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diazepam

Pronunciation

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

What is diazepam?

Diazepam is a benzodiazepine (ben-zoe-dye-AZE-eh-peens). Diazepam affects chemicals in the brain that may be unbalanced in people with 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.

What is the most important information I should know about diazepam?

You should not use this medicine 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.

Diazepam may be habit-forming. Misuse of habit-forming medicine can cause addiction, overdose, or death.

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

What should I discuss with my healthcare provider before taking diazepam?

You should not use this medicine 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;

  • a severe breathing problem;

  • sleep apnea (breathing stops during sleep); or

  • alcoholism, or addiction to drugs similar to diazepam.

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

  • 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;

  • a history of drug or alcohol addiction; or

  • if you use a narcotic (opioid) medication.

When treating 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.

When treating anxiety, alcohol withdrawal, or muscle spasms: If you take diazepam while you are pregnant, your baby could become dependent on the drug. This can cause life-threatening withdrawal symptoms in the baby after it is born. Babies born dependent on habit-forming medicine may need medical treatment for several weeks. Tell your doctor if you are pregnant or plan to become pregnant.

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

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 diazepam.

Diazepam is not approved for use by anyone younger than 6 months old. Do not give this medicine to a child without a doctor's advice.

How should I take diazepam?

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.

Diazepam may be habit-forming. Misuse of habit-forming medicine can cause addiction, overdose, or death. Selling or giving away this medicine is against the law.

Measure liquid medicine with the dosing syringe provided, or 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 medicine for longer than 4 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. After you have stopped using this medicine, flush any unused pills down the toilet.

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 while taking diazepam?

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

Avoid drinking alcohol. Dangerous side effects could occur.

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 signs of an allergic reaction: 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 side effects may include:

  • drowsiness;

  • tired feeling;

  • muscle weakness; or

  • loss of coordination.

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 for Anxiety:

ORAL:
-Usual dose: 2 to 10 mg orally 2 to 4 times a day

PARENTERAL:
Moderate Anxiety Disorders and Symptoms:
-Usual dose: 2 to 5 mg IM or IV, repeated in 3 to 4 hours if necessary

Severe Anxiety Disorders and Symptoms:
-Usual dose: 5 to 10 mg IM or IV, repeated in 3 to 4 hours if necessary

Comments:
-Oral doses should be determined by the severity of symptoms.
-Anxiety associated with the stress of everyday life usually does not require treatment with this drug.

Use: Management of anxiety disorders and short-term relief of anxiety symptoms

Usual Adult Dose for Alcohol Withdrawal:

ORAL:
-Initial dose: 10 mg orally 3 to 4 times a day for the first 24 hours
-Maintenance dose: 5 mg orally 3 to 4 times a day as needed

PARENTERAL:
-Usual dose: 10 mg IM or IV once, then 5 to 10 mg IM or IV in 3 to 4 hours if necessary

Use: Symptomatic relief of acute agitation, tremor, impending/acute delirium tremens, and hallucinations in acute alcohol withdrawal

Usual Adult Dose for Muscle Spasm:

ORAL:
-Usual dose: 2 to 10 mg orally 3 to 4 times a day

PARENTERAL:
-Usual dose: 5 to 10 mg IM or IV, then 5 to 10 mg IM or IV in 3 to 4 hours if necessary

Comment:
-Larger parenteral doses may be necessary for patients with tetanus.

