Diazepam - Common Misconception

Diazepam - Common Misconception

Diazepam - common misconception

Diazepam - Valium Diazepam is used to treat anxiety, alcohol withdrawal and seizures. It is also used to relieve muscle spasms and to provide sedation.

Diazepam is a long-acting benzodiazepine that is utilized to eliminate stress and anxiety,

There is a common misconception that all mental health interventions are complex and can only be performed by highly specialised personnel.

Recent studies have shown the feasibility of drugs and psychosocial interventions in non-specialist health institutions. The model guide is based on a literature review of all scientific research available in this field, and describes recommended interventions that can be used in low- and middle-income countries.

This includes evidence-based intervention guidelines for identifying and dealing with a series of priority situations Australian doctor clinics .

These priority issues include depression, psychosis, manic depression, epilepsy, developmental and behavioural disorders in children and adolescents, dementia, alcohol use disorder, drug use disorder, self-harm/suicide, and other major emotional or medically explainable complaints.

We give priority to these diseases because of their high mortality, morbidity, and disability burden, and are related to violations of human rights.

Through intensive preparation of evidence-based review of the literature out. Form an evidence-based recommendation through a systematic review.

Then work with an international team of experts again to translate these recommendations into clear step-by-step interventions.

General principles of treatment GPC
Australian health service providers face all those who seek treatment All should follow the clinical practice norms.

They should respect the privacy of people with mental disorders, neurological diseases, and substance use disorders who come to seek services, establish good relationships with them and their caregivers, and treat those seeking services in a non-judgmental, non-shameful, and supportive manner.

Respond. Communication with people seeking services and their caregivers

» Confirm that the communication is clear, empathetic and sensitive to differences in age, gender, culture, and language.
»Being friendly, respectful and non-judgmental throughout.
» Use simple, clear language.
» Responding to the disclosure of private and painful information (for example, about sexual assault or self-harm).
» Use words that patients can understand to provide them with information about their health.
» Ask the patient's understanding of the current condition.


» Take medical history, current medical history, related past history and family history.
» Conduct a comprehensive physical assessment.
» Appropriate evaluation, treatment or referral for the current condition.
» Assess psychosocial problems, pay attention to past and current social and interpersonal problems, housing and financial status, and other continuous life stress events.

Treatment and monitoring

» Determine the importance of treatment to patients and whether they are ready to participate in treatment.
» Determine treatment goals for patients and establish a treatment plan that respects their (and, if appropriate, their caregivers) willingness to treat.
» Consult with patients to design continuous treatment and follow-up plans.
» Inform patients about the expected duration of treatment, potential side effects of interventions, other treatment options, the importance of following the treatment plan, and possible prognosis.
»To deal with patients' questions and concerns about treatment, and to communicate about the realistic expectations of better function and rehabilitation.
» Continuously monitor the efficacy and outcome, drug interactions (including alcohol, over-the-counter drugs and auxiliary drugs/traditional drugs), and side effects of treatment, and adjust accordingly.
» Help them to be referred to a possible specialist as needed.
The drug is a long-acting benzodiazepine drugs, can cause inhibition of different parts of the central nervous system, with the increase in the number of clinical manifestations can be from mild sedation to hypnosis or even coma.

Site of action and mechanism of the drug has not been fully elucidated, now that after interaction with specific nerve cell membrane receptors, can strengthen and promote the brain's main inhibitory neurotransmitter γ-aminobutyric acid (GABA) neurotransmission function, mainly in various parts of the central nervous system, from presynaptic and postsynaptic inhibition.

Antiepileptic, anticonvulsant effect:this drug can enhance presynaptic inhibition, inhibit the cortical-dorsal thalamus and limbic system caused by the spread of epilepsy discharge activity, but can not eliminate abnormal discharge activity lesions.Skeletal muscle relaxation: mainly inhibit spinal cord multisynaptic efferent pathway and single synaptic efferent pathway.

Benzodiazepines may also directly inhibit motor and muscle function.Oblivion effect: diazepam in the therapeutic dose, can interfere with the establishment of memory pathways, thus affecting recent memory.


The drug is quickly absorbed orally, intramuscular injection absorption slow and irregular, not complete, should be administered orally or intravenously in urgent need of efficacy.Rectal perfusion absorption is also faster.Oral onset time of 14 ~ 45min, intramuscular injection of 20min, intravenous injection of 1~3min; oral 0.5~2h, intramuscular injection of 0.5~ 1.5 h, intravenous injection of 0.25 h plasma concentration peak, 4 ~ 10 days to steady-state blood concentration.

The drug is highly fat-soluble, easy to pass through the blood-cerebrospinal fluid barrier and placenta.Protein binding rate of 98%.The drug in the liver metabolism, active metabolites are mainly norepinephrine diazepam,oxazepam, temazepam, etc., and ultimately the formation of inactivated glucuronic acid conjugate.Mainly through the kidneys excreted by the urine,can also be discharged from the milk.Long-term use of diazepam, raw

Form and active metabolites have a cumulative effect.After withdrawal to eliminate slow, after termination of treatment blood still contains a number of active metabolites, drug excretion slowly make efficacy for several to several weeks

.The Half-life of the parent drug is 20 ~ 70h,and the Half-Life of the main metabolite norepinephrine diazepam can reach 30 ~ 100h.Half-life in patients with liver and kidney insufficiency can be extended.

