diazepam (Rx)

Brand and Other Names:Valium, Diastat, more...Diastat AcuDial
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablet: Schedule IV

  • 2mg
  • 5mg
  • 10mg

oral solution: Schedule IV

  • 1mg/1mL
  • 5mg/mL

rectal gel: Schedule IV

  • 2.5mg
  • 10mg
  • 20mg

injectable solution: Schedule IV

  • 5mg/mL

intramuscular device: Schedule IV

  • 5mg/mL

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  

Dosage Modifications

Renal impairment: No dose adjustment recommended unless administered for prolonged period; decrease dose in prolonged periods

Hepatic impairment: 50% of maintenance dose

Seizures (Orphan)

Orphan designations for management of acute repetitive seizures or for Dravet syndrome by various administrative routes (eg, intranasal, buccal soluble film, or SC)

Orphan sponsors

  • Intranasal: Neurelis Pharmaceuticals, Inc; 1042-B N. El Camino Real, Suite 430; Encinitas, California 92024
  • SC (Diazepen [TM]): Xeris Pharmaceuticals, Inc; 3208 Red River Street, Suite 300; Austin, Texas 78705
  • Buccal soluble film: MonoSol Rx, LLC; 30 Technology Drive; Warren, New Jersey 07059

Dosage Forms & Strengths

tablet: Schedule IV

  • 2mg
  • 5mg
  • 10mg

oral solution: Schedule IV

  • 1mg/1mL
  • 5mg/mL

rectal gel: Schedule IV

  • 2.5mg
  • 10mg
  • 20mg

injectable solution: Schedule IV

  • 5mg/mL

intramuscular device: Schedule IV

  • 5mg/mL

Sedative/Muscle Relaxant

Potentially toxic dose in patients <6 years: >0.5 mg/kg

<6 months: Not recommended

>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 <6 years: >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

2-2.5 mg PO qDay or q12hr initially; increase gradually PRN

Rectal gel: Use lower dose

Dosing Considerations

Due to long-acting metabolite, not considered a drug of choice in the elderly; associated with falls

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Interactions

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              • abametapir

                abametapir will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir.

              • apalutamide

                apalutamide will decrease the level or effect of diazepam by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP2C19 inducer, with drugs that are CYP2C19 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered.

                apalutamide will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.

              • benzhydrocodone/acetaminophen

                benzhydrocodone/acetaminophen, diazepam. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

              • calcium/magnesium/potassium/sodium oxybates

                diazepam, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

              • carbamazepine

                carbamazepine will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • cimetidine

                cimetidine will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • clarithromycin

                clarithromycin will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • darunavir

                darunavir increases levels of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Use alternatives if available.

              • erythromycin base

                erythromycin base will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • erythromycin ethylsuccinate

                erythromycin ethylsuccinate will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • erythromycin lactobionate

                erythromycin lactobionate will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • erythromycin stearate

                erythromycin stearate will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • fedratinib

                diazepam will increase the level or effect of fedratinib by Other (see comment). Avoid or Use Alternate Drug. Avoid coadministration of fedratinib (a CYP3A4 and CYP2C19 substrate) with dual CYP3A4 and CYP2C19 inhibitor. Effect of coadministration of a dual CYP3A4 and CYP2C19 inhibitor with fedratinib has not been studied.

              • hydrocodone

                hydrocodone, diazepam. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

              • idelalisib

                idelalisib will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates

              • ivosidenib

                ivosidenib will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternate therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.

              • ketoconazole

                ketoconazole will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • lonafarnib

                diazepam will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of lonafarnib (a sensitive CYP3A substrate) with weak CYP3A inhibitors is unavoidable, reduce to, or continue lonafarnib at starting dose. Closely monitor for arrhythmias and events (eg, syncope, heart palpitations) since lonafarnib effect on QT interval is unknown.

                lonafarnib will increase the level or effect of diazepam by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Lonafarnib may increase the AUC and peak concentration of CYP2C19 substrates. If coadministration unavoidable, monitor for adverse reactions and reduce the CYP2C19 substrate dose in accordance with its approved product labeling.

              • metoclopramide intranasal

                diazepam, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

              • mifepristone

                mifepristone will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • nefazodone

                nefazodone will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • rifabutin

                rifabutin will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • rifampin

                rifampin will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • selinexor

                selinexor, diazepam. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • sodium oxybate

                diazepam, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

              • St John's Wort

                St John's Wort will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • sufentanil SL

                sufentanil SL, diazepam. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

              • tipranavir

                tipranavir will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • tucatinib

                tucatinib will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.

              • valerian

                valerian and diazepam both increase sedation. Avoid or Use Alternate Drug.

              • voxelotor

                voxelotor will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.

              Monitor Closely (250)

              • abobotulinumtoxinA

                diazepam increases effects of abobotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Muscle relaxants may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.

              • alfentanil

                diazepam and alfentanil both increase sedation. Use Caution/Monitor.

              • alprazolam

                alprazolam and diazepam both increase sedation. Use Caution/Monitor.

              • amitriptyline

                diazepam and amitriptyline both increase sedation. Use Caution/Monitor.

              • amobarbital

                amobarbital will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

                amobarbital and diazepam both increase sedation. Use Caution/Monitor.

              • amoxapine

                diazepam and amoxapine both increase sedation. Use Caution/Monitor.

              • apomorphine

                diazepam and apomorphine both increase sedation. Use Caution/Monitor.

              • aprepitant

                aprepitant will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • aripiprazole

                diazepam and aripiprazole both increase sedation. Use Caution/Monitor.

              • armodafinil

                armodafinil will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • artemether/lumefantrine

                artemether/lumefantrine will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • atazanavir

                atazanavir increases levels of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. Use alternatives if available. Consider lowering benzodiazepine dose.

              • avapritinib

                diazepam will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • axitinib

                diazepam increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • azelastine

                azelastine and diazepam both increase sedation. Use Caution/Monitor.

              • baclofen

                diazepam and baclofen both increase sedation. Use Caution/Monitor.

              • belladonna and opium

                diazepam and belladonna and opium both increase sedation. Use Caution/Monitor.

              • benperidol

                diazepam and benperidol both increase sedation. Use Caution/Monitor.