Use: Adjunctive treatment for the relief of skeletal muscle spasm due to reflex spasm to local pathology, spasticity caused by upper motor neuron disorders, athetosis, and stiff-man syndrome (e.g., inflammation of the muscles/joints secondary to trauma, cerebral palsy, paraplegia)

Usual Adult Dose for Seizures:

ORAL:
-Usual dose: 2 to 10 mg orally 2 to 4 times a day

RECTAL:
-Initial dose: 0.2 mg/kg rectally, rounded upward to the next available dose. A 2.5 mg rectal dose may be given as a partial replacement if patients expel a portion of the initial dose
-If necessary, a second dose of 0.2 mg/kg may be given rectally 4 to 12 hours after the first dose.
-Maximum Frequency: May be used to treat up to 1 seizure episode every 5 days, and no more than 5 episodes/month

Uses:
-Management of selected, refractory patients with epilepsy on stable regimens of antiepileptic drugs who require intermittent use of this drug to control bouts of increased seizure activity
-Adjunctive treatment for convulsive disorders

Usual Adult Dose for Endoscopy or Radiology Premedication:

PARENTERAL:
Cardioversion:
-Usual dose: 5 to 15 mg once 5 to 10 minutes before the procedure

Endoscopic Procedures:
-Usual IV dose: Usually less than 10 mg, but some patients require up to 20 mg IV, especially when narcotics are omitted
-IV titration: The IV dose should be titrated to desired sedative response (e.g., slurring of speech) with slow administration immediately before the procedure.
-Usual IM dose: 5 to 10 mg IM once 30 minutes prior to the procedure

Comments:
-Narcotic dosing should be reduced by approximately 33%, and may be omitted in some patients.
-The IV route is preferred, but IM administration may be used if IV administration is not possible.

Uses:
-Adjunct prior to endoscopic procedures if apprehension, anxiety, or acute stress reactions are present and to diminish recall of the procedures
-Prior to cardioversion for the relief of anxiety and tension and to diminish the patient's recall of the procedure

Usual Adult Dose for Status Epilepticus:

PARENTERAL:
-Initial dose: 5 to 10 mg IV once, repeated at 10 to 15 minute intervals to a maximum dose of 30 mg if necessary

Comments:
-The IV route is preferred; however, the IM route may be used if IV administration is impossible.
-Treatment may be repeated every 2 to 4 hours, but active metabolites may persist during readministration.
-Patients with chronic lung disease or unstable cardiovascular conditions should be given this drug with extreme caution.

Use: Adjunct to status epilepticus and severe recurrent convulsive seizures

Usual Adult Dose for Light Anesthesia:

PARENTERAL:
Preoperative Medication:
-Usual dose: 10 mg IM once before surgery

Comments:
-The IM route is preferred when given as a preoperative medication.
-Atropine, scopolamine, and other premedications should be administered in separate syringes.

Use: Premedication for the relief of anxiety and tension in patients undergoing surgical procedures

Usual Geriatric Dose for Seizures:

ORAL:
-Initial dose: 2 to 2.5 mg orally once to 2 times a day

RECTAL:
-Initial dose: 0.2 mg/kg rectally, rounded downward to the next available dose. A 2.5 mg rectal dose may be given as a partial replacement if patients expel a portion of the initial dose
-If necessary, a second dose of 0.2 mg/kg may be given rectally 4 to 12 hours after the first dose.
-Maximum Frequency: May be used to treat up to 1 seizure episode every 5 days, and no more than 5 episodes/month

Comment:
-Oral doses may be increased gradually as needed and tolerated, but should be limited to the smallest effective amount

Uses:
-Management of selected, refractory patients with epilepsy on stable regimens of antiepileptic drugs who require intermittent use of this drug to control bouts of increased seizure activity
-Adjunctive treatment in convulsive disorders

Usual Geriatric Dose for Alcohol Withdrawal:

ORAL:
-Initial dose: 2 to 2.5 mg orally once to 2 times a day

PARENTERAL:
-Initial dose: 2 to 5 mg IM or IV, repeated in 3 to 4 hours if necessary

Comments:
-Doses may be increased gradually as needed and tolerated, but should be limited to the smallest effective amount.
-Maintenance doses should be determined by clinical need and patient tolerance.

