Diazepam, commonly sold under the brand name Valium, is a drug belonging to the family of medicines called benzodiazepines. It is most used to treat general anxiety disorders, alcohol withdrawal, muscle spasms, or acute seizures. You should only take diazepam as prescribed by a doctor, as its misuse can lead to addiction, severe side effects and even death. [1]

What are the other names of diazepam?

Its generic drug name is diazepam, however it is also sold under the brands Valium, Dizac, Diastat, and Valtoco in the US. It is sold worldwide, under 500 different names, and it was the most sold drug in the United States of America between 1968 and 1982. [2]

What is diazepam used for?

Diazepam is mainly prescribed for general anxiety disorder, status epilepticus (continuous seizures), muscle spasms, and acute alcohol withdrawal. It is usually prescribed on a short-term basis.

It is used to treat alcohol, opiate, and benzodiazepine withdrawal because of its relatively long “half-life”. A drug’s “half-life” is the amount of time it takes for the active substance of a drug to reduce by half in your body. [1]

It is also used to treat other conditions like insomnia (struggling to get to sleep or to stay asleep), and restless legs syndrome (the uncontrollable urge to move your legs). It is also frequently used to as a “pre-med” sedative before medical or dental operations, to help patients feel relaxed. [3]

How does it work?

Diazepam works by increasing the levels of the calming chemicals in the brain called GABA (gamma-aminobutyric acid) and reducing electrical activity in the brain. It may affect you differently depending on your health condition. It may relax tense muscles, stop seizures, relieve anxiety, or make you feel drowsy. [1]

Due to the risk of falling while taking diazepam, people over the age of 65 usually require a lower dosage [1]

How should this medicine be used?

Diazepam comes in several forms:

  • A tablet.
  • An injection.
  • A concentrate (a liquid that you swallow).
  • A tube that is squeezed inside the rectum.

For seizures, it can also be taken as a nasal spray. [3]

Your healthcare provider will advise which method to use and which daily dose you must adhere to. Follow the directions on the prescription label very carefully, and do not exceed the prescribed dose. [3]

If you miss a dose of diazepam, it is best to wait for the next one rather than double up. Doubling dosage will not improve symptoms faster and can in fact worsen your condition.

How long does Diazepam stay in the system?

Diazepam is a fast-acting and long-lasting drug so this will depend on several factors.

Its half-life is estimated between 30 to 56 hours. This is the amount of time it takes for the active substance to reduce by half in your body. So, on average it will take 10 days for the drug to leave the system entirely. [6]

Diazepam can still be detected long after it has left the system. Saliva, blood, and urine tests are the most common and effective way to determine how long the last dose was taken. Urine tests can detect diazepam for weeks after the last dose.

Depending on which way the drug is administered, you will be able to feel its effects rather quickly. It can take effect from 30 to 90 minutes when taken orally, 30 to 60 minutes by injection or 10 to 45 minutes when injected via the rectum. If taken for muscle spasms, you should begin to feel them subside within 15 minutes and your muscles will begin to relax after taking it for a few days. When used for the treatment of anxiety, it may take a week or two to feel the full effects. [7]

Once your treatment is over, your doctor will often gradually decrease your doses of diazepam to minimize dependence and withdrawal symptoms.

What are the side-effects of diazepam?

The most common side-effects of diazepam are drowsiness or feeling sleepy.

Others may include:

  • Poor coordination
  • Blurred vision
  • Drowsiness/fatigue
  • Muscle weakness
  • Headache
  • Dry mouth
  • Nausea
  • Constipation
  • Confusion
  • Difficulty urinating or frequent urination
  • Changes in sex drive or ability. [3]

Serious side-effects are rare, but include:

  • Increased risk of suicidal thoughts
  • Mood changes such as memory problems, agitation, hallucinations, confusion, restlessness, or depression
  • Decreased breathing
  • Slurred speech
  • Uncontrollable shaking of specific parts of the body (tremors)
  • Slowed heartbeat. [3]
  • Signs of infection such as fever, chills or sore throat
  • Yellowing of skin/eyes

As the long-term use of diazepam is associated with physical dependence, it is usually a short-term medicine. It can also lead to impaired cognition, mobility, and driving skills, particularly in older people, which increases their risk of falling. [4]

Diazepam precautions

Allergic reactions may occur with the first dose. You should tell your healthcare provider if you are allergic to any of the ingredients of diazepam or any other benzodiazepines. It is also essential to share your medical history with your doctor as some conditions may conflict with its use.

