Diazepam

Diazepam, commonly known by the brand name Valium, belongs to the benzodiazepine class of drugs and works as an anxiety reliever. It addresses a wide variety of conditions: anxiety, seizure disorders, alcohol withdrawal, muscle spasms, insomnia, and restless legs syndrome. It can also induce amnesia for certain medical procedures. The drug can be given orally, rectally as a suppository, injected into a muscle or vein, or applied as a nasal spray. When injected into a vein, it takes effect within one to five minutes and lasts about an hour; taken by mouth, it starts working in 15 to 60 minutes.

Frequent side effects include drowsiness and poor coordination. Serious side effects are uncommon but include a higher risk of suicide, slowed breathing, and—if used too often in people with epilepsy—a paradoxical increase in seizure risk. Occasionally, it may cause excitement or agitation. Long-term use leads to tolerance, dependence, and withdrawal symptoms when the dose is reduced. Stopping abruptly after prolonged use can be dangerous, and cognitive issues may persist for six months or longer. It is not advised during pregnancy or breastfeeding. The drug works by boosting the effects of the neurotransmitter GABA.

Diazepam was patented in 1959 by Hoffmann-La Roche and has been one of the world’s most frequently prescribed medications since its 1963 launch. In the United States, it was the top-selling drug from 1968 to 1982, with over 2 billion tablets sold in 1978 alone. By 2023, it ranked 183rd in U.S. prescriptions, with more than 2 million written. Its patent expired in 1985, and over 500 brands are now available. It appears on the World Health Organization’s List of Essential Medicines.

**Medical uses**

Diazepam is primarily used for anxiety, insomnia, panic attacks, and acute alcohol withdrawal symptoms. It is also given before medical procedures like endoscopy to sedate, reduce anxiety, or cause amnesia. In 2020, the U.S. approved a nasal spray form to interrupt seizures in people with epilepsy. Because of its relatively long half-life, diazepam is the most common benzodiazepine for tapering off benzodiazepine dependence, allowing a smoother dose reduction. Benzodiazepines generally have low toxicity in overdose.

Specific uses include: treating anxiety, panic attacks, and agitation; managing vertigo-related neurovegetative symptoms; easing alcohol, opioid, and benzodiazepine withdrawal; short-term insomnia relief; muscle spasms; tetanus (alongside intensive care); spastic muscle weakness from stroke, multiple sclerosis, or spinal cord injury (long-term with other rehab); stiff person syndrome (palliative); pre- or post-surgical sedation and amnesia; complications from stimulant overdoses and psychosis (e.g., cocaine or methamphetamine); organophosphate poisoning (reducing seizure-related brain and heart damage); and preventing oxygen toxicity during hyperbaric oxygen therapy. Doses are tailored to the individual based on the condition, symptom severity, body weight, and other health factors.

**Seizures**

Intravenous diazepam and lorazepam are first-line treatments for status epilepticus, though lorazepam has advantages—higher seizure-stopping rates and longer anticonvulsant effect. Diazepam gel outperformed placebo gel in reducing the risk of ongoing seizures. Diazepam is rarely used long-term for epilepsy because tolerance to its anticonvulsant effects typically develops within six to twelve months, making it ineffective. It can help treat seizures from overdoses or chemical toxins like sarin, VX, soman, other organophosphates, lindane, chloroquine, physostigmine, or pyrethroids. It is sometimes used intermittently to prevent febrile seizures in children under five, lowering recurrence rates but with common side effects; the decision to treat these benign seizures weighs these factors. Long-term epilepsy management with diazepam is not recommended, though a few people with treatment-resistant epilepsy benefit from long-term benzodiazepines; for them, clorazepate is often preferred due to slower tolerance development.

**Alcohol withdrawal**

Diazepam is preferred over other benzodiazepines for moderate to severe alcohol withdrawal due to its long duration of action and proven safety and efficacy. An exception is when an intramuscular injection is needed—then lorazepam or midazolam is recommended.

**Other**

Diazepam is used for emergency treatment of eclampsia when IV magnesium sulfate and blood pressure control fail. Benzodiazepines themselves have no pain-relieving properties and are generally avoided in people with pain.