              • benzphetamine

                diazepam increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • bortezomib

                bortezomib will increase the level or effect of diazepam by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

              • bosentan

                bosentan will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • brexanolone

                brexanolone, diazepam. Either increases toxicity of the other by sedation. Use Caution/Monitor.

              • brompheniramine

                brompheniramine and diazepam both increase sedation. Use Caution/Monitor.

              • buprenorphine

                diazepam and buprenorphine both increase sedation. Use Caution/Monitor.

              • buprenorphine buccal

                diazepam and buprenorphine buccal both increase sedation. Use Caution/Monitor.

              • buprenorphine subdermal implant

                diazepam increases toxicity of buprenorphine subdermal implant by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Studies have shown that the combination of benzodiazepines and buprenorphine altered the usual ceiling effect on buprenorphine-induced respiratory depression, making the respiratory effects of buprenorphine appear similar to those of full opioid agonists. There have been postmarketing reports of coma and death with coadministration of buprenorphine and benzodiazepines. In many, but not all of these cases, buprenorphine was misused by self-injection. If a benzodiazepine must be used for an indication other than seizures, lower the benzodiazepine initial dose and cautiously titrate to clinical response.

              • buprenorphine, long-acting injection

                diazepam increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.

                buprenorphine, long-acting injection increases effects of diazepam by Other (see comment). Modify Therapy/Monitor Closely. Comment: Buprenorphine may enhance the neuromuscular blocking action of skeletal muscle relaxants and increase risk for respiratory depression. Monitor for signs of respiratory depression that may be greater than otherwise expected and decrease muscle relaxant dosage as necessary.

              • butabarbital

                butabarbital will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

                butabarbital and diazepam both increase sedation. Use Caution/Monitor.

              • butalbital

                butalbital will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

                butalbital and diazepam both increase sedation. Use Caution/Monitor.

              • butorphanol

                diazepam and butorphanol both increase sedation. Use Caution/Monitor.

              • cannabidiol

                cannabidiol will increase the level or effect of diazepam by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider reducing the dose of sensitive CYP2C19 substrates, as clinically appropriate, when coadministered with cannabidiol.

              • carbamazepine

                diazepam increases levels of carbamazepine by decreasing metabolism. Use Caution/Monitor.

                carbamazepine decreases levels of diazepam by increasing metabolism. Use Caution/Monitor.

              • carbinoxamine

                carbinoxamine and diazepam both increase sedation. Use Caution/Monitor.

              • carisoprodol

                diazepam and carisoprodol both increase sedation. Use Caution/Monitor.

              • cenobamate

                cenobamate will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                cenobamate will increase the level or effect of diazepam by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.

                cenobamate, diazepam. Either increases effects of the other by sedation. Use Caution/Monitor.

              • chloral hydrate

                diazepam and chloral hydrate both increase sedation. Use Caution/Monitor.

              • chlordiazepoxide

                chlordiazepoxide and diazepam both increase sedation. Use Caution/Monitor.

              • chlorpheniramine

                chlorpheniramine and diazepam both increase sedation. Use Caution/Monitor.

              • chlorpromazine

                diazepam and chlorpromazine both increase sedation. Use Caution/Monitor.

              • chlorzoxazone

                diazepam and chlorzoxazone both increase sedation. Use Caution/Monitor.

              • cinnarizine

                cinnarizine and diazepam both increase sedation. Use Caution/Monitor.

              • clemastine

                clemastine and diazepam both increase sedation. Use Caution/Monitor.

              • clobazam

                diazepam, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).

              • clomipramine

                diazepam and clomipramine both increase sedation. Use Caution/Monitor.

              • clonazepam

                clonazepam and diazepam both increase sedation. Use Caution/Monitor.

              • clonidine

                clonidine, diazepam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration enhances CNS depressant effects.

              • clorazepate

                clorazepate and diazepam both increase sedation. Use Caution/Monitor.

              • clozapine

                diazepam and clozapine both increase sedation. Use Caution/Monitor.

                diazepam, clozapine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Possible risk of cardiorespiratory collapse.

              • cobicistat

                cobicistat will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. A decreased dose of diazepam may be required

              • codeine

                diazepam and codeine both increase sedation. Use Caution/Monitor.

              • conivaptan

                conivaptan will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • crizotinib

                crizotinib increases levels of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Dose reduction may be needed for coadministered drugs that are predominantly metabolized by CYP3A.

              • crofelemer

                crofelemer increases levels of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed.

              • cyclizine

                cyclizine and diazepam both increase sedation. Use Caution/Monitor.

              • cyclobenzaprine

                diazepam and cyclobenzaprine both increase sedation. Use Caution/Monitor.

              • cyclosporine

                cyclosporine will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • cyproheptadine

                cyproheptadine and diazepam both increase sedation. Use Caution/Monitor.

              • dabrafenib

                dabrafenib will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

              • dantrolene

                diazepam and dantrolene both increase sedation. Use Caution/Monitor.

              • darifenacin

                darifenacin will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • dasatinib

                dasatinib will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • deferasirox

                deferasirox will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • desflurane

                desflurane and diazepam both increase sedation. Use Caution/Monitor.

              • desipramine

                diazepam and desipramine both increase sedation. Use Caution/Monitor.

              • deutetrabenazine

                diazepam and deutetrabenazine both increase sedation. Use Caution/Monitor.

              • dexamethasone

                dexamethasone will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • dexchlorpheniramine

                dexchlorpheniramine and diazepam both increase sedation. Use Caution/Monitor.

              • dexfenfluramine

                diazepam increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dexmedetomidine

                diazepam and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • dextromoramide

                diazepam and dextromoramide both increase sedation. Use Caution/Monitor.

              • DHEA, herbal

                DHEA, herbal will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • diamorphine

                diazepam and diamorphine both increase sedation. Use Caution/Monitor.

              • diazepam intranasal

                diazepam intranasal, diazepam. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.

              • difenoxin hcl

                diazepam and difenoxin hcl both increase sedation. Use Caution/Monitor.

              • diltiazem

                diltiazem will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • dimenhydrinate

                dimenhydrinate and diazepam both increase sedation. Use Caution/Monitor.