Diazepam is not suitable for everyone. Certain muscular diseases or respiratory illnesses can be made worse by using the drug; this also concerns mental health disorders like depression or psychosis.

People who have a history of, or currently suffer from the following physical illnesses should consult their healthcare provider before taking diazepam:

  • Liver disease
  • Kidney disease
  • Arteriosclerosis (affects blood flow in the brain)
  • Narrow-angle glaucoma
  • Myasthenia gravis (muscle weakness)
  • Sleep apnea
  • Hypoalbuminemia (low levels of a protein called albumin in your blood)

People who have a history of, or currently suffer from the following psychological conditions should consult their healthcare provider before taking diazepam:

  • Substance/alcohol addiction
  • Depression
  • Personality disorder
  • A recent loss or bereavement

If you are pregnant, trying to get pregnant, or currently breastfeeding, you should tell your doctor before being prescribed diazepam. Additionally, if you have any procedures where you will have a general anesthetic, you should let your doctor and anesthetist know.

Can I take diazepam if I'm pregnant, breastfeeding or intend on getting pregnant?

It is possible to take diazepam while pregnant, but it’s not recommended – particularly towards the end of pregnancy. This is because diazepam use in pregnancy has been associated with an increased risk of congenital malformations and other developmental abnormalities [10]

If you use diazepam regularly while breastfeeding, there is a chance it could pass into your breast milk and build up in the baby’s system and cause sleepiness or affect your child’s weight gain. The product label for diazepam recommends that diazepam should not be used when breastfeeding. Speak to your healthcare provider to determine if the benefit of using diazepam for your condition outweighs the possible risks. [8]

If you are taking diazepam and wish to get pregnant or have just found out you are pregnant, you should speak to your healthcare provider. You should not stop taking diazepam without consulting a medical doctor first. If you suddenly stop taking diazepam after several months of treatment, you might experience withdrawal symptoms which could make your pregnancy more difficult.

Diazepam Interactions

It is essential to keep a detailed list of all prescriptions and non-prescription medicine you are taking and products like vitamins, minerals, or other dietary supplements. You should make your healthcare provider aware of this list before taking diazepam. [3]

If taken with diazepam, recreational drugs such as marijuana, heroin, or methadone can increase its drowsy effect. When mixed, this can send you into a very deep sleep, stop you from breathing properly, and even prevent you from waking up, leading to a coma or death. [7]

Foods like grapefruit and grapefruit juice may lead to some serious adverse effects when interacting with the drug, as it increases the effect of diazepam in the body. Diazepam can also increase the depressive effects of alcohol and other types of sedatives. This is why it should not be used in conjunction with opioid drugs unless no other treatment is available. [10]

How should it be stored?

Diazepam should be stored in the container it came in and is best kept at room temperature, away from heat or moisture (away from your bathroom, for example). All medications should be kept in a safe location and out of children’s reach.

If you find yourself with some unused or out of date medication, you should follow the FDA’s (Food and Drug Administration) guidelines on how to dispose of it. The FDA has a special list of drugs that you can flush down the toilet if you are unable to dispose of it via a drug take-back scheme. [12]

Diazepam overdose

If you think you have overdosed on diazepam, contact your emergency services immediately or the nearest poison control center. Overdoses of benzodiazepines (including diazepam) are usually manifested by symptoms ranging from drowsiness, difficulty breathing to coma.

