Diazepam

What Does Diazepam Do?

Diazepam is a long-acting benzodiazepine primarily utilised for treating anxiety disorders, seizure disorders, muscle spasms, and alcohol withdrawal symptoms. It is also effective for short-term insomnia relief and managing panic attacks. Additionally, it is employed for sedation and anxiolysis in pre- and postoperative settings. 

Diazepam is commonly prescribed for acute lower back pain, especially if the back is in spasm. Patients may find it more effective than anti-inflammatories if the pain is very severe. 

Diazepam is a class C controlled drug. Doctors are advised to prescribe benzodiazepines like diazepam for short-term use only, usually no longer than 2 to 4 weeks, to reduce the risk of dependence.

How Does Diazepam Work? (the complicated stuff!)

Diazepam functions by enhancing the action of the neurotransmitter gamma-aminobutyric acid (GABA) at the GABA_A receptor in the brain. This interaction increases chloride ion flow into the neurons, resulting in a hyperpolarised state, which produces a calming effect on the central nervous system. Consequently, this mechanism aids in the prevention of seizures, alleviates anxiety symptoms, mitigates alcohol withdrawal effects, and promotes muscle relaxation. Additionally, it provides sedation and anxiolysis, making it effective for preoperative procedures.

Drug Type and Category of Diazepam

Diazepam is classified as a long-acting benzodiazepine. 

What dosage of Diazepam should you be taking?

NHS Recommendations ¹

For Anxiety:

• Initial Dose: 2 mg taken three times daily.
• Maintenance Dose: Depending on response, the dose may be increased to 5 mg to 10 mg taken three times daily.

For Sleep Problems Related to Anxiety:

• Dose: 5 mg to 15 mg taken once daily at bedtime.

For Muscle Spasms in Adults:

• Initial Dose: 2 mg to 15 mg per day, which can be taken as 1 mg twice daily and increased up to 5 mg taken three times daily.
• Maximum Dose: Up to 20 mg taken three times daily if needed.

For Muscle Spasms in Children (Aged 1 Month to 17 Years):

• Dose: Varies depending on age; typically taken twice daily with 10 to 12 hours between doses.

Special Considerations:

• Older Adults (Over 65): May require lower doses due to increased sensitivity and the potential for slower metabolism.
• Individuals with Kidney or Liver Problems: Dosage adjustments may be necessary; consult your healthcare provider.

Important Notes:

• Duration of Use: Diazepam is usually prescribed for short-term use, typically not exceeding 4 weeks, to minimise the risk of dependence.
• Administration: Can be taken with or without food. If using the liquid form, use the provided measuring device to ensure accurate dosing.
• Missed Dose: If you miss a dose, take it as soon as you remember unless it's almost time for your next dose. Do not double up to make up for a missed dose.
• Overdose: Taking more than the prescribed dose can lead to serious side effects. If an overdose is suspected, seek immediate medical attention.

What are the side-effects of Diazepam?

Common Side Effects

1. Drowsiness or Fatigue
• Often occurs at the start of treatment and may subside with continued use.
2. Dizziness or Lightheadedness
• May impair coordination and balance.
3. Muscle Weakness
• A relaxing effect on skeletal muscles may cause weakness or lethargy.
4. Blurred Vision
• Temporary changes in vision can occur.
5. Dry Mouth or Increased Salivation
• Some people experience dry mouth, while others may notice increased salivation.

Less Common Side Effects

1. Confusion or Memory Problems
• Short-term memory issues or difficulty concentrating are possible.
2. Headache
• Some individuals report mild to moderate headaches.
3. Nausea or Constipation
• Gastrointestinal disturbances like nausea or constipation are less frequent.
4. Emotional Changes
• Mood swings, irritability, or feelings of euphoria.

Serious Side Effects (Rare)

1. Severe Allergic Reactions (Anaphylaxis)
• Symptoms: Rash, itching, swelling (especially of the face, tongue, or throat), severe dizziness, and difficulty breathing.
• Requires immediate medical attention.
2. Respiratory Depression
• Slowed or shallow breathing, particularly at higher doses or when combined with other central nervous system depressants (e.g., opioids or alcohol).
3. Dependence and Withdrawal Symptoms
• Prolonged use can lead to physical dependence, with withdrawal symptoms like agitation, seizures, or rebound anxiety if stopped abruptly.
4. Paradoxical Reactions
• Rarely, diazepam can cause agitation, aggression, restlessness, or hallucinations.
5. Jaundice or Liver Problems
• Symptoms: Yellowing of the skin or eyes, dark urine, or abdominal pain. These require immediate medical evaluation.
6. Low Blood Pressure (Hypotension)
• Can occur, especially in higher doses or intravenous administration.

Long-Term Side Effects

1. Cognitive Impairment
• Long-term use can affect memory and cognitive function.
2. Tolerance and Dependence
• Over time, higher doses may be needed to achieve the same effect, increasing the risk of dependence.
3. Emotional Blunting
• Reduced ability to feel emotions over extended periods of use.

