Brand Name: Apo-Diazepam (CAN), Diastat, Diazemuls (CAN), Diazepam Intensol, Valium, Vivol (CAN)
Pregnancy Category D, C-IV controlled substance
Drug classes: Benzodiazepine, Antianxiety agent, Antiepileptic agent, Skeletal muscle relaxant, centrally acting
Exact mechanisms of action not understood; acts mainly at the limbic system and reticular formation; may act in spinal cord and at supraspinal sites to produce skeletal muscle relaxation; potentiates the effects of GABA, an inhibitory neurotransmitter; anxiolytic effects occur at doses well below those necessary to cause sedation, ataxia; has little effect on cortical function.
· Management of anxiety disorders or for short-term relief of symptoms of anxiety
· Acute alcohol withdrawal; may be useful in symptomatic relief of acute agitation, tremor, delirium tremens, hallucinosis
· Muscle relaxant: adjunct for relief of reflex skeletal muscle spasm due to local pathology (inflammation of muscles or joints) or secondary to trauma; spasticity caused by upper motoneuron disorders (cerebral palsy and paraplegia); athetosis, stiff-man syndrome
· Treatment of tetanus (parenteral)
· Antiepileptic: adjunct in status epilepticus and severe recurrent convulsive seizures (parenteral); adjunct in convulsive disorders (oral)
· Preoperative: relief of anxiety and tension and to lessen recall in patients prior to surgical procedures, cardioversion, and endoscopic procedures (parenteral)
· Management of selected, refractory patients with epilepsy who require intermittent use to control bouts of increased seizure activity (rectal)
· Unlabeled use: treatment of panic attacks
· Contraindicated with hypersensitivity to benzodiazepines; psychoses, acute narrow-angle glaucoma, shock, coma, acute alcoholic intoxication; pregnancy (cleft lip or palate, inguinal hernia, cardiac defects, microcephaly, pyloric stenosis when used in first trimester; neonatal withdrawal syndrome reported in newborns); lactation.
Transient, mild drowsiness initially; sedation, depression, lethargy, apathy, fatigue, light-headedness, disorientation, restlessness, confusion, crying, delirium, headache, slurred speech, dysarthria, stupor, rigidity, tremor, dystonia, vertigo, euphoria, nervousness, difficulty in concentration, vivid dreams, psychomotor retardation, extrapyramidal symptoms; mild paradoxical excitatory reactions, during first 2 wk of treatment, visual and auditory disturbances, diplopia, nystagmus, depressed hearing, nasal congestion
Bradycardia, tachycardia, CV collapse, hypertension and hypotension, palpitations, edema
Drug dependence with withdrawal syndrome when drug is discontinued (common with abrupt discontinuation of higher dosage used for longer than 4 mo); IV diazepam: 1.7% incidence of fatalities; oral benzodiazepines ingested alone; no well-documented fatal overdoses
Urticaria, pruritus, skin rash, dermatitis
Constipation; diarrhea, dry mouth; salivation; nausea; anorexia; vomiting; difficulty in swallowing; gastric disorders; elevations of blood enzymes--LDH, alkaline phosphatase, AST, ALT; hepatic dysfunction; jaundice
Incontinence, urinary retention, changes in libido, menstrual irregularities
Decreased hematocrit, blood dyscrasias
Phlebitis and thrombosis at IV injection sites, hiccups, fever, diaphoresis, paresthesias, muscular disturbances, gynecomastia; pain, burning, and redness after IM injection
· Increased CNS depression with alcohol, omeprazole
· Increased pharmacologic effects of diazepam if combined with cimetidine, disulfiram, hormonal contraceptives
· Decreased effects of diazepam with theophyllines, ranitidine
· Do not administer intra-arterially; may produce arteriospasm, gangrene.
· Change from IV therapy to oral therapy as soon as possible.
· Do not use small veins (dorsum of hand or wrist) for IV injection.
· Reduce dose of narcotic analgesics with IV diazepam; dose should be reduced by at least one-third or eliminated.
· Carefully monitor P, BP, respiration during IV administration.
· Maintain patients receiving parenteral benzodiazepines in bed for 3 hr; do not permit ambulatory patients to operate a vehicle following an injection.
· Monitor EEG in patients treated for status epilepticus; seizures may recur after initial control, presumably because of short duration of drug effect.
· Monitor liver and kidney function, CBC during long-term therapy.
· Taper dosage gradually after long-term therapy, especially in epileptic patients.
· Arrange for epileptic patients to wear medical alert ID indicating that they are epileptics taking this medication.
· Discuss risk of fetal abnormalities with patients desiring to become pregnant.