              • diphenhydramine

                diphenhydramine and diazepam both increase sedation. Use Caution/Monitor.

              • diphenoxylate hcl

                diazepam and diphenoxylate hcl both increase sedation. Use Caution/Monitor.

              • dipipanone

                diazepam and dipipanone both increase sedation. Use Caution/Monitor.

              • disulfiram

                disulfiram increases levels of diazepam by decreasing metabolism. Use Caution/Monitor.

              • dopexamine

                diazepam increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dosulepin

                diazepam and dosulepin both increase sedation. Use Caution/Monitor.

              • doxepin

                diazepam and doxepin both increase sedation. Use Caution/Monitor.

              • doxylamine

                diazepam and doxylamine both increase sedation. Use Caution/Monitor.

              • dronedarone

                dronedarone will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • droperidol

                diazepam and droperidol both increase sedation. Use Caution/Monitor.

              • efavirenz

                efavirenz will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • elagolix

                elagolix will increase the level or effect of diazepam by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak CYP2C19 inhibitor. Caution with sensitive CYP2C19 substrates.

                elagolix will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.

              • elvitegravir/cobicistat/emtricitabine/tenofovir DF

                elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; consider benzodiazepine dose reduction.

              • encorafenib

                encorafenib, diazepam. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.

              • enzalutamide

                enzalutamide will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • esketamine intranasal

                esketamine intranasal, diazepam. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

              • eslicarbazepine acetate

                eslicarbazepine acetate will increase the level or effect of diazepam by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

                eslicarbazepine acetate will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • estazolam

                diazepam and estazolam both increase sedation. Use Caution/Monitor.

              • ethanol

                diazepam and ethanol both increase sedation. Use Caution/Monitor.

              • ethinylestradiol

                ethinylestradiol will increase the level or effect of diazepam by Mechanism: decreasing metabolism. Use Caution/Monitor. Ethinyl estradiol may inhibit the clearance of benzodiazepines that undergo oxidation, thereby increasing serum concentrations of concomitantly administered benzodiazepines.

              • etomidate

                etomidate and diazepam both increase sedation. Use Caution/Monitor.

              • etravirine

                etravirine will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • fedratinib

                fedratinib will increase the level or effect of diazepam by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2C19 substrates as necessary.

              • fenfluramine

                diazepam increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • finerenone

                diazepam will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or weak CYP3A4 inhibitors. Adjust finererone dosage as needed.

              • flibanserin

                diazepam and flibanserin both increase sedation. Modify Therapy/Monitor Closely. Risk for sedation increased if flibanserin is coadministration with other CNS depressants.

                diazepam will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased flibanserin adverse effects may occur if coadministered with multiple weak CYP3A4 inhibitors.

              • fluconazole

                fluconazole will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • fludrocortisone

                fludrocortisone will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • fluoxetine

                fluoxetine will increase the level or effect of diazepam by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

              • fluphenazine

                diazepam and fluphenazine both increase sedation. Use Caution/Monitor.

              • flurazepam

                diazepam and flurazepam both increase sedation. Use Caution/Monitor.

              • fluvoxamine

                fluvoxamine will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • fosamprenavir

                fosamprenavir increases levels of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Use alternatives if available.

              • fosphenytoin

                fosphenytoin will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • gabapentin

                gabapentin, diazepam. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

              • gabapentin enacarbil

                gabapentin enacarbil, diazepam. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

              • grapefruit

                grapefruit will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • griseofulvin

                griseofulvin will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • haloperidol

                diazepam and haloperidol both increase sedation. Use Caution/Monitor.

              • hyaluronidase

                hyaluronidase, diazepam. Other (see comment). Use Caution/Monitor. Comment: Drug combination has been found to be incompatible.

              • hydrocortisone

                hydrocortisone will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • hydromorphone

                diazepam and hydromorphone both increase sedation. Use Caution/Monitor.

              • hydroxyzine

                hydroxyzine and diazepam both increase sedation. Use Caution/Monitor.

              • iloperidone

                diazepam and iloperidone both increase sedation. Use Caution/Monitor.

                iloperidone increases levels of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4.

              • imipramine

                diazepam and imipramine both increase sedation. Use Caution/Monitor.

              • incobotulinumtoxinA

                diazepam, incobotulinumtoxinA. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Muscle relaxants may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.

              • indinavir

                indinavir increases levels of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. Use alternatives if available. Consider lowering benzodiazepine dose.

              • isoniazid

                isoniazid will increase the level or effect of diazepam by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

                isoniazid will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • istradefylline

                istradefylline will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.

              • itraconazole

                itraconazole will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

              • ketamine

                ketamine and diazepam both increase sedation. Use Caution/Monitor.

              • ketotifen, ophthalmic

                diazepam and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

              • lapatinib

                lapatinib will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • lasmiditan

                lasmiditan, diazepam. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.

              • lemborexant

                diazepam will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Lower nightly dose of lemborexant recommended if coadministered with weak CYP3A4 inhibitors. See drug monograph for specific dosage modification.

                lemborexant, diazepam. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

              • levonorgestrel oral/ethinylestradiol/ferrous bisglycinate

                levonorgestrel oral/ethinylestradiol/ferrous bisglycinate will increase the level or effect of diazepam by decreasing metabolism. Use Caution/Monitor. Ethinyl estradiol may inhibit the clearance of benzodiazepines that undergo oxidation, thereby increasing serum concentrations of concomitantly administered benzodiazepines.

              • levorphanol

                diazepam and levorphanol both increase sedation. Use Caution/Monitor.

              • lofepramine

                diazepam and lofepramine both increase sedation. Use Caution/Monitor.

              • lofexidine

                diazepam and lofexidine both increase sedation. Use Caution/Monitor.

              • lomitapide

                diazepam increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lomitapide dose should not exceed 30 mg/day.

              • lopinavir

                lopinavir increases levels of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Use alternatives if available.

              • loprazolam

                diazepam and loprazolam both increase sedation. Use Caution/Monitor.

              • lorazepam

                diazepam and lorazepam both increase sedation. Use Caution/Monitor.

              • lorlatinib

                lorlatinib will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • lormetazepam

                diazepam and lormetazepam both increase sedation. Use Caution/Monitor.

