Diazepam
VALIUM
Pronunciation: dye-AZ-e-pam (VAL-ee-um)
“Diaz in the Valley...um”
pink GABA-A theme for benzos
pill bottle → benzodiazepine
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
Available strengths
- tab 2, 5, 10 mg
- inj 5 mg/mL
- sol 5 mg/mL
- gel 2.5 mg/0.5 mL
- gel 10 mg/2 mL
- gel 20 mg/4 mL
- nasal spray 5, 7.5, 10 mg/spray
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
Cost
| Strength | #/mo | generic $ | CostPlus | |
|---|---|---|---|---|
| 2 mg | tab | 60 BID | $1.27/mo | not offered |
| 5 mg | tab | 60 BID | $1.66/mo | not offered |
| 10 mg | tab | 60 BID | $1.70/mo | not offered |
| 5 mg/mL | inj | per unit | not offered |
Generic entry1985
⚠ BOXED WARNINGS
- Risk from concomitant use with opioids
- Abuse, misuse and addiction
- Dependence and withdrawal reactions
Classes and tags
Clinical profile
Legacy pregnancy categoryD
Defining liabilitySedation, falls, dependence and dangerous additive respiratory depression with opioids.
Active metabolites
Open Diazepam in the interactive console ↗
