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Created May 2019 | Updated Nov 2020


  • [VALIUM]

DEA CODE 2765: Schedule 4

About Diazepam:

  • It's used to treat anxiety, muscle spasms and fits (seizures). It's also used in hospital to reduce alcohol withdrawal symptoms, such as sweating or difficulty sleeping.
  • It can also be taken to help you relax before an operation or other medical or dental treatments. This is known as a "pre-med".
  • Diazepam is available on prescription only.
  • Diazepam belongs to a group of medicines called benzodiazepines.
  • It comes as tablets, a liquid that you swallow, or in a rectal tube (medicine that's squeezed into your anus). It can also be given as an injection in hospital.

It works by increasing the levels of a calming chemical in your brain. Depending on your health condition, this can make you feel drowsy, relieve anxiety, stop seizures or relax tense muscles.

Key Facts:

  • The most common side effect is feeling drowsy.
  • You're not recommended to use diazepam for longer than 4 weeks.
  • If you take diazepam and feel sleepy, do not drive or use tools or machines.
  • Do not drink alcohol while taking diazepam. It can make you sleep very deeply. You may have breathing problems and difficulty waking up.
  • Diazepam is known by the brand names:
    • Diazemuls
    • Stesolid Rectal tubes
    • Diazepam Rectubes
    • Diazepam Desitin
  • It's also known as Valium, but this brand is not available in the UK anymore.

How much will I take?

  • Diazepam tablets and liquid can be taken by adults aged 18 years and over.
  • It can also be taken by children aged 1 month or older for muscle spasms.
  • Diazepam rectal tubes can be used by adults and children.
  • Diazepam is usually only recommended for a short period of time of up to 4 weeks.
  • Diazepam is not likely to be addictive if you take it at a low dose for a short time (2 to 4 weeks).

You should take diazepam tablets for as short a period of time as possible.

Diazepam is a benzodiazepine first discovered at Hoffman-La Roche in the late 1950s. Diazepam was approved by FDA for the treatment of anxiety disorders as well as for such conditions as skeletal muscle spasm, alcohol withdrawal syndrom and convulsions (under the most known brand Valium). The drug acts by binding to GABA-A receptors and potentiating GABA evoked current. Chronic diazepam use is associated with tolerance, dependence, and withdrawal.

Diazepam drug usage

135th most prescribed medicine in the United States for 2017

It is approved for the treatment of anxiety, acute seizures, status epilepticus (continuous seizures), muscle spasms, alcohol withdrawal, and as a medication given right before anesthesia. However, benzodiazepines are also commonly used to treat difficulty sleeping. When starting diazepam, anxiety or insomnia may improve rapidly or over a period of days. Do not drive a car or operate machinery until you know how this medication affects you because you may notice that you feel tired or dizzy.

Benzodiazepines, such as diazepam, are often used for short periods of time only. They may produce emotional and/or physical dependence (addiction) even when used as recommended.

The use of diazepam with drugs like opioid medications has led to serious side effects including slowed and difficulty breathing and death. Opioid drugs are medications used to treat pain and include medications such as:
codeine, oxycodone, morphine, and illegal drugs like heroin. Some opioid medications are also in cough syrup.

Diazepam is used to relieve anxiety, muscle spasms, and seizures and to control agitation caused by alcohol withdrawal. Diazepam can be habit-forming. Do not take a larger dose, take it more often, or for a longer time than your doctor tells you to. Tolerance may develop with long-term or excessive use, making the drug less effective. This medication must be taken regularly to be effective. Do not skip doses even if you feel that you do not need them. Do not take diazepam for more than 4 months or stop taking this medication without talking to your doctor. Stopping the drug suddenly can worsen your condition and cause withdrawal symptoms (anxiousness, sleeplessness, and irritability). Your doctor probably will decrease your dose gradually.

