Diazepam: 7 things you should know
Medically reviewed by Carmen Fookes, BPharm. Last updated on Jan 29, 2021.
1. How it works
- Diazepam may be used for the short-term treatment of anxiety and seizure disorders.
- Diazepam acts on nerve cells to calm abnormal electrical activity within the brain.
- Diazepam calms and sedates and may be used in the treatment of anxiety, as an anticonvulsant, as a muscle relaxant, or for its sedative effects.
- Experts aren't exactly sure how diazepam works, but believe its effects are due to its ability to strongly bind to the GABA-benzodiazepine receptor complex, which enhances the affinity for GABA (a neurotransmitter that blocks impulses between nerve cells in the brain). Low levels of GABA have been linked to anxiety, mood disorders, seizure disorders, and pain.
- Diazepam belongs to the class of medicines known as benzodiazepines.
- May be used for the short-term relief of anxiety, to relieve symptoms associated with alcohol withdrawal, and to relieve muscle spasms.
- Can also be used in the treatment of prolonged seizures in conjunction with other anti-seizure medications.
- May also be used off-label, that is, prescribed for conditions that are not FDA-approved. Usually, the use of diazepam in these conditions is well established.
- Generic diazepam is available.
If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:
- Drowsiness, muscle weakness, and unsteadiness upon standing, increasing the risk of falls.
- May also cause confusion, depression, headache, gastrointestinal disturbances, blurred vision, and low blood pressure.
- Amnesia is more likely to occur at higher dosages and has been associated with antisocial behavior.
- May impair reaction skills and affect a person's ability to drive or operate machinery. Avoid alcohol (can enhance the sedative effect).
- Diazepam is potentially addictive and may cause emotional and physical dependence. The lowest dose should be used for the shortest possible time. Diazepam supplies may be sought out by drug seekers.
- Withdrawal symptoms (including convulsions, tremors, cramps, vomiting, sweating, or insomnia) may occur with abrupt discontinuation of extended therapy; taper off slowly under a doctor's supervision.
- May rarely cause respiratory depression (unusually slow and shallow breathing). The risk is greater with larger dosages of diazepam, in people with pre-existing respiratory conditions, or if diazepam is used in addition to other medications that also cause respiratory depression (such as opioids).
- As with other anticonvulsants, diazepam may increase the risk of suicidal thoughts or behavior which may be noticeable as early as 1 week following administration.
- Occasionally, paradoxical reactions (the opposite of what is to be expected) may occur. Symptoms include anxiety, agitation, rage, sleep disturbances, sexual disinhibition, or hallucinations.
- May interact with a number of other medications including opioids, other medications that cause sedation (such as alcohol, antipsychotics, antidepressants, or sedative antihistamines), clozapine, probenecid, and valproate.
- May not be suitable for some people including those with pre-existing respiratory disease (such as COPD or sleep apnea), acute narrow-angle glaucoma, a history of drug or alcohol abuse, at high risk of falls, women who are pregnant, or people with kidney or liver disease. The elderly or frail may be especially sensitive to diazepam's effects. Women should not breastfeed their babies while receiving diazepam.
Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects
4. Bottom Line
Diazepam may be used occasionally to relieve anxiety and prolonged seizures; however, it is addictive and withdrawal symptoms can be severe.
- May be taken with or without food. Swallow whole with a glass of water.
- Take exactly as directed by your doctor. Do not increase or decrease the dosage without his or her advice. May be given as split doses, with the largest dose just before bedtime, but talk to your doctor before doing this. If you have been taking diazepam for a long period of time do not stop suddenly as withdrawal reactions (blurred vision, insomnia, sweating, rarely seizures) may occur. Your doctor will advise you on how to taper off the dose. Keep out of sight of potential drug seekers.
- Avoid operating machinery, driving, or performing tasks that require mental alertness while taking this medicine.
- Grapefruit juice or grapefruit products may increase blood levels of diazepam; avoid concurrent use.
- Mix the concentrated oral solution (Diazepam Intensol) with liquids or semisolid food (such as water, applesauce, puddings), using only the calibrated dropper provided.
- Paradoxical reactions (the opposite of what is expected), such as over-excitation, anxiety, hallucinations, insomnia, and rage have been reported; seek medical advice if these occur.
- Avoid drinking alcohol while taking diazepam because it may enhance the side effects of sedation and respiratory depression.
- Diazepam may make you feel dizzy, increasing your risk of falls. Be careful when sitting or standing up after lying down.
- If you think you have become dependent on diazepam or addicted to it, talk with your doctor.
- Do not take any other medications with diazepam including those bought over the counter without first checking with your pharmacist or doctor that they are compatible.
- If your mood changes or you experience depression or a worsening of depression, talk with your doctor.
- Do not use diazepam if you are allergic to it or other benzodiazepines like alprazolam, lorazepam, or oxazepam.
- Do not start or discontinue diazepam during pregnancy without speaking to your doctor first.
6. Response and effectiveness
- The peak effects of diazepam are seen within 1 to 1.5 hours in most people.
- Diazepam is metabolized to active metabolites and its effects may last for more than 24 hours and extend with repeated dosing as the drug accumulates in the body.
Medicines that interact with diazepam may either decrease its effect, affect how long it works, increase side effects, or have less of an effect when taken with diazepam. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.
Common medications that may interact with diazepam include:
- anti-anxiety medications, including other benzodiazepines, such as lorazepam and oxazepam
- anticonvulsants such as valproate
- antidepressants, such as amitriptyline, imipramine, nortriptyline
- antihistamines that cause sedation, such as diphenhydramine
- monoamine oxidase inhibitors, such as selegiline, isocarboxazid, or phenelzine
- opioid analgesics such as codeine, oxycodone and morphine
- oral contraceptives
- muscle relaxants such as cyclobenzaprine
- sleeping pills, such as zolpidem
- some medications used to treat mental illness, such as clozapine and thioridazine
Alcohol may worsen the side effects of diazepam such as drowsiness and dizziness.
Note that this list is not all-inclusive and includes only common medications that may interact with diazepam. You should refer to the prescribing information for diazepam for a complete list of interactions.
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- Drug class: benzodiazepine anticonvulsants
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Related treatment guides
- Diazepam. Revised 11/2020. ASHP. https://www.drugs.com/monograph/diazepam.html
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.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
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