              • loxapine

                diazepam and loxapine both increase sedation. Use Caution/Monitor.

              • loxapine inhaled

                diazepam and loxapine inhaled both increase sedation. Use Caution/Monitor.

              • lumacaftor/ivacaftor

                lumacaftor/ivacaftor, diazepam. affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. In vitro studies suggest that lumacaftor may induce and ivacaftor may inhibit CYP2C19 substrates. .

              • lumefantrine

                lumefantrine will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • lurasidone

                lurasidone, diazepam. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

              • maprotiline

                diazepam and maprotiline both increase sedation. Use Caution/Monitor.

              • marijuana

                marijuana will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

                diazepam and marijuana both increase sedation. Use Caution/Monitor.

              • melatonin

                diazepam and melatonin both increase sedation. Use Caution/Monitor.

              • meperidine

                diazepam and meperidine both increase sedation. Use Caution/Monitor.

              • meprobamate

                diazepam and meprobamate both increase sedation. Use Caution/Monitor.

              • metaxalone

                diazepam and metaxalone both increase sedation. Use Caution/Monitor.

              • methadone

                diazepam and methadone both increase sedation. Use Caution/Monitor.

              • methamphetamine

                diazepam increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • methocarbamol

                diazepam and methocarbamol both increase sedation. Use Caution/Monitor.

              • methylenedioxymethamphetamine

                diazepam increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • methylprednisolone

                methylprednisolone will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • metronidazole

                metronidazole will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • miconazole vaginal

                miconazole vaginal will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • midazolam

                diazepam and midazolam both increase sedation. Use Caution/Monitor.

              • midazolam intranasal

                diazepam will increase the level or effect of midazolam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of mild CYP3A4 inhibitors with midazolam intranasal may cause higher midazolam systemic exposure, which may prolong sedation.

                midazolam intranasal, diazepam. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

              • midodrine

                diazepam increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • mirtazapine

                diazepam and mirtazapine both increase sedation. Use Caution/Monitor.

              • mitotane

                mitotane decreases levels of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.

              • modafinil

                modafinil will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • morphine

                diazepam and morphine both increase sedation. Use Caution/Monitor.

              • motherwort

                diazepam and motherwort both increase sedation. Use Caution/Monitor.

              • moxonidine

                diazepam and moxonidine both increase sedation. Use Caution/Monitor.

              • nabilone

                diazepam and nabilone both increase sedation. Use Caution/Monitor.

              • nalbuphine

                diazepam and nalbuphine both increase sedation. Use Caution/Monitor.

              • nelfinavir

                nelfinavir increases levels of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Use alternatives if available.

              • nevirapine

                nevirapine will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • nifedipine

                nifedipine will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • nilotinib

                nilotinib will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • nortriptyline

                diazepam and nortriptyline both increase sedation. Use Caution/Monitor.

              • olanzapine

                diazepam and olanzapine both increase sedation. Use Caution/Monitor.

              • oliceridine

                oliceridine, diazepam. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

                diazepam increases toxicity of oliceridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. Monitor for signs of urinary retention or reduced gastric motility if oliceridine is coadministered with anticholinergics.

              • ombitasvir/paritaprevir/ritonavir & dasabuvir

                ombitasvir/paritaprevir/ritonavir & dasabuvir decreases effects of diazepam by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Increase dose if clinically indicated.

              • opium tincture

                diazepam and opium tincture both increase sedation. Use Caution/Monitor.

              • orlistat

                orlistat decreases levels of diazepam by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Risk of convulsions.

              • orphenadrine

                diazepam and orphenadrine both increase sedation. Use Caution/Monitor.

              • oxazepam

                diazepam and oxazepam both increase sedation. Use Caution/Monitor.

              • oxcarbazepine

                oxcarbazepine will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • oxycodone

                diazepam and oxycodone both increase sedation. Use Caution/Monitor.

              • oxymorphone

                diazepam and oxymorphone both increase sedation. Use Caution/Monitor.

              • paliperidone

                diazepam and paliperidone both increase sedation. Use Caution/Monitor.

              • papaveretum

                diazepam and papaveretum both increase sedation. Use Caution/Monitor.

              • papaverine

                diazepam and papaverine both increase sedation. Use Caution/Monitor.

              • pentazocine

                diazepam and pentazocine both increase sedation. Use Caution/Monitor.

              • pentobarbital

                pentobarbital will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

                pentobarbital and diazepam both increase sedation. Use Caution/Monitor.

              • perampanel

                perampanel and diazepam both increase sedation. Use Caution/Monitor.

              • perphenazine

                diazepam and perphenazine both increase sedation. Use Caution/Monitor.

              • phenobarbital

                phenobarbital will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

                phenobarbital and diazepam both increase sedation. Use Caution/Monitor.

              • phenylephrine PO

                diazepam increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • phenytoin

                phenytoin will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • pholcodine

                diazepam and pholcodine both increase sedation. Use Caution/Monitor.

              • pimozide

                diazepam and pimozide both increase sedation. Use Caution/Monitor.

              • posaconazole

                posaconazole will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • prabotulinumtoxinA

                diazepam increases effects of prabotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Muscle relaxants may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.

              • prednisone

                prednisone will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • pregabalin

                pregabalin, diazepam. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

              • primidone

                primidone will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

                primidone and diazepam both increase sedation. Use Caution/Monitor.

              • prochlorperazine

                diazepam and prochlorperazine both increase sedation. Use Caution/Monitor.

              • promethazine

                promethazine and diazepam both increase sedation. Use Caution/Monitor.

              • propofol

                propofol and diazepam both increase sedation. Use Caution/Monitor.

              • propylhexedrine

                diazepam increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • protriptyline

                diazepam and protriptyline both increase sedation. Use Caution/Monitor.

              • quazepam

                diazepam and quazepam both increase sedation. Use Caution/Monitor.

              • quetiapine

                diazepam and quetiapine both increase sedation. Use Caution/Monitor.

              • quinupristin/dalfopristin

                quinupristin/dalfopristin will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • ramelteon

                diazepam and ramelteon both increase sedation. Use Caution/Monitor.

