Introduction
Diazepam is a drug that is sold in pharmacies, for example under the trade name Valium®. The drug belongs to the group of long-acting benzodiazepines (it has a comparatively long half-life) and is used in many different ways as a psychotropic drug. Diazepam is used to treat anxiety, as a sleeping pill and/or in epilepsy therapy.
The greatest danger of using diazepam is the development of dependence. For this reason, it is preferably prescribed for acute therapy and less for long-term treatment. The drug diazepam mediates its action by modulating GABA (gamma-aminobutyric acid) receptors in the spinal cord.
After binding to a so-called benzodiazepine binding site of the GABA receptor, diazepam causes a structural change in the receptor, thereby increasing its sensitivity to gamma-aminobutyric acid. This also increases the probability of opening the receptor-associated chloride channel, followed by an increased influx of chloride ions. The increase of the intracellular (in the cell) chloride concentration in turn leads to hyperpolarization of the cell.
In simple terms, this means that the cell is less sensitive to external stimuli because of the diazepam influence. The effect of diazepam is contained in the drug known as Valium®, among others. Diazepam belongs to the group of long-acting benzodiazepines, which have a comparatively long half-life, and is used in many different ways as a psychotropic drug.
Diazepam is used in the treatment of anxiety, as a sleeping pill and/or in epilepsy therapy. One of the most serious side effects that can occur while using diazepam is the development of addiction (high risk of addiction). Therefore, Valium® and/or other diazepam-containing drugs are usually prescribed only for acute therapy and less for long-term treatment.
- As a sleeping pill: the effects of diazepam from a non-pharmacological point of view can be divided into several categories. The active ingredient primarily conveys a sedative (sleep-inducing, calming) effect, which is mediated by the inhibition of specific regions within the brain (more precisely: the brain stem) (limbic system and reticular formatio). However, the sedative effect of diazepam is relatively small, as it has no narcotic effects whatsoever.
- As a sedative: In addition, the effect of diazepam includes a soothing effect on anxiety and panic attacks (anxiolysis).
This effect is also mediated by inhibition of various specific structures in the brain stem. In addition, the effect of diazepam includes a relaxing effect on the muscles. This effect is mediated by intervening in the natural processes of the brain stem and its interaction with the spinal cord.
It is precisely in view of this effect of Valium® and other diazepam-containing drugs that patients are recommended to take it shortly before bedtime. The medication should only be taken when the patient no longer needs to get up, as there is a high risk of bone fractures due to the relaxation of the muscles, especially in older people.
Diazepam is mainly used to treat mental tension and anxiety. In addition, diazepam is considered a standard drug in preoperative medication.
This means that this drug is administered orally to patients shortly before a surgical procedure and has a strong sedative effect. In emergency treatment, diazepam is often administered to treat patients with acute epileptic seizures. Diazepam has become an indispensable part of the drug market due to its reliable action, but certain contraindications must be ruled out before taking it.
The reason for this is that diazepam can lead to dependence if taken for a long time. This danger exists not only in the case of misuse, but also when the preparation is used properly. Diazepam should never be discontinued suddenly, otherwise there is a risk that the treated patients may suffer withdrawal symptoms.
- Severe breathing difficulties (for example sleep apnoea syndrome)
- Liver diseases and/or muscle weakness
- Allergies to the active substance diazepam
- Drug, drug and/or alcohol addiction
The dosage of diazepam depends on the indications. In anxiety states treated on an outpatient basis, the administration is usually 2.5 to 10 mg.For inpatient treatment of anxiety, up to 60 mg per day can be given orally. For anxiety-agitated arousal states, 10 mg orally, intravenously or intramuscularly, repeated once or twice at 30-minute intervals, is usually recommended.
Only in exceptional cases is an administration of more than 40 mg within the first 24 hours advisable. In elderly patients, treatment with diazepam is gradual. In alcohol withdrawal syndrome, 3-4 doses of 10 mg are recommended on day 1 and 3-4 doses of 5 mg a day thereafter.
In some cases the daily dose may be significantly higher. If you have trouble falling asleep, 5 to 20 mg are usually administered in the evening. For acute seizures, the so-called epileptic seizures, 10 mg is administered intravenously.
If this does not work, other drugs are used in these acute situations, such as phenytoin, rhenobarbital or valproate. The most common side effect of diazepam is after the drug is stopped too quickly. The occurrence of so-called paradoxical side effects, i.e. abnormalities that are supposed to be suppressed by taking diazepam, is not uncommon.
Some patients report sudden onset of anxiety and outbursts of anger. Diazepam may also have an irritating effect on the gastrointestinal tract, dry mouth, abdominal pain and/or diarrhoea. An overdose of the active substance usually causes dizziness and temporary loss of memory.
In some patients, speech disorders (e.g. lisping) and enormous coordination problems can be observed. Since diazepam has an inhibitory effect on muscle tone, an extreme overdose can lead to reduced breathing and, in the worst case, to respiratory arrest.
- Severe withdrawal symptoms, which manifest themselves as anxiety, hallucinations, seizures and irritability.
- Tiredness, drowsiness and drowsiness (due to strong sedative effect)
- Partially severe headaches
- Extended reaction time up to temporary memory loss
- Speech formation disorders, gait insecurity, muscle cramps and sleep disorders
If diazepam and alcohol are consumed together, the consequences can be fatal.
Alcohol increases the side effects of diazepam in an unpredictable way. Therefore, alcohol should not be consumed when taking diazepam. Diazepam dependence is fundamentally different from other addictions.
Accordingly, withdrawal is also characterized by a few special features. Usually the dose of diazepam is within the therapeutic range. This means that patients have usually not increased the dose themselves.
This is why it is often a so-called low-dose dependence. This usually does not exceed 20 mg per day. In order to achieve successful withdrawal treatment, it is essential to make people aware of the dangers of long-term use of diazepam.
This requires a great deal of sensitivity on the part of the doctor. Withdrawal should be carried out with a doctor of confidence. Diazepam should never be discontinued abruptly.
The withdrawal dose is usually taken in 2.5 – 5 mg steps. Due to good divisibility the dose can be administered throughout the day. This gives a constant level of efficacy and can thus minimize withdrawal symptoms.
A withdrawal period of 3 – 5 weeks is recommended for inpatient treatment. If the withdrawal is carried out on an outpatient basis, a period of 2 – 4 months may be appropriate. However, the withdrawal should not be too slow, as the patient’s patience and endurance may be required too much. Frequent withdrawal symptoms are sleep disorders, anxiety, mood swings, muscle pain, muscle twitching, trembling, headaches, nausea and loss of appetite. All topics about medications under: Medication A-Z
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