovascular

Cardiovascular effects of diazepam (the active ingredient contained in Valium) including hypotension and possible anti-ischemic effects by reducing myocardial oxygen consumption have been reported.[Ref]

Ocular

Ocular side effects including blurred vision and diplopia have been reported. A case of maculopathy has also been reported.[Ref]

Other

A case of acute febrile neutrophilic dermatosis (Sweet's syndrome) has been reported consisting of an acute painful rash, high fever, and severe arthralgias.[Ref]

Dermatologic

Dermatologic side effects including skin reactions have been reported.

References

1. Rickels K, Downing RW, Case GW, et al "Six-week trial with diazepam: some clinical observations." J Clin Psychiatry 46 (1985): 470-4

2. Smith VM "Paradoxical reactions to diazepam." Gastrointest Endosc 41 (1995): 182-3

3. Greenblatt DJ, Koch-Weser J "Clinical toxicity of chlordiazepoxide and diazepam in relation to serum albumin concentration: a report from the Boston collaborative drug surveillance program." Eur J Clin Pharmacol 7 (1974): 259-62

4. Greenblatt DJ, Shader RI, Abernethy DR "Current status of benzodiazepines (second of two parts): clinical use of benzoidazepines." N Engl J Med 309 (1983): 410-6

5. Donaldson D, Gibson G "System complications with intravenous diazepam." Oral Surg Oral Med Oral Patho 49 (1980): 126-30

6. Hooker EA, Danzl DF "Acute dystonic reaction due to diazepam." J Emerg Med 6 (1988): 491-3

7. Sullivan JT, Jasinski DR, Johnson RE "Single-dose pharmacodynamics of diazepam and pentobarbital in substance abusers." Clin Pharmacol Ther 54 (1993): 645-53

8. Tata PR, Rollings J, Collins M, Pickering A, Jacobson RR "Lack of cognitive recovery following withdrawal from long-term benzodiazepine use." Psychol Med 24 (1994): 203-13

9. Eldridge PR, Punt JA "Risks associated with giving benzodiazepines to patients with acute neurological injuries." Br Med J 300 (1990): 1189-90

10. Fontaine R, Chouinard G, Annable L "Rebound anxiety in anxious patients after abrupt withdrawal of benzodiazepine treatment." Am J Psychiatry 141 (1984): 848-52

11. Balon R, Ramesh C, Pohl R "Sexual dysfunction associated with diazepam but not with clonazepam." Can J Psychiatry 34 (1989): 947-8

12. Busto U, Kaplan HL, Zawertailo L, Sellers EM "Pharmacologic effects and abuse liability of bretazenil, diazepam, and alprazolam in humans." Clin Pharmacol Ther 55 (1994): 451-63

13. Litchfield NB "Venous complications of intravenous diazepam." J Oral Maxillofac Surg 41 (1983): 701-5

14. Deardon DJ, Bird GL "Acute (type 1) hypersensitivity to intravenous diazemuls." Br J Anaesth 59 (1987): 391

15. Carrougher JG, Kadakia S, Shaffer RT, Barrilleaux C "Venous complications of midazolam versus diazepam." Gastrointest Endosc 39 (1993): 396-9

16. Tin LNW, Elalaoui MY, Akula E "Arterial spasm after administration of diazepam." Br J Anaesth 72 (1994): 139

17. von Dardel O, Mebius C, Mossberg T "Diazepam in emulsion form for intravenous usage." Acta Anaesthesiol Scand 20 (1976): 221-4

18. "Product Information. Dizac (diazepam)." Ohmeda Pharmaceutical Products Division, Liberty Corner, NJ.

19. Murphy PJ, Erskine R, Langton JA "The effect of intravenously administered diazepam, midazolam and flumazenil on the sensitivity of upper airway reflexes." Anaesthesia 49 (1994): 105-10

20. Robinson GM, Sellers EM "Diazepam withdrawal seizures." Can Med Assoc J 126 (1982): 944-5

21. Rosebush PI, Mazurek MF "Catatonia after benzodiazepine withdrawal." J Clin Psychopharmacol 16 (1996): 315-9

22. Hayward P, Wardle J, Higgitt A, Gray J "Changes in ''withdrawal symptoms'' following discontinuation of low-dose diazepam." Psychopharmacology (Berl) 125 (1996): 392-7

23. Schifano F, Magni G "Panic attacks and major depression after discontinuation of long-term diazepam abuse." DICP 23 (1989): 989-90

24. Roy-Byrne PP, Sullivan MD, Cowley DS, Ries RK "Adjunctive treatment of benzodiazepine discontinuation syndromes - a review." J Psychiatr Res 27 Suppl (1993): 143-53

25. Klotz U, Avant GR, Hoyumpa A, Schenker S, Wikinson GR "The effects of age and liver disease on the disposition and elimination of diazepam in adult man." J Clin Invest 55 (1975): 347-59

26. Podevin P, Biour M "Drug-induced ''allergic hepatitis''." Clin Rev Allergy Immunol 13 (1995): 223-44

27. Tedesco FJ, Mills LR "Diazepam (valium) hepatitis." Dig Dis Sci 27 (1982): 470-2

28. Llop R, Gomez-Farran F, Figueras A, Capella D, LaPorte JR "Gynecomastia associated with enalapril and diazepam." Ann Pharmacother 28 (1994): 671-2

29. Fernandez-Real JM, Ricart-Engel W, Camafort-Babkowski M "Hyponatremia and benzodiazepines result in rhabdomyolysis." Ann Pharmacother 28 (1994): 1200-1

30. Rossetti E, Fragasso G, Xuereb RG, Xuereb M, Margonato A, Chierchia SL "Antiischemic effects of intravenous diazepam in patients with coronary artery disease." J Cardiovasc Pharmacol 24 (1994): 55-8

31. Manners TD, Clarke MP "Maculopathy associated with diazepam." Eye 9 (1995): 660-2

32. Franco RC "Diazepam-associated Sweet's syndrome." Int J Dermatol 39 (2000): 795-8

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