              • remimazolam

                remimazolam, diazepam. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

              • ribociclib

                ribociclib will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • rifapentine

                rifapentine will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • risperidone

                diazepam and risperidone both increase sedation. Use Caution/Monitor.

              • ritonavir

                ritonavir increases levels of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Use alternatives if available.

              • rufinamide

                rufinamide will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • saquinavir

                saquinavir increases levels of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Use alternatives if available.

              • scullcap

                diazepam and scullcap both increase sedation. Use Caution/Monitor.

              • secobarbital

                secobarbital will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

                secobarbital and diazepam both increase sedation. Use Caution/Monitor.

              • sevelamer

                sevelamer decreases levels of diazepam by increasing elimination. Use Caution/Monitor.

              • sevoflurane

                sevoflurane and diazepam both increase sedation. Use Caution/Monitor.

              • shepherd's purse

                diazepam and shepherd's purse both increase sedation. Use Caution/Monitor.

              • sofosbuvir/velpatasvir

                sofosbuvir/velpatasvir increases levels of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Velpatasvir inhibits CYP3A4. Caution if coadministered with drugs with narrow therapeutics indexes.

              • stiripentol

                stiripentol, diazepam. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.

                stiripentol will decrease the level or effect of diazepam by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider reducing the dose of CYP2C19 substrates, if adverse reactions are experienced when administered concomitantly with stiripentol.

                stiripentol, diazepam. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

              • sufentanil

                diazepam and sufentanil both increase sedation. Use Caution/Monitor.

              • suvorexant

                suvorexant and diazepam both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessary

              • tapentadol

                diazepam and tapentadol both increase sedation. Use Caution/Monitor.

              • tazemetostat

                tazemetostat will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

                diazepam will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • tecovirimat

                tecovirimat will increase the level or effect of diazepam by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Tecovirimat is a weak inhibitor of CYP2C8 and CYP2C19. Monitor for adverse effects if coadministered with sensitive substrates of these enzymes.

                tecovirimat will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.

              • teduglutide

                teduglutide increases levels of diazepam by Other (see comment). Use Caution/Monitor. Comment: Teduglutide may increase absorption of concomitant PO medications; caution with with drugs requiring titration or those with a narrow therapeutic index; dose adjustment may be necessary.

              • temazepam

                diazepam and temazepam both increase sedation. Use Caution/Monitor.

              • thioridazine

                diazepam and thioridazine both increase sedation. Use Caution/Monitor.

              • thiothixene

                diazepam and thiothixene both increase sedation. Use Caution/Monitor.

              • tinidazole

                diazepam will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • topiramate

                topiramate will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

                diazepam and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • tramadol

                diazepam and tramadol both increase sedation. Use Caution/Monitor.

              • trazodone

                diazepam and trazodone both increase sedation. Use Caution/Monitor.

              • triazolam

                diazepam and triazolam both increase sedation. Use Caution/Monitor.

              • triclabendazole

                triclabendazole will increase the level or effect of diazepam by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. If plasma concentrations of the CYP2C19 substrates are elevated during triclabendazole, recheck plasma concentration of the CYP2C19 substrates after discontinuation of triclabendazole.

              • triclofos

                diazepam and triclofos both increase sedation. Use Caution/Monitor.

              • trifluoperazine

                diazepam and trifluoperazine both increase sedation. Use Caution/Monitor.

              • trimipramine

                diazepam and trimipramine both increase sedation. Use Caution/Monitor.

              • verapamil

                verapamil will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • voriconazole

                voriconazole will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • xylometazoline

                diazepam increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • zafirlukast

                zafirlukast will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • ziconotide

                diazepam and ziconotide both increase sedation. Use Caution/Monitor.

              • ziprasidone

                diazepam and ziprasidone both increase sedation. Use Caution/Monitor.

              • zotepine

                diazepam and zotepine both increase sedation. Use Caution/Monitor.

                diazepam increases levels of zotepine by decreasing metabolism. Use Caution/Monitor.

              Minor (39)

              • acetaminophen

                diazepam decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

              • acetaminophen IV

                diazepam decreases levels of acetaminophen IV by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

              • acetaminophen rectal

                diazepam decreases levels of acetaminophen rectal by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

              • armodafinil

                armodafinil will increase the level or effect of diazepam by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.

              • atracurium

                diazepam decreases effects of atracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • biotin

                diazepam decreases levels of biotin by unspecified interaction mechanism. Minor/Significance Unknown. Biotin supplementation may be necessary.

              • brimonidine

                brimonidine increases effects of diazepam by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

              • ciprofloxacin

                ciprofloxacin increases levels of diazepam by decreasing metabolism. Minor/Significance Unknown.

              • cisatracurium

                diazepam decreases effects of cisatracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • dexmethylphenidate

                dexmethylphenidate increases effects of diazepam by decreasing metabolism. Minor/Significance Unknown.

              • efavirenz

                efavirenz will increase the level or effect of diazepam by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.

              • esomeprazole

                esomeprazole will increase the level or effect of diazepam by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.

              • etravirine

                etravirine will increase the level or effect of diazepam by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.

              • eucalyptus

                diazepam and eucalyptus both increase sedation. Minor/Significance Unknown.

              • felbamate

                felbamate will increase the level or effect of diazepam by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.

              • fluconazole

                fluconazole will increase the level or effect of diazepam by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.

              • green tea

                green tea decreases effects of diazepam by pharmacodynamic antagonism. Minor/Significance Unknown. Caffeine component of green tea may decrease sedative effects of benzodiazepines.

              • labetalol

                labetalol increases effects of diazepam by decreasing metabolism. Minor/Significance Unknown.

              • metoprolol

                metoprolol increases effects of diazepam by decreasing metabolism. Minor/Significance Unknown.

              • modafinil

                modafinil will increase the level or effect of diazepam by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.

              • omeprazole

                omeprazole will increase the level or effect of diazepam by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.

              • onabotulinumtoxinA

                diazepam decreases effects of onabotulinumtoxinA by pharmacodynamic antagonism. Minor/Significance Unknown.

              • oxcarbazepine

                oxcarbazepine will increase the level or effect of diazepam by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.

              • pancuronium

                diazepam decreases effects of pancuronium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • parecoxib

                parecoxib will increase the level or effect of diazepam by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.