The Effects of Mixing Diazepam and Alcohol
Some people mix alcohol and diazepam in an effort to intensify the relaxing effects of alcohol or control the symptoms of alcohol withdrawal without understanding the effects of mixing diazepam and alcohol. Detoxing is one of the biggest fears of many people suffering from alcoholism. In fact, this fear is what leads many people to mix diazepam with alcohol. They often hope that by taking diazepam while drinking alcohol they will avoid alcohol withdrawal symptoms. Unfortunately, this couldn't be further from the truth. The effects of mixing diazepam and alcohol intensify the symptoms of alcohol withdrawal.

Diazepam and alcohol are both central nervous system depressants. Therefore, the effects of mixing diazepam and alcohol can be unpleasant and life threatening. In addition to experiencing nausea, your breathing can become suppressed to a point that leads to death. If you or a loved one is addicted to diazepam and alcohol, it's important that you get help now.

Diazepam is the generic name for Valium, a prescription drug. Abuse of benzodiazepines, especially in combination with opiate painkillers, has become increasingly common in recent years. Because these drugs can increase the effects of prescription painkillers such as opioids, some people abuse benzodiazepines along with opioids for the relaxed, euphoric "high" this combination offers. Cocaine addicts can use benzodiazepines to relieve uncomfortable side effects, like irritability and agitation. Abuse of benzodiazepines also includes using them to boost the effects of alcohol and ease the symptoms of alcohol withdrawal. Valium can be habit-forming. If you take it for a long time, your body will build up tolerance. Valium is intended for short-term use because it may be habit-forming. If you have had problems with drug or alcohol abuse in the past, you may be at higher risk for Valium becoming habit-forming. Drinking alcohol may make some side effects of Valium more severe.

Valium for Dogs and Cats
Valium is also given to dogs, cats, and other animals to treat anxiety, seizures, or loss of appetite. Additionally, it may be used as a sedative prior to surgery or other veterinary procedures. Valium for dogs and cats should only be used under a veterinarian's guidance.

It is reported that Elvis was found with ten times the standard amount of codeine in his body. He was also reportedly addicted to a variety of substances, such as diazepam, methaqualone, phenobarbital, ethchlorvynol and ethinamate. The toxicology report concluded, at the time, that 'the strong possibility is that these drugs were the major contribution to his demise'. But modern medical advancements now suggest that his underlying heart problems were exacerbated by the heady concoction of drugs found in his system - but they were not a direct cause.

Valium, Diastat (diazepam) (Rx)
Black Box Warnings:

Risks from concomitant use with opioids

  • Concomitant use of benzodiazepines and opioids may result in profound sedation, respiratory depression, coma, and death
  • Reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate
  • Limit dosages and durations to the minimum required
  • Follow patients for signs and symptoms of respiratory depression and sedation
  • Inform patients and caregivers that potentially fatal additive effects may occur if diazepam is used with opioids and that such drugs should not be used concomitantly unless supervised by a health care provider
  • Prescribers are strongly advised to take all reasonable steps to ensure that caregivers fully understand their role and obligations vis a vis the administration of diazepam rectal gel to individuals in their care
  • Prescribers should advise caregivers that they expect to be informed immediately if a patient develops any new findings which are not typical of the patient's characteristic seizure episode

Addiction, abuse, and misuse

  • On September 2020, FDA addressed serious risks of benzodiazepine addiction, abuse, and misuse, which can lead to overdose and death
  • Physical dependence can occur when taken steadily for several days to weeks, even as prescribed
  • Stopping abruptly or reducing dosage too quickly can result in withdrawal reactions, including seizures, which can be life-threatening
  • Assess each patient's risk prior to prescribing and monitor regularly for the development of these behaviors or conditions


A very common and widely prescribed benzodiazepine with hypnotic and sedative qualities. The metre by which other benzodiazepines are compared. May cause amnesia and lowered inhibitions in excess. Has a relatively long half-life in comparison with other benzodiazepines.

RouteOnsetDurationAfter Effects
Tripsit Factsheets
All ROAs:30-90 minutes10-24 hours1-120 hours
Diazepam Duration
All other CNS depressants
Memory loss, Blackout potential, Motor skill impairment, Dizziness, Depression, Irritability, Aggression, Rage, Personality changes, Drowsiness, Appetite fluctuation, Euphoria, Relaxation, Anxiety suppression, Muscle relaxation, Emotional and social dissociation or de-realization (normally seen with long term use).

