Valium - Diazepam (diazepam)
Diazepam is a benzodiazepine derivative drug. It possesses anxiolytic, anticonvulsant, sedative, skeletal muscle relaxant and amnestic properties. It is commonly used for treating anxiety, insomnia, seizures, alcohol withdrawal, and muscle spasms. It may also be used before certain medical procedures (such as endoscopies) to reduce tension and anxiety, and in some surgical procedures to induce amnesia.
Diazepam is a core medicine in the World Health Organization's "Essential Drugs List", which is a list of minimum medical needs for a basic health care system. Diazepam is used to treat a wide range of conditions and has been one of the most frequently prescribed medications in the world for the past 40 years.
Diazepam appears to act on areas of the limbic system, thalamus and hypothalamus, inducing anxiolytic effects. Its actions are due to the enhancement of GABA activity. Benzodiazepine drugs including diazepam increase the inhibitory processes in the cerebral cortex.
The muscle relaxant properties of diazepam are produced via inhibition of polysynaptic pathways in the spinal cord.
Indications:
Diazepam is mainly used to treat anxiety, insomnia, and symptoms of acute alcohol or opiate withdrawal. It is also used as a premedication for inducing sedation, anxiolysis or amnesia before certain medical procedures (e.g. endoscopy).
Diazepam is rarely used for the long-term treatment of epilepsy because tolerance to the anticonvulsant effects of diazepam usually develops within 6 to 12 months of treatment, effectively rendering it useless for this purpose and also because of side-effects - in particular sedation.
Diazepam has a broad spectrum of indications including treatment of: anxiety, panic attacks, and states of agitation; status epilepticus, adjunctive treatment of other forms of epilepsy; vertigo associated with Meniere's Disease, the symptoms of alcohol and opiate withdrawal; tetanus, together with other measures of intensive-treatment; overdosage with hallucinogens or CNS stimulants; irritable bowel syndrome; short-term treatment of insomnia; initial management of mania, together with firstline drugs like lithium, valproate, lamotrigine and antipsychotics. Adjunctive treatment of painful muscle conditions; spastic muscular paresis (para-/tetraplegia) caused by cerebral or spinal cord conditions such as stroke, multiple sclerosis, spinal cord injury (long-term treatment is coupled with other rehabilitative measures), drug-induced seizures, resulting from exposure to sarin, VX, soman (or other organophosphate poisons), lindane, chloroquine, physostigmine, or pyrethroids. It is used to alleviate the symptoms of Lesch-Nyhan Syndrome; to treat pain resulting from muscle spasms caused by various spastic dystonias, including blepharospasm, spasmodic dysphonia and Meige's Syndrome; in pre-/postoperative sedation, anxiolysis and/or amnesia (e.g. before endoscopic or surgical procedures). Diazepam is used in palliative treatment of stiff person syndrome; emergency treatment of eclampsia, along with IV magnesium sulfate; prophylactic treatment of oxygen toxicity during hyperbaric oxygen therapy; and more.
How to take Diazepam:
Diazepam can be administered orally, intravenously, intramuscularly, or as a suppository.
When diazepam is administered orally, it is rapidly absorbed and has a fast onset of action. Peak plasma levels are achieved 30 minutes to 2 hours after oral administration.
Diazepam is highly lipid-soluble, and is widely distributed throughout the body after administration. It easily crosses both the blood-brain barrier and the placenta, and is excreted into breast milk. After absorption, diazepam is redistributed into muscle and adipose tissue. Continual daily doses of diazepam will quickly build up to a high concentration in the body (mainly in adipose tissue), which will be far in excess of the actual dose for any given day.
Dosage:
Dosages should be determined on an individual basis, depending upon the condition to be treated, the severity of symptoms, the body weight of the patient, and any comorbid conditions the patient may have.
Typical dosages for healthy adults range from 2 mg per dose to 10 mg per dose taken 2 to 4 times per day, depending on such factors as body weight and condition being treated. For the elderly or people with liver disorders, initial dose is at the low end of the range, with the dose being increased as required.
Side effects:
Diazepam has a range of side effects which are common to most benzodiazepines. Most common side effects include:
- Somnolence, suppression of REM sleep, impaired motor function (coordination, balance, dizziness and nausea), depression, impaired learning, anterograde amnesia (especially pronounced in higher doses), cognitive deficits, reflex tachycardia.
- Rare paradoxical side effects can include: nervousness, irritability, insomnia, muscle cramps, and in extreme cases, rage, and violence. If these side effects are present, diazepam treatment should be immediately terminated.
Precautions:
If Valium is to be combined with other psychotropic agents or anticonvulsant drugs, careful consideration should be given to the pharmacology of the agents to be employed—particularly with known compounds which may potentiate the action of Valium, such as phenothiazines, narcotics, barbiturates, MAO inhibitors and other antidepressants.
The usual precautions are indicated for severely depressed patients or those in whom there is any evidence of latent depression; particularly the recognition that suicidal tendencies may be present and protective measures may be necessary. The usual precautions in treating patients with impaired renal or hepatic function should be observed.
In elderly and debilitated patients, it is recommended that the dosage be limited to the smallest effective amount to preclude the development of ataxia or oversedation (2 mg to 2½ mg once or twice daily, initially, to be increased gradually as needed and tolerated).
Since Valium has a central nervous system depressant effect, patients should be advised against the simultaneous ingestion of alcohol and other CNS-depressant drugs during Valium therapy.
Using diazepam during the first three months of pregnancy can cause unwanted side effects. The use of this medicine during the last weeks of pregnancy can cause breathing problems in the infant. If breast-feeding, Diazepam can cause drowsiness, slow heartbeat, and shortness of breath in a nursing infant.
Use only as directed by your physician—do not increase or decrease the dosage without consultation with your doctor. Valium can be habit-forming or addictive. You may experience withdrawal symptoms if you stop using this drug abruptly.