              • phenobarbital

                phenobarbital will decrease the level or effect of diazepam by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.

              • primidone

                primidone will decrease the level or effect of diazepam by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.

              • propranolol

                propranolol increases effects of diazepam by decreasing metabolism. Minor/Significance Unknown.

              • rapacuronium

                diazepam decreases effects of rapacuronium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • rifabutin

                rifabutin decreases levels of diazepam by increasing metabolism. Minor/Significance Unknown.

              • rifampin

                rifampin will decrease the level or effect of diazepam by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.

              • rocuronium

                diazepam decreases effects of rocuronium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • ruxolitinib

                diazepam will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • sage

                diazepam and sage both increase sedation. Minor/Significance Unknown.

                sage decreases effects of diazepam by pharmacodynamic antagonism. Minor/Significance Unknown. Theoretical interaction; some species of sage may cause convulsions.

              • succinylcholine

                diazepam decreases effects of succinylcholine by pharmacodynamic antagonism. Minor/Significance Unknown.

              • vecuronium

                diazepam decreases effects of vecuronium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • vinpocetine

                diazepam increases effects of vinpocetine by unspecified interaction mechanism. Minor/Significance Unknown. Desirable interaction enhanced memory improvement (based on preliminary trial).

              • voriconazole

                voriconazole will increase the level or effect of diazepam by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.

              • zolpidem

                zolpidem, diazepam. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

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              Adverse Effects

              1-10%

              Atax (3%)

              Euphoria (3%, rectal gel)

              Incoordination (3%, rectal gel)

              Somnolence (>1%)

              Rash (3%, rectal gel)

              Diarrhea (4%, rectal gel)

              Frequency Not Defined

              Common

              • Hypotension
              • Fatigue
              • Muscle weakness
              • Respiratory depression
              • Urinary retention
              • Depression
              • Incontinence
              • Blurred vision
              • Dysarthria
              • Headache
              • Skin rash
              • Changes in salivation

              Serious

              • Neutropenia
              • Jaundice
              • Local effects: Pain, swelling, thrombophlebitis, carpal tunnel syndrome, tissue necrosis
              • Phlebitis if too rapid IV push

              Postmarketing Reports

              Injury, poisoning and procedural complications: Falls and fractures; increased risk in those taking concomitant sedatives (including alcoholic beverages) and in the elderly, suicide attempt, suicidal ideation

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              Warnings

              Black Box Warnings

              Risks from concomitant use with opioids

              • Concomitant use of benzodiazepines and opioids may result in profound sedation, respiratory depression, coma, and death
              • Reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate
              • Limit dosages and durations to the minimum required
              • Follow patients for signs and symptoms of respiratory depression and sedation
              • Inform patients and caregivers that potentially fatal additive effects may occur if diazepam is used with opioids and that such drugs should not be used concomitantly unless supervised by a health care provider
              • Prescribers are strongly advised to take all reasonable steps to ensure that caregivers fully understand their role and obligations vis a vis the administration of diazepam rectal gel to individuals in their care
              • Prescribers should advise caregivers that they expect to be informed immediately if a patient develops any new findings which are not typical of the patient’s characteristic seizure episode

              Addiction, abuse, and misuse

              • On September 2020, FDA addressed serious risks of benzodiazepine addiction, abuse, and misuse, which can lead to overdose and death
              • Abuse and misuse of benzodiazepines commonly involve concomitant use of other medications, alcohol, and/or illicit substances, which is associated with an increased frequency of serious adverse outcomes; before prescribing and throughout treatment, assess each patient’s risk for abuse, misuse, and addiction
              • Physical dependence can occur when taken steadily for several days to weeks, even as prescribed
              • Risks of dependence and withdrawal increase with longer treatment duration and higher daily dose; although injection is indicated only for intermittent use, if used more frequently than recommended, abrupt discontinuation or rapid dosage reduction may precipitate acute
              • withdrawal reactions, including seizures, which can be life-threatening; use gradual taper when discontinuing therapy to reduce withdrawal reactions risk
              • Assess each patient’s risk prior to prescribing and monitor regularly for the development of these conditions

              Contraindications

              Documented hypersensitivity

              Acute alcohol intoxication

              Myasthenia gravis (allowable in limited circumstances)

              Acute narrow angle glaucoma and open angle glaucoma unless patients receiving appropriate therapy

              Severe respiratory depression

              IV use in shock, coma, depressed respiration, patients who recently received other respiratory depressants

              Sleep apnea

              Children <6 months

              Cautions

              Concomitant use of benzodiazepines, including diazepam, and opioids may result in profound sedation, respiratory depression, coma, and death; reserve concomitant prescribing of benzodiazepines and opioids for use in patients for whom alternative treatment options are inadequate; reduce opiate dose one-third when diazepam is added

              Advise both patients and caregivers about risks of respiratory depression and sedation when diazepam is used with opioids; advise patients not to drive or operate heavy machinery until the effects of concomitant use with the opioid have been determined

              Use caution in COPD, sleep apnea, renal/hepatic disease, open-angle glaucoma (questionable), depression, suicide ideation, impaired gag reflex, history of drug abuse, or obese patients (prolonged action when discontinued)

              Use of benzodiazepines, including diazepam, both used alone and in combination with other CNS depressants, may lead to potentially fatal respiratory depression

              May impair ability to perform hazardous tasks

              Use with caution in patients with a history of drug abuse or acute alcoholism; tolerance, psychological, and physical dependence may occur with prolonged use (>10 days)

              Use of drug, particularly in patients at elevated risk, necessitates counseling about risks and proper use of drug along with monitoring for signs and symptoms of abuse, misuse, and addiction; do not exceed recommended dosing frequency

              Avoid or minimize concomitant use of CNS depressants and other substances associated with abuse, misuse, and addiction (eg, opioid analgesics, stimulants); advise patients on proper disposal of unused drug; if a substance use disorder is suspected, evaluate patient and institute (or refer them for) early treatment, as appropriate

              For patients using treated more frequently than recommended, to reduce risk of withdrawal reactions, use a gradual taper to discontinue therapy (a patient-specific plan should be used to taper the dose)

