Overview
Diazepam is a benzodiazepine medication primarily used for the management of anxiety disorders and short-term relief of anxiety symptoms. It also serves as an adjunctive treatment for acute alcohol withdrawal, skeletal muscle spasm, and convulsive disorders. Due to its potential for dependence and sedation, it should be used at the lowest effective dose for the shortest duration necessary.
Mechanism of Action
Diazepam enhances the effect of gamma-aminobutyric acid (GABA), the major inhibitory neurotransmitter in the central nervous system, by binding to specific sites on GABA-A receptors. This potentiates GABA-mediated chloride ion influx, resulting in neuronal hyperpolarization and reduced neuronal excitability, producing anxiolytic, sedative, muscle relaxant, and anticonvulsant effects.
Indications
- Management of anxiety disorders
- Short-term relief of anxiety symptoms
- Symptomatic relief in acute alcohol withdrawal (agitation, tremor, delirium tremens)
- Adjunctive therapy for skeletal muscle spasm due to local pathology or upper motor neuron disorders
- Adjunctive treatment in convulsive disorders
Common Doses
- 2 mg
- 5 mg
- 10 mg
Dosage
Dosage must be individualized based on indication and patient response. For anxiety: 2-10 mg 2-4 times daily. Acute alcohol withdrawal: 10 mg 3-4 times first 24 hours, then reduce to 5 mg 3-4 times daily. Muscle spasm: 2-10 mg 3-4 times daily. Convulsive disorders: 2-10 mg 2-4 times daily. Geriatric/debilitated patients: Start 2-2.5 mg 1-2 times daily. Pediatric (≥6 months): Start 1-2.5 mg 3-4 times daily.
Contraindications
- Hypersensitivity to diazepam or other benzodiazepines
- Pediatric patients under 6 months of age
- Myasthenia gravis
- Severe respiratory insufficiency
- Severe hepatic insufficiency
- Sleep apnea syndrome
- Acute narrow-angle glaucoma
Side Effects
- Drowsiness, fatigue, muscle weakness, ataxia
- Confusion, depression, headache, slurred speech, tremor, vertigo
- Gastrointestinal disturbances, nausea, constipation
- Blurred vision, diplopia, dizziness
- Hypotension
- Paradoxical reactions (agitation, anxiety, aggression, hallucinations)
- Urinary retention, incontinence, libido changes
- Skin reactions
- Elevated liver enzymes
- Antegrade amnesia
Interactions
- Alcohol and other CNS depressants increase sedation and respiratory depression risk
- Opioids significantly increase risk of profound sedation, respiratory depression, coma, and death
- Enzyme inhibitors (e.g., cimetidine, fluoxetine) may increase diazepam levels
- Enzyme inducers (e.g., carbamazepine, phenytoin, rifampin) may decrease diazepam effectiveness
Counseling Points
- May cause drowsiness and dizziness; avoid alcohol and other sedatives
- Do not drive or operate machinery until effects are known
- Take exactly as prescribed; do not increase dose or frequency
- Do not stop abruptly after prolonged use due to withdrawal risk
- Inform healthcare provider of all medications being taken
- Store securely to prevent misuse by others
- Report unusual mood changes, agitation, or memory problems