Psychotropic Medication > Anxiolytics > Valium

Valium (Diazepam)

Valium (diazepam), an anxiolytic (antipanic and antianxiety) medication, belongs to the class of drugs known as benzodiazepines. It is used for its sedative, anxiety-relieving, and muscle-relaxing effects. It acts on gamma-aminobutyric acid (GABA) receptors, causing the release of a neurotransmitter called GABA in the brain.

Valium was released in 1963 as an improved version of Librium. It is more potent than Librium and quickly surpassed Librium in terms of sales. After the success of Valium, other pharmaceutical companies started introducing other benzodiazepine derivatives.

How Does Valium Work?

Valium acts on GABA receptors. It appears to act on areas of the limbic system, thalamus, and hypothalamus, inducing anxiolytic effects. Diazepam increases the inhibitory processes in the cerebral cortex. The anticonvulsant properties of the drug are due to its binding with voltage-dependent sodium channels rather than GABA receptors. The drug produces muscle relaxant effects through inhibition of polysynaptic pathways in the spinal cord.

Dosage FAQs

  • What is this drug used to treat?
    Valium has many uses as a medication. In addition to the treatment of anxiety, it is used for pre-surgery sedation, alcohol withdrawal, muscle spasms, and various types of seizures.
     
  • What is a safe dose of this medication?
    • Anxiety: For anxiety-related conditions, this drug is given in doses of 2 mg to 10 mg orally two to three times a day. An Intravenous dose of Valium is 2 mg to 10 mg two to three times a day. The maximum dose, however, should not exceed 30 mg every eight hours.
    • Alcohol Withdrawal: A 10 mg oral dose of this medication is administered after every three to four hours during first 24 hours, after which it is reduced to a 5 mg oral dose as required.
    • Preoperative Sedation: A 10 mg intramuscular dose may be administered before surgery.
    • Muscle Spasm: A 2 mg to 10 mg oral dose of this drug may be given three to four times a day or as required.
       
  • How does my body process this drug?
    Diazepam is well-absorbed in the gastrointestinal tract. It has a bioavailability of 93% with a volume of distribution 0.8 to 1.0 L/kg. The protein binding of Valium is 98.5%. The active metabolite of this drug is desmethyldiazepam. It has a half-life of about 43 hours and ranges from 40 to 100 hours. This long half-life is due to the active metabolites. It is removed from the body in the urine.
     
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    Is this drug safe for me if I become pregnant?
    This medication has been placed in pregnancy category D by the U.S. Food and Drug Administration, which means there is positive evidence of a risk to the fetus. However, if a person is experiencing epileptic seizures, the potential benefits may outweigh the risk. Before this drug is used during pregnancy, a thorough assessment should be performed by you and your doctor to ensure there are no alternative treatments and the benefits are worth the risks.
     
  • Are there ways to get more out of my treatment with this medication?
    This drug is prescribed for several conditions that are also regularly addressed with psychotherapy. If you are prescribed this drug for anxiety related conditions or for alcohol withdrawal, consider pairing your treatment with a therapist or counselor. Finding a therapist with whom you can form a therapeutic relationship may help you achieve a better, longer-lasting mental health outcome.

Possible Side Effects

This medication may produce some adverse effects. Contact your health care provider if you experience the following after taking this drug:

  • Ataxia
  • Poor coordination
  • Drowsiness
  • Rash
  • Diarrhea
  • Hypotension
  • Muscle weakness
  • Respiratory depression
  • Urinary retention
  • Depression
  • Blurred vision
  • Slurred speech
  • Headache

It is best to take Valium with a meal.

Drug interactions

Valium has several drug interactions of which to be aware. If you are prescribed this drug, make sure you discuss possible interactions with your doctor and/or pharmacist.

Avoid alcohol and excessive caffeine consumption while taking Valium. Also, avoid consuming grapefruit juice and products containing grapefruit while taking this medication.

Additionally, the following medications affect the metabolism, increase or decrease the effects of the drug, and/or increase the toxicity of Valium:

  • Indinavir
  • Fosamprenavir
  • Etravirine
  • Amprenavir
  • Clarithromycin
  • Cimetidine
  • Digoxin
  • Josamycin
  • Erythromycin
  • Mephenytoin
  • Ethotoin
  • Fosphenytoin
  • Phenytoin
  • Ketoconazole
  • Itraconazole
  • Fluconazole
  • Quinupristin
  • Rifampicin
  • Telithromycin
  • Ticlopidine
  • Voriconazole

This medication combined with antidepressants may increase sedation.

Safe Withdrawal from Valium

In general, the longer a person takes this medication for treatment, the great possibility he or she will experience withdrawal symptoms. A person can become dependent on this drug and if treatment needs to be stopped, a safe plan should be worked out with their health care provider to taper down the dosage. Abruptly stopping this medication will lead to a greater incidence and intensity of withdrawal symptoms.

References:

  1. Rudolph U, Mohler H: GABA-based therapeutic approaches: GABA A receptor subtype functions. Current Opinion in Pharmacology 2006;6:18.
  2. Schutte-Rodin S et al: Clinical guideline for the evaluation and management of chronic insomnia in adults. Journal of Clinical Sleep Medication 2008;4:487.
  3. Poulos CX, Zack M (November 2004). "Low-dose diazepam primes motivation for alcohol and alcohol-related semantic networks in problem drinkers". Behavioural Pharmacology 15 (7): 503–12. doi:10.1097/00008877-200411000-00006. PMID 15472572.
  4. Vorma H, Naukkarinen HH, Sarna SJ, Kuoppasalmi KI (2005). "Predictors of benzodiazepine discontinuation in subjects manifesting complicated dependence". Substance Use & Misuse 40 (4): 499–510. doi:10.1081/JA-200052433. PMID 15830732.

Page content reviewed by James Pendleton, ND.

Last Update: 05-01-2015

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