Uses:
-Management of anxiety disorders and short-term relief of anxiety symptoms
-Symptomatic relief of acute agitation, tremor, impending/acute delirium tremens, and hallucinations in acute alcohol withdrawal
-Adjunctive treatment for the relief of skeletal muscle spasm due to reflex spasm to local pathology, spasticity caused by upper motor neuron disorders, athetosis, and stiff-man syndrome (e.g., inflammation of the muscles/joints secondary to trauma, cerebral palsy, paraplegia)

Usual Geriatric Dose for Anxiety:

ORAL:
-Initial dose: 2 to 2.5 mg orally once to 2 times a day

PARENTERAL:
-Initial dose: 2 to 5 mg IM or IV, repeated in 3 to 4 hours if necessary

Comments:
-Doses may be increased gradually as needed and tolerated, but should be limited to the smallest effective amount.
-Maintenance doses should be determined by clinical need and patient tolerance.

Uses:
-Management of anxiety disorders and short-term relief of anxiety symptoms
-Symptomatic relief of acute agitation, tremor, impending/acute delirium tremens, and hallucinations in acute alcohol withdrawal
-Adjunctive treatment for the relief of skeletal muscle spasm due to reflex spasm to local pathology, spasticity caused by upper motor neuron disorders, athetosis, and stiff-man syndrome (e.g., inflammation of the muscles/joints secondary to trauma, cerebral palsy, paraplegia)

Usual Geriatric Dose for Muscle Spasm:

ORAL:
-Initial dose: 2 to 2.5 mg orally once to 2 times a day

PARENTERAL:
-Initial dose: 2 to 5 mg IM or IV, repeated in 3 to 4 hours if necessary

Comments:
-Doses may be increased gradually as needed and tolerated, but should be limited to the smallest effective amount.
-Maintenance doses should be determined by clinical need and patient tolerance.

Uses:
-Management of anxiety disorders and short-term relief of anxiety symptoms
-Symptomatic relief of acute agitation, tremor, impending/acute delirium tremens, and hallucinations in acute alcohol withdrawal
-Adjunctive treatment for the relief of skeletal muscle spasm due to reflex spasm to local pathology, spasticity caused by upper motor neuron disorders, athetosis, and stiff-man syndrome (e.g., inflammation of the muscles/joints secondary to trauma, cerebral palsy, paraplegia)

Usual Pediatric Dose for Seizures:

ORAL:
6 months and older:
-Initial dose: 1 to 2.5 mg orally 3 to 4 times a day

RECTAL:
2 to 5 years:
-Initial dose: 0.5 mg/kg rectally, rounded upward to the next available dose. A 2.5 mg rectal dose may be given as a partial replacement if patients expel a portion of the initial dose
-If necessary, a second dose of 0.5 mg/kg may be given rectally 4 to 12 hours after the first dose.
-Maximum Frequency: 1 episode every 5 days, and no more than 5 episodes/month

6 to 11 years:
-Initial dose: 0.3 mg/kg rectally, rounded upward to the next available dose. A 2.5 mg rectal dose may be given as a partial replacement if patients expel a portion of the initial dose
-If necessary, a second dose of 0.3 mg/kg may be given rectally 4 to 12 hours after the first dose.
-Maximum Frequency: 1 episode every 5 days, and no more than 5 episodes/month

12 years and older:
-Initial dose: 0.2 mg/kg rectally, rounded upward to the next available dose. A 2.5 mg rectal dose may be given as a partial replacement if patients expel a portion of the initial dose
-If necessary, a second dose of 0.2 mg/kg may be given rectally 4 to 12 hours after the first dose.
-Maximum Frequency: May be used to treat up to 1 seizure episode every 5 days, and no more than 5 episodes/month

Comment:
-Oral doses may be increased gradually as needed and tolerated, but should be limited to the smallest effective amount

Uses:
-Management of selected, refractory patients with epilepsy on stable regimens of antiepileptic drugs who require intermittent use of this drug to control bouts of increased seizure activity
-Adjunctive treatment in convulsive disorders

Usual Pediatric Dose for Status Epilepticus:

PARENTERAL:
IV Injection:
30 days to less than 5 years:
-Usual dose: 0.2 to 0.5 mg slow IV injection every 2 to 5 minutes, up to a maximum dose of 5 mg. Repeat in 2 to 4 hours if needed.

