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Generic Name: Diazepam
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How does Diazepam work?
Diazepam is a type of medicine called a benzodiazepine. Benzodiazepines are used for their sedative and anxiety-relieving effects.
Diazepam works by acting on receptors in the brain called GABA receptors. This causes the release of a neurotransmitter called GABA in the brain.
Neurotransmitters are chemicals that are stored in nerve cells in the brain and nervous system. They are involved in transmitting messages between the nerve cells. GABA is a neurotransmitter that acts as a natural 'nerve-calming' agent. It helps keep the nerve activity in the brain in balance, and is involved in inducing sleepiness, reducing anxiety and relaxing muscles.
As diazepam increases the activity of GABA in the brain, it increases its calming effect and results in sleepiness, a decrease in anxiety and relaxation of muscles.
Diazepam has several uses. Firstly, it can be used to calm severe anxiety and agitation. For example, benzodiazepines such as diazepam are effective at quickly reducing the symptoms of anxiety and agitation that occur in a manic episode of the psychiatric illness, bipolar affective disorder. A benzodiazepine may be given as part of the initial treatment of a manic episode, though they are not licensed specifically for this purpose. Benzodiazepines help calm the individual while the main medicines for this condition (mood stabilisers) begin to take effect.
Oral forms of diazepam are also used for short-term treatment of severe anxiety associated with insomnia, as well as for night terrors and sleep-walking in children. Diazepam decreases the time taken to fall asleep and nocturnal awakenings, as well as increasing the total amount of time spent sleeping. However, it is only suitable for short-term treatment of insomnia and anxiety as it has a high potential for dependence and addiction. As diazepam remains active in the body for many hours, drowsiness may also persist into the next day.
Diazepam is also given for its sedating and anxiety-relieving effects as a pre-med before surgery or medical investigations or procedures, and to alcoholics during acute alcohol withdrawal.
The second main use of diazepam is in controlling convulsions, for example epilepsy, or seizures associated with fever in children (febrile convulsions). It is particularly useful for controlling repeated epileptic fits when a patient does not recover conciousness between fits (status epilepticus). Diazepam helps control convulsions because the increased activity of GABA that it causes in the brain helps to calm excessive electrical nerve activity that is responsible for causing seizures.
A further use of diazepam is in controlling muscle spasms due to tetanus or poisoning.
Diazepam may be given as tablets, oral solution, injection or a rectal solution, depending on what condition is being treated.
What is it used for?
• Short-term treatment of severe anxiety or agitation
• Short-term treatment of severe insomnia (oral forms of diazepam only)
• Night terrors and sleepwalking in children (oral forms of diazepam only)
• Acute alcohol withdrawal (used in combination with other treatment)
• Convulsions, eg epilepsy
• Repeated fitting with no recovery of conciousness between seizures (status epilepticus)
• Fitting associated with fever (febrile convulsions)
• Muscle spasms due to tetanus or poisoning
• Relieving anxiety and causing sedation prior to surgery or medical procedures (pre-med)
• This medicine is generally only suitable for short-term use. If it is used for long periods or in high doses, tolerance to and dependence upon the medicine may develop, and withdrawal symptoms may occur if treatment is stopped suddenly. For this reason, treatment with this medicine should usually be stopped gradually, following the instructions given by your doctor, in order to avoid withdrawal symptoms such as rebound insomnia or anxiety, confusion, sweating, tremor, loss of appetite, irritability or convulsions.
Use with caution in
• This medicine causes drowsiness, muscle weakness and impairs concentration and alertness. These effects may continue into the following day and are made worse by drinking alcohol. If you are affected you should avoid potentially hazardous tasks such as driving or operating machinary. Avoid alcohol.
Not to be used in
• Elderly people
• Weak or debilitated people
• Decreased kidney function
• Decreased liver function
• Disease affecting the airways or lungs (respiratory disease)
• History of alcoholism or drug abuse
• Personality disorders
• Life long inherited blood diseases which can cause a variety of symptoms, including mental health problems (porphyrias)
• Abnormal muscle weakness (myasthenia gravis)
• A sudden worsening of any underlying lung disease (acute pulmonary insufficiency)
This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.
• Slow, shallow breathing (respiratory depression)
• Syndrome involving short spells when breathing stops during sleep (sleep apnoea syndrome)
• Long-term psychotic illness
• Phobias or obsessional states
• Severely decreased liver function
If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
Pregnancy and Breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
• This medicine should be avoided during pregnancy unless considered essential by your doctor, for example for controlling seizures. This is because it may be harmful to the developing baby. Regular use should be avoided as it can cause withdrawal symptoms in the baby. This is particularly important during the third trimester of pregnancy and prior to or during labour.
• Significant amounts of this medicine may pass into breast milk. It should not be used by breastfeeding mothers as it may be harmful to the nursing infant. Seek medical advice from your doctor.
• This medication causes drowsiness which may continue the next day. If affected do not drive or operate machinery. Avoid alcoholic drink.
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.
The side effects listed above may not include all of the side effects reported by the drug's manufacturer.
• Drowsiness and lightheadedness the next day
• Shaky movements and unsteady walk (ataxia)
• Muscle weakness
• Loss of memory (amnesia)
• Skin rashes
• Disturbances of the gut such as diarrhoea, constipation, nausea, vomiting or abdominal pain
• Difficulty in passing urine (urinary retention)
• Visual disturbances
• Low blood pressure (hypotension)
• Unexpected increase in aggression (paradoxical aggression)
• Changes in sex drive
• Blood disorders
For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
How can this medicine affect other medicines?
It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to ensure that the combination is safe.
There may be an increased risk of drowsiness and sedation if diazepam is taken with any of the following (which can also cause drowsiness):
The following medicines may increase the blood level of diazepam and may therefore increase its sedative effects:
• tricyclic antidepressants, eg amitriptyline
• MAOI antidepressants, eg phenelzine
• antipsychotics, eg chlorpromazine, clozapine
• opioids, eg morphine, codeine, dihydrocodeine
• other benzodiazepines, eg temazepam
• barbiturates, eg phenobarbital
• sedating antihistamines, eg chlorphenamine
• sleeping tablets.
Your doctor may need to prescribe a lower than normal dose of diazepam if you are taking any of these medicines.
The following medicines may decrease the blood level of diazepam, making it less effective:
Your doctor may need to prescribe a larger than normal dose of diazepam if you are taking any of these medicines.
Caffeine and theophylline may reduce the sedative and anxiety-reducing effects of diazepam.
Diazepam may reduce the effectiveness of levodopa in treating Parkinson's disease.
Diazepam may increase or decrease blood phenytoin levels.