Relium

Indications

Diazepam is used for the short-term relief of severe anxiety, short-term treatment of sleeplessness caused by anxiety, muscle spasm, and symptoms of alcohol withdrawal. Rectal, nasal and injection forms are used to stop prolonged seizures (fits), including fits with fever in children, and the injection is used for sedation before some medical procedures.

How It Works

Diazepam is a benzodiazepine. It boosts the effect of GABA, a natural calming chemical in the brain. This reduces anxiety, relaxes muscles, causes sleepiness and helps stop seizures.

Dosage and Administration

• Anxiety, adults: usually 2 mg three times a day, increased by the doctor if needed. The daily total is usually not more than 30 mg, in divided doses.
• Sleeplessness with anxiety, adults: 5 to 15 mg at bedtime.
• Muscle spasm, adults: 2 to 15 mg a day in divided doses.
• Older or frail people: usually half the adult dose or less.
• Seizures, alcohol withdrawal, children, suppositories and nasal spray: only as prescribed.
• Injection: given by a doctor or nurse.

Treatment for anxiety or sleep is usually limited to 2 to 4 weeks. Do not increase the dose on your own.

Interactions

Alcohol and opioid medicines (such as Tramadol, Codeine or Morphine) taken with diazepam can cause dangerously slow breathing, deep sleep and death. Other medicines that cause drowsiness add to its effect, including sleeping pills, sedating antihistamines (such as Chlorpheniramine), antipsychotics, some antidepressants and Pregabalin or Gabapentin. Omeprazole, Esomeprazole, Cimetidine, Fluconazole and Fluvoxamine can raise diazepam levels. Rifampicin, Carbamazepine and Phenytoin can lower them.

Contraindications

• Severe breathing problems or respiratory failure
• Sleep apnoea (breathing stops repeatedly during sleep)
• Severe liver disease
• Myasthenia gravis (a condition causing severe muscle weakness)
• Allergy to diazepam or other benzodiazepines
• Use alone to treat depression or psychosis

Side Effects

Common: drowsiness, tiredness, unsteadiness, dizziness, muscle weakness and poor memory. Older people may become confused and are more likely to fall.

Get urgent medical help if breathing becomes very slow or shallow, the person is very hard to wake, there is an allergic reaction (swelling of the face or throat, difficulty breathing), or there are unusual changes such as agitation, aggression, hallucinations, worsening depression or thoughts of self-harm, or yellow skin or eyes.

Pregnancy and Lactation

Avoid in pregnancy unless a doctor decides it is necessary. Use in late pregnancy or during labour can make the newborn floppy, sleepy, have breathing or feeding problems, or show withdrawal symptoms. Diazepam passes into breast milk and can make the baby sleepy and feed poorly, so it is not recommended while breastfeeding.

Precautions and Warnings

• Diazepam can cause dependence, especially with regular use for more than a few weeks or at high doses. Do not stop suddenly; your doctor will reduce the dose slowly.
• Do not drive or use machines if you feel sleepy; effects can last into the next day.
• Avoid alcohol completely.
• Take extra care in older people, and in lung, kidney or liver disease, or a past history of drug or alcohol misuse.
• This is a controlled, prescription-only medicine. Never share it with anyone.

Overdose

Signs include heavy drowsiness, confusion, slurred speech, poor coordination, slow breathing and loss of consciousness. The danger is much greater if alcohol or opioids were also taken. Call for emergency help immediately.

Therapeutic Class

Benzodiazepine (anti-anxiety medicine, sedative, anticonvulsant and muscle relaxant).

Storage

Store below 30°C in a dry place, away from light, and out of the reach and sight of children. Keep it secure, as it can be misused.