              Patients at an increased risk of withdrawal adverse reactions after benzodiazepine discontinuation or rapid dosage reduction include those who take higher dosages, and those who have had longer durations of use

              In some cases, benzodiazepine users have developed a protracted withdrawal syndrome with withdrawal symptoms lasting weeks to more than 12 months

              Anterograde amnesia reported with benzodiazepine use

              Avoid extravasation with IV dosing

              Paradoxical reactions may occur including hallucinations, aggressive behavior, and psychoses; dinscontinue use if reactions occur

              Drug interactions overview

              • When benzodiazepines and opioids are combined, the potential for benzodiazepines to significantly worsen opioid-related respiratory depression exists; limit dosage and duration of concomitant use of benzodiazepines and opioids, and monitor patients closely for respiratory depression and sedation
              • If rectal gel is to be combined with other psychotropic agents or other CNS depressants, careful consideration should be given to the pharmacology of agents to be employed particularly with known compounds which may potentiate the action of diazepam, such as phenothiazines, narcotics, barbiturates, MAO inhibitors and other antidepressants
              • Valproate may potentiate the CNS-depressant effects of diazepam
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              Pregnancy & Lactation

              Pregnancy category: D

              Lactation: Enters breast milk; not recommended

              Minor tranquilizers should be avoided in first trimester of pregnancy due to increased risk of congenital malformations

              Maternal use shortly before delivery is associated with floppy infant syndrome (good and consistent evidence)

              Prenatal benzodiazepine exposure slightly increased oral cleft risk (limited or inconsistent evidence)

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              Modulates postsynaptic effects of GABA-A transmission, resulting in an increase in presynaptic inhibition. Appears to act on part of the limbic system, as well as on the thalamus and hypothalamus, to induce a calming effect

              Absorption

              Bioavailability: 90% (PR)

              Duration: Variable, dependent on dose and frequency (PO [hypnotic action]); 15-60 min (IV [sedative action])

              Peak plasma time: 30-90 min (PO), 5-90 min (PR)

              Peak plasma concentration: 373 ng/mL (initial at 45 min); 447 ng/mL (second peak at 70 min)

              Distribution

              Protein bound: 98%

              Vd: 0.8-1 L/kg

              Metabolism

              Metabolized by hepatic P450 enzymes CYP2C19, CYP3A4

              Metabolites: N-desmethyldiazepam, 3-hydroxdiazepam, oxazepam

              Elimination

              Half-life: 20-70 hr (active metabolite)

              Renal clearance: 20-30 mL/min

              Excretion: Urine

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              Administration

              IV Incompatibilities

              Solution: D5W(?), Ringer's(?), LR(?), NS(?) (See IV Preparation)

              Additive: Bleomycin, dobutamine, doxorubicin, floxacillin, fluorouracil, furosemide

              Syringe: Doxapram, glycopyrrolate, heparin, hydromorphone, ketorolac(?), nalbuphine(?), ranitidine(?), sufentanil

              Y-site: Amphotericin B cholesteryl SO4, atracurium, bivalirudin, cefepime, dexmedetomidine, diltiazem, fenoldopam, fluconazole, foscarnet, gatifloxacin, heparin, heparin/hydrocortisone, Hextend, hydromorphone, linezolid, meropenem, pancuronium, KCl, propofol, remifentanil(?), tirofiban, vecuronium, vitamin B/C

              Not specified: Atropine, epinephrine, hydroxyzine, lidocaine, meperidine, morphine, norepinephrine, pentobarbital, Na bicarbonate

              IV Compatibilities

              Additive: Netilmicin, verapamil

              Syringe: Cimetidine

              Y-site: Cisatracurium (may be incompatible at higher concentration), dobutamine, fentanyl, hydromorphone (may be incompatible at higher concentration), methadone, morphine sulfate, nafcillin, quinidine, remifentanil (may be incompatible at higher concentration), sufentanil

              Not specified: Aminophylline, cefazolin

              IV Preparation

              Compatibility with D5W, NS, and Ringer's controversial. If infusion is selected, adding the infusion solution to the diazepam injection (and not the other way around) may prevent precipitate formation

              IV Administration

              Administer over 3 min; no more than 5 mg/min

              Monitor respiration q5-15min and before each IV dose

              Have airway support ready until effects of IV administration are known

              Thrombosis prevention

              • Administer directly into a large vein to avoid thrombosis
              • If this is not feasible, give drug into tubing of a flowing IV solution as close as possible to vein insertion
              • Do not use small veins such as those of wrist or dorsum of hand

              Oral Administration

              Dilute oral concentrate with water/juice/carbonated beverages or mix with semisolid foods

              Rectal Administration

              Place patient on side facing you with upper leg bent forward, lubricate rectal applicator tip, gently insert syringe tip in rectum and slowly push plunger

              Rectal gel should not be used more than 5 episodes/month and no more than one episode q5days

              Storage

              Store intact vials at room temperature; protect from light

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              diazepam oral
              -
              5 mg tablet
              diazepam oral
              -
              2 mg tablet
              diazepam oral
              -
              10 mg tablet
              diazepam oral
              -
              5 mg tablet
              diazepam oral
              -
              5 mg/mL liquid
              diazepam oral
              -
              10 mg tablet
              diazepam oral
              -
              5 mg tablet
              diazepam oral
              -
              10 mg tablet
              diazepam oral
              -
              10 mg tablet
              diazepam oral
              -
              5 mg tablet
              diazepam oral
              -
              5 mg tablet
              diazepam oral
              -
              2 mg tablet
              diazepam oral
              -
              2 mg tablet
              diazepam oral
              -
              2 mg tablet
              diazepam oral
              -
              5 mg/5 mL (1 mg/mL) solution
              Valium oral
              -
              5 mg tablet
              Valium oral
              -
              2 mg tablet
              Valium oral
              -
              10 mg tablet
              diazepam injection
              -
              5 mg/mL solution
              diazepam injection
              -
              5 mg/mL solution
              diazepam injection
              -
              5 mg/mL solution
              diazepam injection
              -
              5 mg/mL solution
              Diazepam Intensol oral
              -
              5 mg/mL liquid
              diazepam rectal
              -
              12.5-15-17.5-20 mg kit
              diazepam rectal
              -
              5-7.5-10 mg kit
              Diastat AcuDial rectal
              -
              12.5-15-17.5-20 mg kit
              Diastat AcuDial rectal
              -
              5-7.5-10 mg kit
              Diastat rectal
              -
              2.5 mg kit