5 years and older:
-Usual dose: 1 mg slow IV injection every 2 to 5 minutes, up to a maximum dose of 10 mg. Repeat in 2 to 4 hours if needed.

Comment:
-EEG monitoring may be helpful to monitor seizure activity.

Use: Adjunct in status epilepticus and severe recurrent convulsive seizures

Usual Pediatric Dose for Anxiety:

ORAL:
6 months and older:
-Initial dose: 1 to 2.5 mg orally 3 to 4 times a day

Comments:
-Doses may be increased gradually as needed and tolerated, but should be limited to the smallest effective amount.
-Maintenance doses should be determined by clinical need and patient tolerance.

Uses:
-Management of anxiety disorders and short-term relief of anxiety symptoms
-Symptomatic relief of acute agitation, tremor, impending/acute delirium tremens, and hallucinations in acute alcohol withdrawal
-Adjunctive treatment for the relief of skeletal muscle spasm due to reflex spasm to local pathology, spasticity caused by upper motor neuron disorders, athetosis, and stiff-man syndrome (e.g., inflammation of the muscles/joints secondary to trauma, cerebral palsy, paraplegia)

Usual Pediatric Dose for Muscle Spasm:

ORAL:
6 months and older:
-Initial dose: 1 to 2.5 mg orally 3 to 4 times a day

Comments:
-Doses may be increased gradually as needed and tolerated, but should be limited to the smallest effective amount.
-Maintenance doses should be determined by clinical need and patient tolerance.

Uses:
-Management of anxiety disorders and short-term relief of anxiety symptoms
-Symptomatic relief of acute agitation, tremor, impending/acute delirium tremens, and hallucinations in acute alcohol withdrawal
-Adjunctive treatment for the relief of skeletal muscle spasm due to reflex spasm to local pathology, spasticity caused by upper motor neuron disorders, athetosis, and stiff-man syndrome (e.g., inflammation of the muscles/joints secondary to trauma, cerebral palsy, paraplegia)

Usual Pediatric Dose for Seizure Prophylaxis:

ORAL:
6 months and older:
-Initial dose: 1 to 2.5 mg orally 3 to 4 times a day

Comments:
-Doses may be increased gradually as needed and tolerated, but should be limited to the smallest effective amount.
-Maintenance doses should be determined by clinical need and patient tolerance.

Uses:
-Management of anxiety disorders and short-term relief of anxiety symptoms
-Symptomatic relief of acute agitation, tremor, impending/acute delirium tremens, and hallucinations in acute alcohol withdrawal
-Adjunctive treatment for the relief of skeletal muscle spasm due to reflex spasm to local pathology, spasticity caused by upper motor neuron disorders, athetosis, and stiff-man syndrome (e.g., inflammation of the muscles/joints secondary to trauma, cerebral palsy, paraplegia)

Usual Pediatric Dose for Tetanus:

PARENTERAL:
30 days to 5 years:
-Usual dose: 1 to 2 mg IM or slow IV injection, repeated every 3 to 4 hours as necessary

5 years and older:
-Usual dose: 5 to 10 mg IM or slow IV injection, repeated every 3 to 4 hours as necessary to control spasms

Comment:
-Respiratory assistance should be available for patients.

Use: Tetanus

What other drugs will affect diazepam?

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

Tell your doctor about all your current medicines and any you start or stop using, especially:

  • cimetidine;

  • disulfiram (Antabuse);

  • omeprazole;

  • phenytoin;

  • an antibiotic--clarithromycin, erythromycin, telithromycin;

  • an antidepressant such as 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 this medication 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 1996-2012 Cerner Multum, Inc. Version: 13.04.

Date modified: January 10, 2017
Last reviewed: December 14, 2016

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