Clinical Overview
Diazepam is a long-acting benzodiazepine indicated for anxiety disorders, acute alcohol withdrawal, muscle spasticity, and seizure disorders. It is one of the most widely prescribed benzodiazepines due to its versatility, multiple formulations, and well-established efficacy across various conditions.
Primary Clinical Applications
Diazepam is effective for generalized anxiety disorder, panic disorder, acute alcohol withdrawal syndrome, muscle spasticity, and as adjunctive therapy for seizure disorders. Its long half-life makes it suitable for conditions requiring sustained anxiolytic or anticonvulsant effects.
Mechanism and Clinical Profile
Diazepam enhances GABA activity at benzodiazepine receptors, producing anxiolytic, sedative, muscle relaxant, and anticonvulsant effects. Its long half-life (20-50 hours) and active metabolites provide sustained therapeutic effects but also increase the risk of accumulation, particularly in elderly patients.
Formulation Advantages
Available in multiple formulations including oral tablets, oral solution, rectal gel (Diastat), and nasal spray (Valtoco), allowing for flexible administration routes depending on clinical situation and patient needs. The variety of formulations makes it suitable for both chronic and acute treatment scenarios.
Prescribing Information
Dosing & Administration
Anxiety Disorders – Adults:
- Oral: 2-10 mg 2-4 times daily
- Elderly/Debilitated: 2-2.5 mg 1-2 times daily initially
Acute Alcohol Withdrawal:
- Oral: 10 mg 3-4 times during first 24 hours, then 5 mg 3-4 times daily as needed
Muscle Spasm:
- Adults: 2-10 mg 3-4 times daily
- Elderly: 2-5 mg 2-4 times daily
Status Epilepticus:
- IV: 5-10 mg, may repeat every 10-15 minutes up to 30 mg
- Rectal (Diastat): 0.2-0.5 mg/kg depending on age
Seizure Clusters (Valtoco nasal spray):
- Adults: 5-20 mg intranasally, may repeat once if needed
Indications
- Management of anxiety disorders
- Short-term relief of anxiety symptoms
- Acute alcohol withdrawal syndrome
- Adjunctive therapy for muscle spasticity
- Adjunctive therapy in convulsive disorders
- Status epilepticus and severe recurrent seizures
Contraindications
- Hypersensitivity to benzodiazepines
- Myasthenia gravis
- Severe respiratory insufficiency
- Severe hepatic insufficiency
- Sleep apnea syndrome
- Acute narrow-angle glaucoma
Warnings & Precautions
- Boxed Warning: Risk of abuse, misuse, dependence; respiratory depression with opioids
- Physical dependence: Risk increases with dose and duration
- Withdrawal syndrome: Taper gradually to avoid seizures
- Respiratory depression: Enhanced with CNS depressants
- Cognitive impairment: May affect memory and concentration
- Falls risk: Particularly in elderly patients
Drug Interactions
- Opioids: Increased risk of respiratory depression and death
- CNS depressants: Enhanced sedation and respiratory depression
- Alcohol: Dangerous potentiation of effects
- CYP3A4 inhibitors: May increase diazepam levels
- Phenytoin: May increase phenytoin levels
Adverse Reactions
Common:
- Drowsiness, fatigue, ataxia, confusion
- Anterograde amnesia, muscle weakness
Serious:
- Respiratory depression, severe sedation, dependence
Special Populations
- Elderly: Increased sensitivity, higher fall risk, start with lower doses
- Hepatic Impairment: Contraindicated in severe impairment
- Pregnancy: Category D – avoid in pregnancy
- Long half-life: Risk of accumulation wit
Medical Disclaimer: This information is for educational purposes only and is not intended as medical advice. Always consult with qualified healthcare professionals before making any treatment decisions. Individual patient circumstances may vary significantly.