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Select a drug:
              Patient Education
              diazepam oral

              DIAZEPAM - ORAL

              (dye-AZ-e-pam)

              COMMON BRAND NAME(S): Valium

              WARNING: Diazepam has a risk for abuse and addiction, which can lead to overdose and death. Taking this medication with alcohol or other drugs that can cause drowsiness or breathing problems (especially opioid medications such as codeine, hydrocodone) may cause very serious side effects, including death. To lower your risk, your doctor should have you take the smallest dose of diazepam that works, and take it for the shortest possible time. Be sure you know how to take diazepam and what other drugs you should avoid taking with it. See also Drug Interactions section. Get medical help right away if any of these very serious side effects occur: slow/shallow breathing, unusual lightheadedness, severe drowsiness/dizziness, difficulty waking up.Suddenly stopping this medication may cause serious (possibly fatal) withdrawal, especially if you have used it for a long time or in high doses. To prevent withdrawal, your doctor may lower your dose slowly. Tell your doctor or pharmacist right away if you have any withdrawal symptoms such as headaches, trouble sleeping, restlessness, hallucinations/confusion, depression, nausea, or seizures. Withdrawal symptoms may sometimes last weeks to months.

              USES: Diazepam is used to treat anxiety, alcohol withdrawal, and seizures. It is also used to relieve muscle spasms and to provide sedation before medical procedures. This medication works by calming the brain and nerves. Diazepam belongs to a class of drugs known as benzodiazepines.

              HOW TO USE: See also Warning section.Read the Medication Guide provided by your pharmacist before you start taking diazepam and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication by mouth with or without food as directed by your doctor. If you are using the liquid form of this medication, carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose.If you are using the concentrated solution, use the medicine dropper provided and mix the measured dose with a small amount of liquid or soft food (such as applesauce, pudding). Take all of the mixture right away. Do not store the mixture for later use.The dosage is based on your medical condition, age, and response to treatment. Do not increase your dose or use this drug more often or for longer than prescribed. Your condition will not improve any faster, and your risk of side effects will increase. Properly stop the medication when so directed.When this medication is used for a long time, it may not work as well. Talk with your doctor if this medication stops working well.Though it helps many people, this medication may sometimes cause addiction. This risk may be higher if you have a substance use disorder (such as overuse of or addiction to drugs/alcohol). Take this medication exactly as prescribed to lower the risk of addiction. Ask your doctor or pharmacist for more details.Avoid eating grapefruit or drinking grapefruit juice while using this medication unless your doctor or pharmacist says you may do so safely. Grapefruit can increase the chance of side effects with this medicine. Ask your doctor or pharmacist for more details.If directed by your doctor, take this medication regularly to get the most benefit from it. To help you remember, take it at the same time(s) each day.Tell your doctor if your condition lasts or gets worse.

              SIDE EFFECTS: See also Warning section.Drowsiness, dizziness, tiredness, blurred vision, or unsteadiness may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: mental/mood changes (such as memory problems, agitation, hallucinations, confusion, restlessness, depression), trouble speaking, trouble walking, muscle weakness, shaking (tremors), trouble urinating, yellowing eyes/skin, signs of infection (such as sore throat that doesn't go away, fever, chills).Get medical help right away if you have any very serious side effects, including: slow/shallow breathing.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before taking diazepam, tell your doctor or pharmacist if you are allergic to it; or to other benzodiazepines (such as oxazepam, temazepam); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: a certain muscle disease (myasthenia gravis), lung/breathing problems (such as COPD, sleep apnea), mental/mood disorders (such as depression, thoughts of suicide, psychosis), personal or family history of a substance use disorder (such as overuse of or addiction to drugs/alcohol), glaucoma, liver disease, kidney disease.This drug may make you dizzy or drowsy or blur your vision. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness or clear vision until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Some liquid products may contain alcohol. Ask your doctor or pharmacist about using this product safely.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).For some children, instead of having a calming effect, diazepam may have the opposite effect, causing mental/mood changes (such as agitation, hallucinations, restlessness).Older adults may be more sensitive to the side effects of this drug, especially drowsiness and loss of coordination. These side effects can increase the risk of falling. For some older adults, instead of having a calming effect, diazepam may have the opposite effect, causing mental/mood changes (such as agitation, hallucinations, restlessness).This medication is not recommended for use during pregnancy. It may harm an unborn baby. If you become pregnant or think you may be pregnant, tell your doctor right away. Consult your doctor for more details.This drug passes into breast milk and may have undesirable effects on a nursing infant. Breast-feeding while using this medication is not recommended. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: See also Warning and How to Use sections.Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: clozapine, fluvoxamine, orlistat, sodium oxybate.The risk of serious side effects (such as slow/shallow breathing, severe drowsiness/dizziness) may be increased if this medication is taken with other products that may also cause drowsiness or breathing problems. Tell your doctor or pharmacist if you are taking other products such as opioid pain or cough relievers (such as codeine, hydrocodone), alcohol, marijuana (cannabis), other drugs for sleep or anxiety (such as alprazolam, lorazepam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), or antihistamines (such as cetirizine, diphenhydramine).Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.This medication may interfere with certain lab tests, possibly causing false test results. Make sure lab personnel and all your doctors know you use this drug.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe drowsiness, slow reflexes, slow/shallow breathing, fainting, loss of consciousness.

              NOTES: Do not share this medication with others. Sharing it is against the law.If this drug is used for a long period of time, lab and/or medical tests (such as liver function tests, complete blood count) may be done while you are taking this medication. Keep all medical and lab appointments.

              MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

              STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. If you are using the concentrated solution, discard the opened bottle after 90 days. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

              MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).

              Information last revised March 2021. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

              To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

              Adding plans allows you to:

              • View the formulary and any restrictions for each plan.
              • Manage and view all your plans together – even plans in different states.
              • Compare formulary status to other drugs in the same class.
              • Access your plan list on any device – mobile or desktop.

              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.