EMC PDF Diazepam

Medsafe PDF Diazepam

Valium (diazepam tablets)
Side Effects:
Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.
Diazepam can slow or stop your breathing, and death may occur. A person caring for you should seek emergency medical attention if you have slow breathing with long pauses, blue colored lips, or if you are hard to wake up.
Call your doctor at once if you have:
  • weak or shallow breathing
  • severe drowsiness or feeling like you might pass out
  • depressed mood, thoughts of suicide or hurting yourself
  • confusion, hallucinations
  • anxiety, panic attacks, trouble sleeping
  • hyperactivity, agitation, aggression, hostility
  • unusual risk-taking behavior
  • new or worsening seizures
The sedative effects of diazepam may last longer in older adults. Accidental falls are common in elderly patients who take benzodiazepines. Use caution to avoid falling or accidental injury while you are taking diazepam.
Common side effects may include:
  • drowsiness
  • tired feeling
  • muscle weakness
  • loss of coordination
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Appropriate studies have not been performed on the relationship of age to the effects of diazepam in children younger than 6 months of age.

Safety and efficacy have not been established.

Use of diazepam tablets is not recommended in children up to 6 months of age.

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of diazepam in the elderly. However, elderly patients are more likely to have unwanted effects (eg, severe drowsiness, dizziness, confusion, clumsiness, or unsteadiness) and age-related kidney problems, which may require caution and an adjustment in the dose for patients receiving diazepam.

Other Interactions:

  • Grapefruit Juice

Other Medical Problems:
Make sure you tell your doctor if you have any other medical problems, especially:

  • Alcohol abuse, or history of,
  • Depression, or history of
  • Drug abuse or dependence, history of
  • Lung or breathing problems (eg, respiratory depression)
  • Mental health problems, or history of
  • Seizures, history of - Use with caution. May make these conditions worse
  • Breathing problems, severe
  • Glaucoma, narrow-angle
  • Liver disease, severe
  • Myasthenia gravis
  • Sleep apnea (temporary stopping of breathing during sleep) - Should not be used in patients with these conditions
  • Kidney disease
  • Liver disease, mild or moderate - Use with caution. The effects may be increased because of slower removal of the medicine from the body

Diazepam therapy has not been associated with serum aminotransferase elevations, and clinically apparent liver injury from diazepam has been reported, but is exceedingly rare.

Diazepam (Oral) Hepatotoxicity:
Like other benzodiazepines, diazepam is rarely associated with serum ALT elevations during therapy. Furthermore, clinically apparent liver injury from diazepam is exceedingly rare. A small number of cases of hepatic injury have been described in patients on oral diazepam, but the clinical pattern has varied. The onset of injury has ranged from 1 to 6 months, and pattern of serum enzyme elevations has typically been cholestatic or mixed. Fever and rash are uncommon as is autoantibody formation. In large surveys and case series of clinically apparent drug induced liver injury, diazepam and other benzodiazepines are usually not listed. There have been no case reports of hepatotoxicity from diazepam since the 1980s.

D Likelihood score: D (Possible but rare cause of clinically apparent liver injury).

Valium (diazepam)
Maximum Dosage:
Prescribers Digital Reference
Adults:Dosage must be individualized. Suggested maximum doses: 40 mg/day PO in divided doses for chronic ambulatory uses. A maximum dose has not been specifically defined by the manufacturer for emergent conditions.
Geriatric:Dosage must be individualized. Suggested maximum dose: 40 mg/day PO in divided doses for many chronic ambulatory uses. A maximum dose has not been specifically defined by the manufacturer for emergent conditions.
Adolescents:Dosage must be individualized. Suggested maximum dose: 0.6 mg/kg IV in 8 hour period for acute anxiety.
Children:Dosage must be individualized. Suggested maximum dose: 0.6 mg/kg IV in 8 hour period for acute anxiety.
Infants:Maximum dosage not established.
Neonates:Maximum dosage not established.

