Diazepam
Diazepam
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 a liquid oral form of the drug available, and diazepam is also available as a rectal gel, marketed as Diastat AcuDial®.
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 more unusual 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
KEY TERMS
Albumin —A simple protein that is widely distributed in human blood.
Anxiety —A feeling of apprehension and fear characterized by physical symptoms (heart palpitations, sweating, and feelings of stress, for example).
Benzodiazepines —A group of central nervous system depressants used to relieve anxiety or to induce sleep.
Glaucoma —A group of eye diseases characterized by increased pressure within the eye significant enough to damage eye tissue and structures. If untreated, glaucoma results in blindness.
Tranquilizer —A medication that induces a feeling of calm and relaxation.
antifungal drugs, such as fluconazole. Alcohol should not be used when taking diazepam and other benzodiazepine drugs. There may also be an interaction between this drug and grapefruit juice. 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.
Those who rely on urine tests to monitor blood sugar should know that this drug can produce false results with tests using Clinistix and Diastix, and that they should instead use TesTape for urine testing of sugar.
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 ed. 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.
OTHER
National Library of Medicine. National Institutes of Health. “Diazepam.” <http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682047.html>.
U.S. Food and Drug Administration. “Diazepam Rectal Gel, Patient Information.” <http://www.fda.gov/CDER/DRUG/InfoSheets/patient/diazepam_RGPIS.pdf>.
U.S. Food and Drug Administration. “Diazepam Rectal Gel Drug Information Sheet.” <http://www.fda.gov/cder/foi/label/2005/020648s008lbl.pdf>.
Mark Mitchell, MD
Emily Jane Willingham, PhD
Diazepam
Diazepam
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 DrugReference 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'sThe 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 MedicalDictionary. 19th ed. Philadelphia: F. A. Davis, 2001.
Mark Mitchell, M.D.
Diazepam
Diazepam
Definition
Diazepam is an antianxiety medication that is also useful in the treatment of muscle spasms and some types of seizures . The drug belongs to the class of medications known as benzodiazepines that depress activity of the central nervous system .
Purpose
Diazepam, which is marketed under the brand names of Valium, Diastat, T-Quil, and Valrelease, is taken by millions of people to relieve feelings of anxiety. As well, the drug can lessen muscle spasms and can control some types of seizures. Diazepam is also used to therapeutically lessen the agitation caused during alcohol withdrawal by someone who is physically addicted to alcohol. Additionally, diazepam is used in the treatment of irritable bowel syndrome and to lessen the symptoms of panic attacks.
Description
Diazepam is supplied as a tablet, as a capsule that releases the active drug at a slower rate, or as a liquid. All three of these forms of the drug are taken orally. The time-release capsule should be swallowed whole. Diazepam should be stored at room temperature in a tightly closed container to avoid alteration in the compound due to excessive heat or moisture. Valium is also available in an injectable form.
Recommended dosage
Diazepam dosage is determined by a physician taking into account the nature of the problem, severity of the symptoms, and the person's response to the drug. Typical adult doses range from 2–10 mg taken two to four times a day. Children and elderly adults will typically receive 1–2 mg one to four times daily.
The dosage of diazepam typically prescribed by a physician is taken anywhere from one to four times each day, depending on the strength of the individual dose. This maintains the concentration of the drug at a therapeutic level, as diazepam is quickly absorbed from the gastrointestinal tract. Peak levels of the drug are reached within a couple of hours after administration, with levels dropping below therapeutic effectiveness within six to eight hours.
Diazepam can be taken with or without food. The liquid form can be mixed with other fluids or select foods such as applesauce.
Precautions
The recommended dosage should not be exceeded, nor should it continue to be taken after the prescribed time. Such abuse can lead to a dependence on the drug, or the establishment of tolerance. As the effectiveness of diazepam is related to its concentration, it is important to take the drug regularly. Doses should not be skipped as this could lead to a worsening of the symptoms.
Diazepam should not be taken with other central nervous system depressants such as narcotics, sleeping pills, or alcohol. The combinations could lower blood pressure and suppress breathing to the point of unconsciousness and death.
Persons taking diazepam should exercise extreme caution when driving or operating machinery. These activities should be avoided during periods of drowsiness associated with diazepam therapy.
Pregnant and breast-feeding woman should not take diazepam, nor should someone with myasthenia gravis . The drug should be used cautiously in those with epilepsy , as diazepam may trigger an epileptic seizure.
Side effects
Some people are allergic to diazepam. In this case, other drugs can be substituted. These include alprazolam (Xanax), chlordiazepoxide (Librium), and triazolam (Halcion).
Common side effects from diazepam include drowsiness, dizziness , blurred vision, headache , fatigue , muscle weakness, memory loss, skin rash, diarrhea, dry mouth, stomach upset, decreased sexual drive, and an altered appetite. Less common side effects include jaundice, decreased white blood cell count (leukopenia), insomnia, hallucinations, and irritability.
Interactions
Diazepam can interact with other prescription medicines, especially antihistamines, as well as cimetidine (Tagamet), disulfiram (Antabuse), and fluoxetine (Prozac). Additionally, interaction can occur with medications given for the relief of depression , pain , Parkinson's disease , asthma, and colds, and with muscle relaxants, oral contraceptives, sedatives and sleeping pills, tranquilizers, and even some vitamins. In general, the result of the interaction is to increase the drowsiness caused by diazepam.
Resources
BOOKS
Diazepam: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References. San Diego: Icon Health International, 2004.
OTHER
"Diazepam." Drugs.com. May 5, 2004 (May 22, 2004.) <http://www.drugs.com/diazepam.html>.
"Diazepam." Medline Plus. National Library of Medicine. May 5, 2004 (May 22, 2004). <http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682047.html>.
Brian Douglas Hoyle, PhD
diazepam
di·az·e·pam / dīˈazəˌpam/ • n. a tranquilizing muscle-relaxant drug, C16H13N2OCl, used chiefly to relieve anxiety. Also called Valium.