In some milder cases, symptoms may include drowsiness, confusion, and lethargy.

In more serious cases, symptoms may include:

  • Ataxia (uncoordinated movements)
  • Diminished reflexes
  • Hypotonia (decreased muscle tone)
  • Hypotension (low blood pressure)
  • Respiratory depression

In very rare cases, diazepam overdose can result in coma or even death. Overdose of benzodiazepines in combination with other depressants (including alcohol and opioids) may be fatal. [11]

Frequently asked questions about diazepam

Is diazepam addictive?

Diazepam has the potential to cause dependency. Its rapid absorption means it can enter the brain tissue quickly, leading to reinforcement (behavior that will be repeated). [5] Using diazepam excessively or incorrectly can lead to addiction.

Some groups of people are at a higher risk of dependence than others. People with a history of substance abuse and people with severe personality disorders. [13]

Can you drive on diazepam?

No, you should not be driving or using heavy machinery as it may affect your ability to operate them. The most common effects of diazepam are drowsiness, sleepiness, and poor coordination, which makes it very dangerous for you and others. [7]

Can diazepam affect my contraception?

Some contraceptive pills can keep diazepam in your body for longer and increase its effect. [7] You may also get bleeding between your periods if you take diazepam and contraceptive pills together, but it will not stop the pill from being effective.

Resources:

  1. NHS website. (2022, March 8). About diazepam. nhs.uk. Retrieved October 15, 2022, from https://www.nhs.uk/medicines/diazepam/about-diazepam/
  2. Sternbach, L. (2014, February 19). Classics in Chemical Neuroscience: Diazepam (Valium) - PMC. NCBI. Retrieved October 15, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3990949/
  3. Diazepam: MedlinePlus Drug Information. (n.d.). Retrieved October 15, 2022, from https://medlineplus.gov/druginfo/meds/a682047.html
  4. Benzodiazepine Often Used in Older People Despite Risks. (2015, September 22). National Institutes of Health (NIH). Retrieved October 18, 2022, from https://www.nih.gov/news-events/nih-research-matters/benzodiazepine-often-used-older-people-despite-risks
  5. Juergens, S. (n.d.). Alprazolam and diazepam: addiction potential. PubMed. Retrieved October 18, 2022, from https://pubmed.ncbi.nlm.nih.gov/2051498/
  6. Crane, M. (2022, September 9). How Long Does Valium Stay in Your System? (Blood, Urine, Saliva). American Addiction Centers. Retrieved October 18, 2022, from https://americanaddictioncenters.org/valium-treatment/how-long-in-system
  7. NHS website. (2022b, May 5). Common questions about diazepam. nhs.uk. Retrieved October 18, 2022, from https://www.nhs.uk/medicines/diazepam/common-questions-about-diazepam/
  8. Diazepam (Valium®) - Mother To Baby | Fact Sheet. (n.d.). NCBI. Retrieved October 18, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK582671/
  9. NHS website. (2022a, February 7). Who can and cannot take diazepam. nhs.uk. Retrieved October 18, 2022, from https://www.nhs.uk/medicines/diazepam/who-can-and-cannot-take-diazepam/
  10. Diazepam and Alcohol/Food Interactions. (n.d.). Drugs.com. Retrieved October 18, 2022, from https://www.drugs.com/food-interactions/diazepam.html
  11. FDA. (n.d.). VALIUM (DIAZEPAM) Label. Accessdata.fda.gov. Retrieved October 18, 2022, from https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/013263s094lbl.pdf
  12. Center for Drug Evaluation and Research. (2020, October 1). Drug Disposal: FDA’s Flush List for Certain Medicines. U.S. Food And Drug Administration. Retrieved October 18, 2022, from https://www.fda.gov/drugs/disposal-unused-medicines-what-you-should-know/drug-disposal-fdas-flush-list-certain-medicines
  13. Diazepam. (n.d.). Drugs.com. Retrieved October 19, 2022, from https://www.drugs.com/diazepam.html