Diazepam
A long-acting benzodiazepine used for anxiety, alcohol withdrawal, muscle spasm and seizure emergencies.
Drug card
- Class
- Benzodiazepine
- How it works
- Boosting GABA at GABA-A receptors, so chloride channels open more often
- Used for
- Anxiety disorders
- Alcohol withdrawal
- Muscle spasm and spasticity
- Status epilepticus and seizure clusters
- Known for
- Drowsiness
- Unsteadiness and poor coordination (ataxia)
- Its name
- -azepam, -azolam means a benzodiazepine
Study it as a flashcard, and it comes back before you forget it.
Mechanism of action
How does diazepam work?
Diazepam enhances GABA's action at GABA-A receptors, increasing chloride channel opening. CYP3A4 and CYP2C19 turn it into active metabolites, desmethyldiazepam and temazepam, then oxazepam. Desmethyldiazepam's half-life can reach about 100 hours, so diazepam builds up with repeated doses.
Like other benzodiazepines: Benzodiazepines bind their own site on the GABA-A receptor, apart from the GABA site, and increase the receptor's affinity for GABA. The chloride channel then opens more often, hyperpolarizing neurons and damping their firing. Depending on the drug and dose, the result is anxiety relief, sedation, muscle relaxation, seizure control and amnesia.
Uses
What is diazepam used for?
- Anxiety disorders
- Alcohol withdrawal
- Muscle spasm and spasticity
- Status epilepticus and seizure clusters
- Sedation before surgery or procedures
Side effects
Side effects of diazepam
- DrowsinessKnown for
- Unsteadiness and poor coordination (ataxia)Known for
- Tiredness and muscle weakness
- Confusion
- Memory loss for events after a dose (amnesia)
- Low blood pressure
- Blurred or double vision
- Paradoxical agitation, aggression or rage
- Dependence and misuseSerious
- Withdrawal reactions if stopped suddenlySerious
- Slowed breathing, especially with opioidsSerious
- Falls and fractures, mainly in older peopleSerious
Known for marks what an exam expects you to know it for.
Watch for
Cautions and what sets it apart
- Contraindicated in myasthenia gravis, severe respiratory or liver insufficiency, sleep apnea and acute narrow-angle glaucoma.
- It accumulates with repeated doses, so frail people start on the smallest effective dose to avoid ataxia and oversedation.
- Taper slowly after regular use; abrupt stopping can cause seizures and other withdrawal reactions.
Good to know: Longer-acting than lorazepam, alprazolam or midazolam: its active metabolite desmethyldiazepam lasts for days, so effects accumulate with regular use.
Remember it
A way to remember it
CALMS
- C
- Convulsions controlled
- A
- Anxiety relief
- L
- Loss of memory for events after a dose (amnesia)
- M
- Muscle relaxation
- S
- Sedation
Written for biofideX
Its name
-azepam, -azolam means benzodiazepine
Diazepam and lorazepam end in -azepam; alprazolam and midazolam, with an added triazole or imidazole ring, end in -azolam. Clobazam and chlordiazepoxide are benzodiazepines too.
- Every drug name stem
Its class
Benzodiazepines
Other benzodiazepines with a card:
Easily mixed up with Z-drugs.
Sources
Checked against
Written for biofideX in plain words, after checking these references:
- Diazepam tablets: label (DailyMed)
- Diazepam injection: label (DailyMed)
- Diazepam (NCI Thesaurus)
- Diazepam (NHS)
For learning pharmacology, not for treatment decisions: no doses are given, and a prescriber, pharmacist or the product's own label is the word on any one patient. Spotted a mistake? Tell us and we'll correct it.
Depression, anxiety and sleep
Diazepam is one of 15 drugs practiced together here: their classes, how they work, what they treat and what they're known for.
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