Precautions

• Avoid activities requiring alertness (e.g., driving or operating machinery) until you know how diazepam affects you.
• Do not consume alcohol while taking diazepam, as it can increase sedation and respiratory depression.

Interactions

Medications That Enhance Sedation or CNS Depression

Combining diazepam with other central nervous system (CNS) depressants can lead to increased sedation, drowsiness, and respiratory depression.

1. Opioids
• Examples: Morphine, oxycodone, fentanyl.
• Significantly increases the risk of severe respiratory depression and sedation.
2. Other Benzodiazepines or Sedatives
• Examples: Lorazepam, zolpidem.
• Amplifies sedative and respiratory depressant effects.
3. Antihistamines
• Examples: Diphenhydramine, hydroxyzine.
• Can enhance drowsiness and dizziness.
4. Antipsychotics
• Examples: Haloperidol, quetiapine.
• May increase sedation and the risk of extrapyramidal symptoms.
5. Alcohol
• Combining alcohol with diazepam greatly increases sedation, drowsiness, and the risk of respiratory depression.

Medications That Affect Diazepam Metabolism

Diazepam is metabolised in the liver by cytochrome P450 enzymes, primarily CYP3A4 and CYP2C19. Drugs affecting these enzymes can alter diazepam levels.

1. CYP3A4 Inhibitors (Increase Diazepam Levels)
• Examples: Ketoconazole, erythromycin, fluvoxamine.
• Can increase sedation and prolong the effects of diazepam.
2. CYP3A4 Inducers (Decrease Diazepam Levels)
• Examples: Rifampin, carbamazepine, St. John’s Wort.
• May reduce diazepam’s effectiveness.
3. CYP2C19 Inhibitors
• Examples: Omeprazole, fluoxetine.
• May increase diazepam’s effects and side effects.

Medications That Increase the Risk of Side Effects

1. Muscle Relaxants
• Examples: Baclofen, tizanidine.
• Enhanced muscle-relaxant effects can lead to profound weakness or respiratory difficulties.
2. Antidepressants
• Examples: Amitriptyline, sertraline.
• Combined use may increase sedation or the risk of paradoxical reactions like agitation.
3. Anticonvulsants
• Examples: Phenytoin, valproate.
• Diazepam may enhance the effects of these drugs, requiring dosage adjustments.

Medications That Mask Symptoms

1. Beta-Blockers
• Examples: Propranolol, atenolol.
• Can mask symptoms of CNS depression, complicating the assessment of diazepam’s effects.

Special Considerations

1. Pregnancy and Breastfeeding
• Diazepam can cross the placenta and is excreted in breast milk. Combining it with other medications during pregnancy or breastfeeding increases risks to the baby.
2. Grapefruit Juice
• Can inhibit the metabolism of diazepam, leading to prolonged effects and increased sedation.
3. Herbal Supplements
• Kava and valerian root: May enhance sedation and increase the risk of CNS depression.
• St. John’s Wort: Can reduce diazepam levels and effectiveness.

Natural Alternatives to Diazepam

1. Herbal Remedies

• Valerian Root
• Often used for its calming effects, valerian root may help reduce anxiety and improve sleep quality².
• Works by increasing gamma-aminobutyric acid (GABA) levels, similar to diazepam's mechanism.
• Chamomile
• Chamomile tea has mild sedative effects that can help reduce anxiety and promote relaxation³.
• Contains apigenin, which binds to GABA receptors in the brain.
• Passionflower (Passiflora incarnata)
• Known for its anxiolytic and sedative properties, passionflower can help alleviate mild anxiety⁴.
• May increase GABA levels in the brain.
• Kava (Piper methysticum)
• A traditional Polynesian remedy for stress and anxiety, kava acts on GABA receptors and provides calming effects⁵.
• Long-term use may have potential liver toxicity, so moderation is essential.

2. Supplements

• Magnesium
• Magnesium deficiency has been linked to increased anxiety. Supplementation may help relax muscles and improve sleep⁶.
• Works by regulating the hypothalamic-pituitary-adrenal (HPA) axis and reducing stress responses.
• L-Theanine
• An amino acid found in green tea, L-theanine promotes relaxation without sedation⁷.
• May increase alpha brain waves, associated with a state of calm alertness.
• 5-HTP (5-Hydroxytryptophan)
• A precursor to serotonin, 5-HTP supplementation may help regulate mood and reduce anxiety⁸.
• Often combined with magnesium or valerian root for enhanced effects.
• Ashwagandha
• This adaptogenic herb can help the body manage stress and reduce cortisol levels⁹.
• Regular use has shown benefits for both anxiety and insomnia.

