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Diazepam is a prescription medicine used in the treatment of short-term anxiety. It can also be used to treat acute alcohol withdrawal, to relieve muscle spasm and as adjunctive therapy for seizures. This medicine relaxes the nerve cells and calms the brain. Diazepam may be taken with or without food. However, take it at the same time each day as this helps to maintain a consistent level of medicine in the body. Take this medicine in the dose and duration as advised by your doctor as it has a high potential of habit-forming. If you have missed any doses, take it as soon as you remember it and finish the full course of treatment even if you feel better. Do not stop taking this medicine suddenly without talking to your doctor as it can cause withdrawal effects like depression and difficulty sleeping. Side effects of this medicine include fatigue, confusion, tremor, double vision, insomnia, dry mouth, and headache. It may cause dizziness and sleepiness, so do not drive or do anything that requires mental focus until you know how this medicine affects you. This medicine may cause weight gain. But, a good balanced diet and regular exercise can help to reduce extra weight. If you have been taking this medicine for a long time then regular monitoring of blood and liver functions may be required. Diazepam is a benzodiazepine. It works by increasing the action of a chemical messenger (GABA) which suppresses the abnormal and excessive activity of the nerve cells in the brain.

• Short term anxiety • Alcohol withdrawal • Muscle spasm • Epilepsy

Diazepam is a long-acting benzodiazepine w/ anticonvulsant, anxiolytic, sedative, muscle relaxant and amnestic properties. It increases neuronal membrane permeability to Cl ions by binding to stereospecific benzodiazepine receptors on the postsynaptic GABA neuron w/in the CNS and enhancing the GABA inhibitory effects resulting in hyperpolarisation and stabilisation.

Adult Dose: Anxiety 2-10 mg PO q6-12hr, OR 2-10 mg IV/IM q6-12hr; no more than 30 mg/8 hours Alcohol Withdrawal 10 mg PO q6-8hr during first 24hr; reduce to 5 mg PO q6-8hr PRN Initial: 10 mg IV/IM, may give additional doses of 5-10 mg IV q6-8hr as needed Endoscopy IV: Titrate dose to 10 mg or less immediately before procedure, not to exceed cumulative dose of 20 mg; reduce dose of narcotic by one third or omit, OR IM: 5-10 mg 30 minutes before procedure Preoperative Sedation 10 mg IM before surgery Sedation in the ICU 5-10 mg IV 1-2 hours before surgery; 0.03-0.1 mg/kg q30min to 6hr Muscle Spasm 2-10 mg PO q6-8hr PRN, OR 5-10 mg IV/IM initially; THEN q3-4hr if necessary Seizure Disorder 2-10 mg PO q6-12hr as adjunct, OR 0.2 mg/kg PR, repeat after 4-12 hours PRN Status Epilepticus 5-10 mg IV/IM q5-10min; not to exceed 30 mg, OR 0.5 mg/kg PR (using parenteral solution), THEN 0.25 mg/kg in 10 minutes PRN Elderly: Should not exceed half the adult dose. Hepatic impairment: Dose reduction may be required. Child Dose: Sedative/Muscle Relaxant Potentially toxic dose in patients 0.5 mg/kg 12 years 0.12-0.8 mg/kg/day PO divided q6-8hr, OR 0.04-0.2 mg/kg IV/IM q2-4hr; no more than 0.6 mg/kg within 8 hours Status Epilepticus Potentially toxic dose in patients 0.5 mg/kg PR 2-6 years: 0.5 mg/kg; may repeat in 4-12 hours PRN 6-12 years: 0.3 mg/kg; may repeat in 4-12 hours PRN >12 years: 0.2 mg/kg; may repeat in 4-12 hours PRN IV 6 months-5 years: 0.2-0.5 mg IV initially, repeat every 2-5 minutes; do not exceed 5 mg; may repeat 2-4 hours later PRN >5 years: 1 mg IV given slowly every 2-5 min; not to exceed 10 mg total dose; may repeat in 2-4 hours if necessary Renal Dose: Renal impairment: Dose reduction may be required.

Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Diazepam may be taken with or without food, but it is better to take it at a fixed time.

If you miss a dose of Diazepam, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular schedule. Do not double the dose.

Common: • Fatigue • Impaired coordination • Drowsiness • Muscle weakness

[UNSAFE] Diazepam may cause side effects which could affect your ability to drive. Diazepam can make you sleepy, forgetful, and have poor co-ordination. This may affect your ability to drive. Diazepam helps treat short term anxiety. Safety of this medicine is not established for long-term use. Do not use it for more than 4 weeks. The addiction / habit-forming potential of this medicine is very high. Take it only as per the dose and duration advised by your doctor It may cause dizziness. Do not drive or do anything that requires mental focus until you know how this medicine affects you. Avoid consuming alcohol as it may increase dizziness and drowsiness. Inform your doctor if you are pregnant, planning to conceive or breastfeeding. Do not stop taking medication suddenly without talking to your doctor as that may lead to nausea, anxiety, agitation, flu-like symptoms, sweating, tremor, and confusion.

Hypersensitivity; myasthenia gravis, preexisting CNS depression or coma, respiratory depression; acute pulmonary insufficiency or sleep apnoea syndrome; severe hepatic impairment; acute narrow angle glaucoma; children <6 mth (oral); pregnancy and lactation.

May significantly enhance CNS depressant effect w/ antivirals (e.g. amprenavir, ritonavir). May enhance CNS depressant effect w/ anaesth, narcotic analgesics, antidepressants, antipsychotics, anxiolytics, antiepileptics, antihistamines, antihypertensives, muscle relaxants (e.g. tizanidine, baclofen), nabilone. May decrease clearance w/ antibacterials that interfere w/ metabolism by hepatic enzymes (e.g. isoniazid and erythromycin), OC, cimetidine, omeprazole. May increase clearance w/ antibacterials which are known inducers of hepatic enzymes (e.g. rifampicin). May increase serum level w/ disulfiram. May reduce clearance of digoxin. May reduce therapeutic effect w/ theophylline. Reversible deterioration of parkinsonism w/ levodopa.

[UNSAFE] It is unsafe to consume alcohol with Diazepam.

[CONSULT YOUR DOCTOR] Diazepam is unsafe to use during pregnancy as there is definite evidence of risk to the developing baby. However, the doctor may rarely prescribe it in some life-threatening situations if the benefits are more than the potential risks. Please consult your doctor.

[CONSULT YOUR DOCTOR] Diazepam is probably unsafe to use during breastfeeding. Limited human data suggests that the drug may pass into the breastmilk and harm the baby.

[CAUTION] Diazepam should be used with caution in patients with kidney disease. Dose adjustment of Diazepam may be needed. Please consult your doctor. Dose adjustment may be required if it is to be given for a long period [CAUTION] Diazepam should be used with caution in patients with liver disease. Dose adjustment of Diazepam may be needed. Please consult your doctor.

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