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Diazapam, first marketed as Valium, is a medicine of the benzodiazepines family that acts as an anxiolytic. It is commonly used to treat a range of conditions, including anxiety, seizures, alcohol withdrawal syndrome, benzodiazepine withdrawal syndrome, muscle spasms, insomia, and restless leg syndrome. It may also be used to cause memory lost during certain medical procedures. It can be taken by mouth, inserted into the rectum, injected into muscle, injected into a vein or used as a nasal spray.When given into a vein, effects begin in one to five minutes and last up to an hour. By mouth, effects begin after 15 to 60 minutes.

Common side effects include sleepiness and trouble with coordination. Serious side effects are rare. They include suicide, decreased breathing, and an increased risk of seizures if used too frequently in those with epilepsy. Occasionally, excitement or agitation may occur. Long term use can result in tolerance, dependence, and withdrawal symptoms on dose reduction. Abrupt stopping after long-term use can be potentially dangerous. After stopping, cognitive problems may persist for six months or longer. It is not recommended during pregnancy or breastfeeding. Its mechanism of action is by increasing the effect of the neurotransmitter Gamma-Aminobutyric Acid (GABA).

Diazepam was patented in 1959 by Hoffmann-La Roche. It has been one of the most frequently prescribed medications in the world since its launch in 1963. In the United States it was the highest selling medication between 1968 and 1982, selling more than 2 billion tablets in 1978 alone. In 2018, it was the 115th most commonly prescribed medication in the United States, with more than 6 million prescriptions. In 1985 the patent ended, and there are more than 500 brands available on the market.

Medical Use

Diazepam is mainly used to treat anxiety, insomnia, panic attacks and symptoms of acute alcohol withdrawal. It is also used as a premedication for inducing sedation, anxiolysis, or amnesia before certain medical procedures (e.g., endoscopy). In 2020, it was approved for use in the United States as a nasal spray to interrupt seizure activity in people with epilepsy. Diazepam is the drug of choice for treating benzodiazepine dependence with its long half-life allowing easier dose reduction. Benzodiazepines have a relatively low toxicity in overdose.

Diazepam has a number of uses including:

Treatment of anxiety, panic attacks, and states of agitation
Treatment of neurovegetative symptoms associated with vertigo
Treatment of the symptoms of alcohol, opiate, and benzodiazepine withdrawal
Short-term treatment of insomnia
Treatment of muscle spasms
Treatment of tetanus, together with other measures of intensive treatment
Adjunctive treatment of spastic muscular paresis (paraplegia/tetraplegia) caused by cerebral or spinal cord conditions such as stroke, multiple sclerosis, or spinal cord injury (long-term treatment is coupled with other rehabilitative measures)
Palliative treatment of stiff person syndrome
Pre- or postoperative sedation, anxiolysis or amnesia (e.g., before endoscopic or surgical procedures)
Treatment of complications with a hallucinogen crisis and stimulant overdoses and psychosis, such as LSD, cocaine, or methamphetamine

Used in treatment of organophosphate poisoning and reduces the risk of seizure induced brain and cardiac damage.

Preventive treatment of oxygen toxicity during hyparberic oxygen therapy

Dosages should be determined on an individual basis, depending on the condition being treated, severity of symptoms, patient body weight, and any other conditions the person may have

Side Effects

Drowsiness, dizziness, tiredness, blurred vision, or unsteadiness may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.

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Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor right away if you have any serious side effects, including: mental/mood changes (such as memory problems, agitation, hallucination, confusion, restlessness, depression), trouble speaking, trouble walking, muscle weakness, shaking (tremors), trouble urinating, yellowing eyes/skin, signs of infection (such as sore throat that doesn’t go away, fever, chills).

Get medical help right away if you have any very serious side effects, including: slow/shallow breathing.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.