Anti-anxiety: for anxiety disorders and depression associated with anxiety.
Sedative hypnosis: used to treat insomnia.

Antiepileptic, anticonvulsant: intravenous injection is the preferred drug for the treatment of persistent epilepsy, but at the same time must be consolidated and maintained with other antiepileptic drugs; also effective for tetanus paroxysmal convulsions.

Central muscle relaxation: can relieve: reflex muscle spasms

(1)local muscle or joint inflammation caused;
(2) motor neuron lesions, hand and foot Xu motility disease and stiff human syndrome muscle spasms;
(3) temporomandibular joint lesions caused by facial muscle spasms.

It can also be used for administration before anesthesia, tension headache, horror anxiety disorder, alcohol-dependent alcoholism syndrome, Parkinson's disease in the elderly and idiopathic tremor.

People who are allergic to this drug.
Acute angle-closure glaucoma.
Patients with myasthenia gravis.
4.30 days for infants.

With caution:

(1) the central nervous system in a suppressed state of acute alcoholism;
(2)coma or Shock;
(3)a history of drug abuse or addiction;
(4)liver and kidney insufficiency;
(5)hyperactivity disorder patients;
(6)hypoproteinemia patients;
(7)severe depression;
(8) severe chronic obstructive pulmonary disease patients.

Effects of drugs on children: children (especially young children)of the central nervous system is abnormally sensitive to the drug, the drug is not easy to metabolize newborns inactive products, resulting in lasting central nervous system inhibition.

Effects of drugs on the elderly: the central nervous system of the elderly is also more sensitive to the drug, intravenous injection can appear apnea, hypotension, bradycardia and even cardiac arrest.

Effect of the drug on pregnancy: this drug can pass through the placenta.In the first three months of pregnancy, there is an increased risk of fetal teratogenicity,except for antiepileptic, during this period try not to use.Long-term use in pregnant women can cause into

Addiction, so that newborns exhibit withdrawal symptoms.Hypnosis in the last few weeks of pregnancy can inhibit the central nervous system activity of newborns,the use of this drug before or during childbirth, can lead to weak muscle tone in newborns.The U.S. Food and Drug Administration(FDA)classifies pregnancy as Class D.

Effects of drugs on lactation:metabolites can be secreted into the milk, nursing mothers can take the baby's body of the drug and its metabolites accumulate, so that the baby lethargy, and even feeding difficulties, weight loss.
It has been reported that the urine test value will be reduced.
Before and after medication and medication should be checked or monitored: (1)Blood Count; (2)liver function.

Adverse reactions

The more common adverse reactions are drowsiness,dizziness,fatigue, etc.; large doses may have ataxia,tremor (more common in the elderly).
Less common adverse reactions are mental retardation,unclear vision, constipation, dizziness, dry mouth, headache, nausea or vomiting, difficulty urinating, dysarthria, trembling.

Rare adverse reactions are allergic reactions, impaired liver function, muscle weakness, granulocytopenia, etc. Individual patients develop excitement, multilingualism, sleep disorders and even hallucinations, these symptoms quickly subside after deactivation.


Which is stronger diazepam or clonazepam ?
Which is stronger diazepam or lorazepam ?
Which is better diazepam or lorazepam ?
Which is stronger diazepam or temazepam ?
Which is stronger diazepam or cyclobenzaprine ?
Which is stronger diazepam or tramadol ?

Usage and dosage
Oral Administration: (1)anti-anxiety: 2.5 ~ 10mg each time, 2 to 4 times a day.(2)sedation, hypnosis, acute alcohol withdrawal: 10mg each time on the first day, 3 to 4 times a day, after the need to reduce to 5mg each time, 3 to 4 times a day.(3)antiepileptic: 2.5 ~ 10mg each time, 2 to 4 times a day.(4)relieve muscle spasms: 2.5 ~ 10mg each time, 3 to 4 times a day.(5)treatment of alcohol withdrawal syndrome: 10mg per day, 3 to 4 times a day.Then gradually increase the dosage as needed.

Intramuscular injection: (1)Basic anesthesia or intravenous general anesthesia: 10 ~ 30mg.(2)Sedation, hypnosis or acute alcohol withdrawal: start with 10mg, after every 3 ~ 4h plus 5 ~ 10mg on demand.The total amount of 24h is limited to 40 ~ 50mg.(3)Relieve muscle spasms: initially 5 ~ 10mg, after the need to increase to achieve the maximum amount.Larger doses may be required for tetanus.

Intravenous injection: (1)Basic anesthesia or intravenous general anesthesia: with intramuscular injection term.(2)Sedation, hypnosis or acute alcohol withdrawal: intramuscular injection.(3)persistent epilepsy and severe recurrent epilepsy:at the beginning of intravenous injection of 10mg, each interval of 10 ~ 15min can be repeated on demand, up to 30mg.Treatment can be repeated after 2 ~ 4h when needed.(4)relieve muscle spasms: with intramuscular injection term.

