Diazepam
Valium · Valtoco
BenzodiazepineSchedule IVGeneric availableTDM data
Clinical Pharmacology Diazepam is a benzodiazepine that exerts anxiolytic, sedative, muscle-relaxant, anticonvulsant and amnestic effects. Most of these effects are thought to result from a facilitation of the action of gamma aminobutyric acid (GABA), an inhibitory neurotransmitter in the central nervous system.
Compare Diazepam →FDA-Approved Indications
- anxiety disorders or for the short-term relief of the symptoms of anxiety
Common Off-Label Uses
- Alcohol withdrawal
- Muscle spasm
- Spasticity
- Night terrors
What Sets This Drug Apart
- Very long-acting (t1/2 20-100h) due to active metabolite desmethyldiazepam (t1/2 50-100h); first-choice IV benzodiazepine for status epilepticus
- Most formulation options of any benzodiazepine: oral tablet, liquid, IV, IM, rectal gel (Diastat) — flexibility when oral route is unavailable
- Active metabolites accumulate significantly in elderly; not suitable for 'take as needed' use in older patients due to prolonged effects
- CYP3A4 and CYP2C19 substrate — broader interaction profile than lorazepam (which has no CYP metabolism)
- FDA-approved for anxiety, muscle spasm, seizures, and alcohol withdrawal — broadest labeled indication set among benzos
Boxed Warning
WARNING: RISKS FROM CONCOMITANT USE WITH OPIOIDS