Important Information:
You should not use this medicine if you are allergic to diazepam or similar medicines (Klonopin, Xanax, and others), or if you have myasthenia gravis, severe liver disease, narrow-angle glaucoma, a severe breathing problem, or sleep apnea.

MISUSE OF THIS MEDICINE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH, especially in a child or other person using the medicine without a prescription.

Fatal side effects can occur if you use this medicine with opioid medicine, alcohol, or other drugs that cause drowsiness or slow your breathing.

Do not give this medication to a child younger than 6 months old.

Do not drink alcohol. Dangerous side effects could occur.

Avoid driving or hazardous activity until you know how this medicine will affect you. Dizziness or drowsiness can cause falls, accidents, or severe injuries.

Grapefruit may interact with diazepam and lead to unwanted side effects. Avoid the use of grapefruit products.


Drug Interactions (455) Alcohol/Food Interactions (2) Disease Interactions (12)

What other drugs will affect Diazepam?
Taking diazepam with other drugs that make you sleepy or slow your breathing can cause dangerous side effects or death. Ask your doctor before taking a sleeping pill, opioid pain medicine, prescription cough medicine, a muscle relaxer, or medicine for anxiety, depression, or seizures. Other drugs may interact with diazepam, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all your current medicines and any medicine you start or stop using.

A total of 455 drugs are known to interact with Diazepam.

  • 28 major drug interactions
  • 380 moderate drug interactions
  • 47 minor drug interactions

RocheCanada PDF Valium

Diazepam may increase the risk of serious or life-threatening breathing problems, sedation, or coma if used along with certain medications. Tell your doctor if you are taking or plan to take certain opiate medications for cough such as codeine (in Triacin-C, in Tuzistra XR) or hydrocodone (in Anexsia, in Norco, in Zyfrel) or for pain such as codeine (in Fiorinal), fentanyl (Actiq, Duragesic, Subsys, others), hydromorphone (Dilaudid, Exalgo), meperidine (Demerol), methadone (Dolophine, Methadose), morphine (Astramorph, Duramorph PF, Kadian), oxycodone (in Oxycet, in Percocet, in Roxicet, others), and tramadol (Conzip, Ultram, in Ultracet). Your doctor may need to change the dosages of your medications and will monitor you carefully. If you take diazepam with any of these medications and you develop any of the following symptoms, call your doctor immediately or seek emergency medical care immediately: unusual dizziness, lightheadedness, extreme sleepiness, slowed or difficult breathing, or unresponsiveness. Be sure that your caregiver or family members know which symptoms may be serious so they can call the doctor or emergency medical care if you are unable to seek treatment on your own. Drinking alcohol or using street drugs during your treatment with diazepam also increases the risk that you will experience these serious, life-threatening side effects. Do not drink alcohol or use street drugs during your treatment.

Is the brand name used in the United States and Canada for the seizure medicine with the generic name diazepam.


Summary of Use During Lactation:
Diazepam is excreted into breastmilk and it and its active metabolite, nordiazepam, accumulate in the serum of breastfed infants with repeated doses.

Because the half-life of diazepam and nordiazepam are long, timing breastfeeding with respect to the dose is of little or no benefit in reducing infant exposure.

Other agents are preferred, especially while nursing a newborn or preterm infant.

After a single dose of diazepam, as for sedation before a procedure or for a seizure, there is usually no need to wait to resume breastfeeding, although with a newborn or preterm infant, a cautious approach would be to wait a period of 6 to 8 hours before resuming nursing.

Drug Levels:
Diazepam is metabolized to the active metabolites nordiazepam (desmethyldiazepam) and temazepam, which are in turn metabolized to the active metabolite oxazepam.

Alternate Drugs to Consider:

The advantages of diazepam in comparison to certain other benzodiazepines are a rapid onset of action. It has been one of the most frequently prescribed medications in the world since its launch in 1963. In 1985 the patent ended, and there are now more than 500 brands available on the market. When taken by mouth, effects may take 40 minutes to begin.

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