Drug interaction

When combined with general anesthetics, analgesics, monoamine oxidase inhibitors, tricyclic antidepressants and clonidine, etc., can be mutually synergistic.The amount of opioid analgesics should be reduced by at least 1/3 and then gradually increased as needed.

In combination with propofol can prolong the duration of the sedative effect of diazepam.

And amprenavir, ritonavir combined with diazepam serum concentrations can be increased, causing the potential danger of excessive sedation and respiratory depression.

Macrolide antibiotics (such as clarithromycin,erythromycin,erythromycin / sulfisoxazole, cross sandomycin, roxithromycin, acetomycin, etc.) can inhibit the metabolism of liver enzymes of the drug, so that the plasma concentration of diazepam increased.

Cimetidine, disulphilan, isomoprazole, omeprazole, fluvoxamine (500mg per day, for 2 weeks)will reduce the clearance of diazepam, clear Half-Life is extended.
Itraconazole, ketoconazole can increase the serum concentration of diazepam and increase the adverse reactions of diazepam (sedation, fatigue, slurred speech, slowing the reaction and other psychomotor damage).

Oral contraceptives and valproic acid,isoniazid can slow down the metabolism of the drug, increasing the plasma concentration of the drug.
Can ketoprofen, phenytoin, digoxin clearance is reduced, plasma concentrations increased.

Why diazepam is given slowly ?
Why diazepam not given im ?
Why diazepam is not used in neonates ?

When combined with carbamazepine, due to the induction of liver microsomal enzymes so that carbamazepine and (or)decreased plasma concentration of the drug, the removal Half-Life is shortened.

Ranitidine can significantly reduce the steady-state plasma concentration of oral diazepam, improve its plasma clearance.

When combined with rifampicin, rifabutin, increase the excretion of the drug, the plasma concentration decreases.

When combined with levodopa, the drug can reduce the efficacy of the latter.
When combined with antacids, can delay the absorption of diazepam.
In combination with calcium channel antagonists, blood pressure can be increased.

When combined with other addictive drugs, the risk of addiction increases.
Administration of diazepam as an inducing agent, followed by the use of fentanyl cause systemic vascular resistance is reduced,and secondary mean arterial pressure was significantly reduced.

When combined with propranolol, flutterone, can lead to changes in the type and / or frequency of seizures.?

Theophylline can reverse the sedative effect of diazepam.

Combined with therapeutic doses of diazepam and buprenorphine can cause respiratory and cardiovascular system failure in patients.

Alcohol can enhance the central inhibition of the drug,should avoid drinking when taking the drug.

Certain components of tobacco can induce liver drug enzymes, thereby accelerating the metabolic removal of the drug by the liver.

High doses of caffeine (500mg, equivalent to 4 cups or more than 4 cups of brewed coffee)can interfere with anxiolytic effects, but its clinical significance is uncertain.

Grapefruit juice can increase the plasma concentration of the drug.
After intravenous administration of the drug consumption of high-fat diet, serum concentration of the drug was significantly increased.

Expert reviews
This product is the most commonly used clinical treatment of anxiety, insomnia and neurosis drugs.Intractable epilepsy has a significant inhibitory effect on all types of epilepsy are effective, clinically can be used as an adjutant anti epileptic drugs.Because of its Rapid Action, for the treatment of epilepsy persistent state significant effect, is currently one of the preferred drugs.

Diazepam poisoning from Dr Renju Ravi

What is diazepam used for?
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How diazepam affects the brain ?
How diazepam causes muscle relaxation ?
Diazepam how long does it last ?
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Why diazepam is used in status epilepticus ?
Why diazepam is given slowly ?
Why diazepam not given im ?
Why diazepam is not used in neonates ?
Why diazepam is contraindicated in glaucoma ?
What diazepam is good for ?
What diazepam used for ?
What diazepam does to the brain ?
What's diazepam prescribed for ?
Which is stronger diazepam or clonazepam ?
Which is stronger diazepam or lorazepam ?
Which is better diazepam or lorazepam ?
Which is stronger diazepam or temazepam ?
Which is stronger diazepam or cyclobenzaprine ?
Which is stronger diazepam or tramadol ?
How long diazepam works ?

Just a moment... (nps.org.au)
Diazepam | healthdirect (healthdirect.gov.au)
The use of rectal diazepam for the treatment of prolonged convulsions in children - Australian Prescriber (nps.org.au)
Pharmaceutical Benefits Scheme (PBS) | (pbs.gov.au)
TGA eBS - Product and Consumer Medicine Information (ebs.tga.gov.au)
Neurology : Rectal diazepam (rch.org.au)
Valpam 5 (diazepam) 5 mg tablets in 50 tablet blister packs | Therapeutic Goods Administration (TGA) (tga.gov.au)
Benzodiazepines - Better Health Channel (betterhealth.vic.gov.au)
Valium (diazepam) 5 mg tablets in 50 tablet blister packs | Therapeutic Goods Administration (TGA) (tga.gov.au)

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