Diazepam
VALIUM
What it isLong-acting GABA-A positive allosteric modulator; anxiety, seizures, muscle spasm, and alcohol withdrawal.
Why this oneRapid onset plus a long-lived active metabolite gives alcohol withdrawal a built-in self-taper.
What limits itIt accumulates in older adults and liver disease; opioids magnify respiratory depression, and regular use causes dependence.
FDA-approved for
- anxiety (1963)
- seizures (~1968)
- muscle spasm (~1968)
Off-label
- alcohol withdrawal
- catatonia
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Anxiety disorders / symptom relief | Adults | 2–10 mg BID–QID | ||
| Acute alcohol withdrawal | Adults | 10 mg TID–QID first 24h, then 5 mg TID–QID | ||
| Skeletal muscle spasm (adjunct) | Adults | 2–10 mg TID–QID | ||
| Convulsive disorders (adjunct) | Adults | 2–10 mg BID–QID | ||
| Any (geriatric/debilitated) | Geriatric/debilitated | 2–2.5 mg QD–BID initially | ||
| Any | Pediatric (≥6 mo) | 1–2.5 mg TID–QID initially |
Renal Undefined
Hepatic Contraindicated in severe hepatic insufficiency.
Instructions
- Individualize dose; increase gradually as needed and tolerated
- To discontinue or reduce dose, taper gradually to reduce risk of withdrawal reactions
- Not for use in pediatric patients under 6 months
Contraindications
- Pediatric patients under 6 months of age
- Myasthenia gravis
- Severe respiratory insufficiency
- Severe hepatic insufficiency
- Sleep apnea syndrome
- Acute narrow-angle glaucoma
Cautions
- Concomitant opioids: profound sedation, respiratory depression, death
- CNS depression impairing driving/machinery
- Dependence and withdrawal with abrupt discontinuation
- Paradoxical reactions (agitation, aggression)
- Use caution in elderly/debilitated
Adverse reactions
- Drowsiness
- Fatigue
- Muscle weakness
- Ataxia
- Confusion, dysarthria, tremor, vertigo
Pregnancy Pregnancy exposure registry exists; benzodiazepines may cause fetal harm.
Lactation Undefined
⚠ BOXED WARNINGS
- Risk from concomitant use with opioids
- Abuse, misuse and addiction
- Dependence and withdrawal reactions
Cost, est. cash$5–$150/month
Generic entry1985
Classes and tags
Clinical profile
Legacy pregnancy categoryD
Defining liabilitySedation, falls, dependence and dangerous additive respiratory depression with opioids.
Active metabolites
Mechanism of action: Diazepam ballicule
Open Diazepam in the interactive console ↗
Memory aids: mascots and interaction avatars
pink GABA-A theme for benzos
pill bottle → benzodiazepine