3. Aromatherapy

• Lavender Oil
• Inhaling lavender essential oil or using it in a diffuser can reduce anxiety and improve sleep quality¹⁰.
• Lavender may work by modulating serotonin levels and enhancing relaxation.
• Bergamot and Ylang-Ylang Oils
• These oils are known for their calming properties and may help alleviate mild stress and anxiety¹¹.

4. Relaxation Techniques

• Meditation and Mindfulness
• Regular meditation can lower anxiety levels by reducing activity in the brain's fear center (amygdala)¹².
• Mindfulness practices improve emotional regulation and overall mental well-being.
• Yoga
• Combines physical postures, breathing exercises, and meditation to reduce stress and improve relaxation¹³.
• Breathing Exercises
• Techniques like diaphragmatic breathing and the 4-7-8 method can help calm the nervous system and reduce anxiety¹⁴.

5. Lifestyle Changes

• Regular Physical Activity
  • Exercise releases endorphins, reduces cortisol levels, and improves mood and sleep quality¹⁵.
  • Activities like walking, swimming, or cycling are particularly effective.
• Sleep Hygiene
  • Maintaining a consistent sleep schedule and avoiding stimulants like caffeine can improve sleep quality and reduce anxiety¹⁶.
• Dietary Adjustments
  • Consuming foods rich in omega-3 fatty acids (e.g., salmon, flaxseed) and antioxidants (e.g., berries, spinach) may support brain health and reduce stress¹⁷.

6. Manual Therapies

• Therapies such as osteopathy, physiotherapy, sports therapy, and chiropractic often help reduce muscle spasm and acute lower back pain, and are likely to provide a good alternative to drug therapy. 

Interesting facts about Diazepam

Diazepam was one of the first benzodiazepines discovered and was introduced in 1963 by Hoffmann-La Roche. It quickly became one of the most widely prescribed medications worldwide.

Diazepam is quickly absorbed, with effects starting within 15–60 minutes after oral administration, making it effective for acute anxiety or seizures.

Diazepam is used in veterinary medicine to treat anxiety, seizures, and muscle spasms in animals, including dogs and cats.

In the 1960s and 1970s, diazepam became a cultural symbol due to its frequent use for stress relief and anxiety, leading to its nickname "Mother’s Little Helper."

Disclaimer

This article is generated for informational purposes only. It was created in March 2025. Medications and medical guidance can change over time. Therefore, it is essential to consult with your general practitioner or healthcare provider before making any decisions regarding medications or treatment plans. Your GP can provide personalised advice based on your specific health needs and conditions.

References

1. https://www.nhs.uk/medicines/diazepam/how-and-when-to-take-diazepam/
2. Bent, S., et al. (2006). "Valerian for Sleep: A Systematic Review and Meta-Analysis." American Journal of Medicine.
3. Srivastava, J. K., et al. (2010). "Chamomile: A Herbal Medicine of the Past with Bright Future." Molecular Medicine Reports.
4. Miyasaka, L. S., et al. (2007). "Passiflora Incarnata L.: A Systematic Review of Clinical Trials." Journal of Ethnopharmacology.
5. Lakhan, S. E., et al. (2010). "Nutritional and Herbal Supplements for Anxiety and Anxiety-Related Disorders: Systematic Review." Nutrition Journal.
6. Boyle, N. B., et al. (2017). "The Effects of Magnesium Supplementation on Subjective Anxiety and Stress." Nutrients.
7. Kimura, K., et al. (2007). "L-Theanine Reduces Psychological and Physiological Stress Responses." Biological Psychology.
8. Bird, J. M., et al. (2010). "5-HTP and Its Role in Anxiety Regulation." Journal of Psychopharmacology.
9. Chandrasekhar, K., et al. (2012). "A Prospective Study of Ashwagandha for Stress and Anxiety Reduction." Indian Journal of Psychological Medicine.
10. Perry, N., et al. (2012). "Lavender and Its Relaxing Effects: A Review." International Journal of Aromatherapy.
11. Hongratanaworakit, T. (2009). "Bergamot and Ylang-Ylang for Stress Relief." Evidence-Based Complementary and Alternative Medicine.
12. Goyal, M., et al. (2014). "Meditation Programs for Psychological Stress and Well-Being." JAMA Internal Medicine.
13. Cramer, H., et al. (2013). "Yoga for Anxiety: A Systematic Review and Meta-Analysis." Depression and Anxiety.
14. Ma, X., et al. (2017). "Breathing Exercises for Anxiety and Stress Reduction: Evidence and Mechanisms." Frontiers in Psychiatry.
15. Herring, M. P., et al. (2010). "The Effect of Exercise on Anxiety and Depression." Journal of Psychiatric Research.
16. Shochat, T., et al. (2014). "The Role of Sleep Hygiene in Anxiety Management." Current Psychiatry Reports.
17. Grosso, G., et al. (2014). "Dietary Omega-3 Fatty Acids and Antioxidants in Anxiety and Stress Management." European Journal of Clinical Nutrition.