Drug reference

Diazepam

Benzodiazepine (long-acting) · Anxiolytic/Sedative

Also known as Valium, Calmpose, Dizac, Pacitane, Diazepin

START

Anxiety: 2 mg PO 2 times daily. Alcohol withdrawal: 10 mg PO/IV q1-4h (CIWA-guided). Seizures: 5-10 mg IV. Use lowest effective dose for shortest duration; avoid in elderly if possible

TYPICAL MAX

40 mg/day (oral); 30 mg IV

STOP IF

Severe respiratory depression, paradoxical agitation, signs of dependence, jaundice

WATCH

Sedation level, respiratory rate (if IV or with opioids), falls risk (elderly), cognitive function, signs of dependence/tolerance, taper gradually (>/=4 weeks for long-term use)

CDSCO approvedSchedule XJan AushadhiNPPA price-controlledATC N05BA01

Dose laddermg/d

Renal dose adjustmenteGFR mL/min/1.73m²

KDIGO 2024 + manufacturer label

Pharmacokineticsplasma · t hours

ONSET: 30min · PO: 15-60 min; IV: 1-5 min
PEAK: 1.5h · PO peak
t½: 2.1d · 20-80 hours (parent); metabolites much longer
DURATION: 12h · 12+ hours (long-acting)

EXCRETION

Renal (metabolites)

route + CYP

INTERACTIONS

12 major

SEVERE in our sources

PREGNANCY

Avoid in pregnancy; risk of congenital malformations (cleft lip/palate) and floppy infant syndrome; contraindicated in first trimester; neonatal withdrawal syndrome

FDA category + note

Top interactionssee all 12 →

AlcoholSevereTextbook-citedKDT 7e · p950
ChlorpromazineSevereTextbook-citedKDT 7e · p950
CodeineSevereTextbook-citedKDT 7e · p950
FentanylSevereTextbook-citedKDT 7e · p950

Available in India

86 branded formulations and 92 fixed-dose combinations. Look up specific brands in the Drugs workspace.

Jan Aushadhi — generic available at GoI pharmacies

Mechanism

Positive allosteric modulator at GABA-A receptors, increasing the frequency of chloride channel opening and enhancing GABA-mediated inhibitory neurotransmission. Long-acting due to active metabolites (desmethyldiazepam, oxazepam, temazepam). Produces anxiolytic, sedative-hypnotic, muscle relaxant, anticonvulsant, and amnestic effects.

Indications

Anxiety disorders (short-term)Acute alcohol withdrawalMuscle spasmSeizures / status epilepticus (IV/rectal)Pre-operative sedationInsomnia (short-term)Convulsive disorders (adjunctive)

Dosing

Adult: Anxiety: 2-10 mg PO 2-4 times daily. Alcohol withdrawal: 10 mg PO/IV q1-4h PRN (CIWA-guided), then taper. Muscle spasm: 2-10 mg PO 3-4 times daily. Seizures: 5-10 mg IV/PR (may repeat q10-15min, max 30 mg). Pre-op: 10 mg PO/IM/IV
Pediatric: >6 months: 1-2.5 mg PO 3-4 times daily. Seizures: 0.2-0.5 mg/kg PR/IV (max 10 mg)
Renal adjustment: No adjustment needed; hepatically metabolized to active metabolites
Hepatic adjustment: Reduce dose by 50%; avoid in severe hepatic impairment (accumulation of active metabolites)
Geriatric: Start 2 mg 1-2 times daily; increased sensitivity to sedation, falls, cognitive effects; avoid if possible
Max dose: 40 mg/day (oral); 30 mg IV (status epilepticus)

Pharmacokinetics

Onset

PO: 15-60 minutes; IV: 1-5 minutes; PR: 5-15 minutes; IM: variable (slow and erratic absorption)

Peak effect

PO: 1-2 hours; IV: immediate

Duration

PO: 6-12 hours (long-acting due to active metabolites); IV: 15-60 minutes

Half-life

Diazepam: 20-80 hours; Desmethyldiazepam (active metabolite): 36-200 hours

Bioavailability

PO: ~100%; IM: variable (not recommended)

Protein binding

98%

Metabolism

Hepatic CYP2C19 and CYP3A4 (N-demethylation to desmethyldiazepam, then hydroxylation to oxazepam and temazepam)

Excretion

Renal (primarily as metabolites)

Contraindications

Hypersensitivity to diazepam or other benzodiazepines
Acute narrow-angle glaucoma
Severe respiratory insufficiency / sleep apnea
Severe hepatic impairment
Myasthenia gravis
Concurrent use with sodium oxybate

Side effects

Common

Sedation / drowsinessFatigueMuscle weaknessAtaxiaDizzinessConfusion (especially elderly)Dry mouthConstipation

Serious

Respiratory depression (especially with opioids or IV)
Dependence and withdrawal syndrome (can be life-threatening)
Paradoxical reactions (agitation, aggression)
Anterograde amnesia
Severe hypotension
Jaundice (rare)

Pregnancy & lactation

Pregnancy

Avoid in pregnancy; risk of congenital malformations (cleft lip/palate) and floppy infant syndrome; contraindicated in first trimester; neonatal withdrawal syndrome

Lactation

Excreted in breast milk; may cause sedation in infant; avoid if possible or use lowest dose

Drug interactions

Alcohol

Severe

Textbook-cited

Excessive sedation, respiratory depression, motor impairment

Avoid concurrent use

Source: KDT 7e · p950

Chlorpromazine

Severe

Textbook-cited