Diazepam

Brand names

• Apo-Diazepam
• Diastat
• Diazemuls
• Diazepam lntensol Oral Solution
• Dizac
• E-Pam
• Meval
• Novo-Dipam
• Q-Pam
• Rival
• Valcaps
• Valium
• Valrelease
• Vazepam
• Vivol
• Zetran

Usage

To treat anxiety, panic attacks, and muscle spasms; also used in acute treatment of seizures.

How it works

In general, diazepam produces mild sedation by depressing activity in the central nervous system. In particular, diazepam appears to enhance the effect of gamma-aminobutyric acid (GABA), a natural chemical that inhibits the firing of neurons and dampens the transmission of nerve signals, thus decreasing nervous excitation.

Side effects

Serious

Difficulty concentrating, outbursts of anger, other behavior problems, depression, hallucinations, low blood pressure (causing faintness or confusion), memory impairment, muscle weakness, skin rash or itching, sore throat, fever and chills, sores or ulcers in throat or mouth, unusual bruising or bleeding, extreme fatigue, yellowish tinge to eyes or skin.

Common

Drowsiness, loss of coordination, unsteady gait, dizziness, lightheadedness, slurred speech.

Less common

Change in sexual desire or ability, constipation, false sense of well-being, nausea and vomiting, urinary problems, unusual fatigue.

Possible interactions

Other medicaments:

Diazepam may increase the effects of:

• digoxin (Lanoxin) and cause digoxin toxicity.
• phenytoin (Dilantin) or fosphenytoin (Cerebyx) and cause toxicity.

Diazepam may decrease the effects of:



• levodopa (Sinemet, etc.) and reduce its effectiveness in treating Parkinson's disease.

Diazepam taken concurrently with:



• fluoxetine (Prozac) may lead to diazepam toxicity.
• fluvoxamine (Luvox) can result in serious accumulation of diazepam and toxicity.
• macrolide antibiotics may lead to toxicity.
• MAO inhibitors may exaggerate breathing depression.
• mirtazapine (Remeron) may worsen motor skills. Avoid operating dangerous machinery or tasks requiring coordination.
• narcotics or other centrally active medicines may cause additive respiratory depression or decreased levels of consciousness.
• olanzapine (Zyprexa) may blood pressure lowering when you stand (orthostatic hypotension).
• propoxyphene (various) may lead to benzodiazepine (diazepam) intoxication.
• quinupristin/dalfopristin (Synercid) may lead to diazepam toxicity.

The following medicaments may increase the effects of diazepam:



• birth control pills (oral contraceptives).
• cimetidine (Tagamet).
• cisapride (Propulsid).
• disulfiram (Antabuse).
• isoniazid (INH, Rifamate, etc.).
• itraconazole (Sporanox), ketoconazole (Nizoral) or other azole antifungals.
• macrolide antibiotics such as erythromycin or clarithromycin.
• omeprazole (Prilosec).
• ritonavir (Norvir) and other protease inhibitors.
• sertraline (Zoloft).
• valproic acid (Depakene).

The following medicaments may decrease the effects of diazepam:



• ranitidine (Zantac).
• rifampin (Rimactane,etc.).
• rifabutin (Mycobutin).
• theophylline (aminophylline, Theo-Dur, etc.).

Herbal medicines or minerals:

Hawthorn may react antagonistically to diazepam. Valerian and kava kava may interact additively (drowsiness). Avoid these combinations. Kava and valerian may exacerbate central nervous system depression (avoid this combination). Kola nut, Siberian ginseng, mate, and ma huang may blunt the benefits of this medicine. While St. John's wort is indicated for anxiety, it is also thought to increase (induce) cytochrome P450 enzymes and will tend to blunt diazepam effectiveness if combined with diazepam.

Beverages:

Avoid excessive intake of caffeine-containing beverages: coffee, tea, cola.

Alcohol:

Alcohol increases the absorption of this medicament and adds to its depressant effects on the brain. It is advisable to avoid alcohol completely-throughout the day and night-if it is necessary to drive or to engage in any hazardous activity.

Tobacco smoking:

Heavy smoking may reduce the calming action of this medicament.

Marijuana smoking:

Increased sedation and impairment of intellectual and physical performance.

Exposure to heat:

Because of reduced urine volume, this medicament may accumulate in the body and produce effects of overdose.

Discontinuation:

Avoid stopping this medicament suddenly if taken for over 4 weeks. Prudent to taper gradually to prevent a withdrawal syndrome (sweating, tremor, depression, hallucinations, seizures and vomiting).