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Back to Psychiatry Drug Index

Back to Benzodiazipines

Name: Diazepam

Pregnancy Category D
C-IV controlled substance

Drug classes

  • Benzodiazepine
  • Antianxiety drug
  • Antiepileptic drug
  • Centrally acting skeletal muscle relaxant

Therapeutic actions

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.

Indications

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)

Unlabeled use: treatment of panic attacks

Contraindications/cautions

Contraindicated in the presence of 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 have been reported when used in first trimester; neonatal withdrawal syndrome reported in babies); lactation.

Use caution in elderly or debilitated patients; impaired liver or kidney function.

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Adverse effects

  • CNS: Transient, mild drowsiness initially; sedation, depression, lethargy, apathy, fatigue, lightheadedness, 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
  • GI: Constipation; diarrhea; dry mouth; salivation; nausea; anorexia; vomiting; difficulty in swallowing; gastric disorders; elevations of blood enzymes-LDH, alkaline phosphatase, SGOT, SGPT; hepatic dysfunction; jaundice
  • CV: Bradycardia, tachycardia, cardiovascular collapse, hypertension and hypotension, palpitations, edema
  • Hematologic: Decreased hematocrit, blood dyscrasias
  • GU: Incontinence, urinary retention, changes in libido, menstrual irregularities
  • Dermatologic: Urticaria, pruritus, skin rash, dermatitis
  • Dependence: Drug dependence with withdrawal syndrome when drug is discontinued (more 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
  • Other: Phlebitis and thrombosis at IV injection sites, hiccups, fever, diaphoresis, paresthesias, muscular disturbances, gynecomastia; pain, burning, and redness after IM injection
 

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