Dosing & Uses
Dosage Forms & Strengths
tablet: Schedule IV
- 2mg
- 5mg
- 10mg
oral solution: Schedule IV
- 1mg/1mL
- 5mg/mL
rectal gel (Diastat Acudial): Schedule IV
- 2.5mg/0.5mL
- 10mg/2mL
- 20mg/4mL
injectable solution: Schedule IV
- 5mg/mL
intramuscular device: Schedule IV
- 5mg/mL
intranasal spray (Valtoco): Schedule IV
- 5mg/0.1mL
- 7.5mg/0.1mL
- 10mg/0.1mL
Anxiety
Indicated for management of anxiety disorders or for short-term relief of the symptoms of anxiety
2-10 mg PO q6-12hr, OR
2-5 mg IV/IM q3-4hr if necessary, for moderate anxiety disorders; 5-10 mg IV/IM q3-4hr for severe anxiety disorders
Alcohol Withdrawal
Aid in symptomatic relief of acute agitation, tremor, impending or acute delirium tremens, hallucinations
10 mg PO q6-8hr during first 24hr; reduce to 5 mg PO q6-8hr PRN OR
10 mg IV/IM, initially may give additional doses of 5-10 mg IV q6-8hr as needed
Endoscopic Precedures
Adjunct use, if apprehension, anxiety or acute stress reactions present prior to endoscopic procedures
≤10 mg adequate; may give up to 20 mg IV, particularly when concomitant narcotics omitted; if IV cannot be used, 5-10 mg IM approximately 30 min prior to procedure
Titrate IV dosage to desired sedative response, such as slurring of speech, with slow administration immediately prior to procedure
Dosage of narcotics should be reduced by at least a third and in some cases may be omitted
Preoperative Sedation
If atropine, scopolamine or other premedications desired, they must be administered in separate syringes
10 mg (IM preferred) 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
May be used adjunctively for relief of skeletal muscle spasm due to reflex spasm to local pathology (eg, inflammation of the muscles or joints, secondary to trauma); spasm associated with local pathology, cerebral palsy, athetosis, stiff-man syndrome, or tetanus
2-10 mg PO q6-8hr PRN, OR
5-10 mg, IV/IM initially, THEN 5-10 mg q3-3hr, if necessary; administer larger doses for tetanus
Seizure Disorder
Indicated for acute treatment of intermittent, stereotypic episodes of frequent seizure activity (ie, seizure clusters, acute repetitive seizures) distinct from a patient’s usual seizure pattern
Used adjunctively in convulsive disorders, although it has not proved useful as the sole therapy
2-10 mg PO q6-12hr
Intranasal spray
- 0.2 mg/kg intranasally as single dose
-
Adolescent or adult weight-based dosing
- 14-27 kg: 5 mg (one 5-mg device); 1 spray in 1 nostril
- 28-50 kg: 10 mg (one 10-mg device); 1 spray in 1 nostril
- 51-75 kg: 15 mg (two 7.5-mg devices); 1 spray in each nostril
- ≥76 kg: 20 mg (two 10-mg devices); 1 spray in each nostril
-
Second dose and maximum dose
- Second dose: When required, may be administered after at least 4 hr after initial dose; if the second dose is administered, use a new blister pack of diazepam intranasal
- Maximum dosage: Not to exceed 2 doses to treat a single episode
- Treatment frequency: Do not use for more than 1 episode q5days and no more than 5 episodes/month
Diazepam gel (rectal)
- 0.2 mg/kg PR or 10-20 mg as single dose
- Rectal gel is measured in 2.5-mg increments from 2.5-20 mg/dose; calculate dose and round upward to next measurable dose
- May prescribe second dose of diazepam rectal gel; when required, may be given 4-12 hr after first dose
-
Adolescent or adult weight-based dosing
- 14-25 kg: 5 mg
- 26-37 kg: 7.5 mg
- 38-50 kg: 10 mg
- 51-62 kg: 12.5 mg
- 63-75 kg: 15 mg
- 76-87 kg: 17.5 mg
- 88-111 kg: 20 mg
Status Epilepticus
5-10 mg initially (IV preferred); injection may be repeated if necessary, at 10-15 minute intervals up to 30 mg maximum; may repeat in 2 to 4 hours if necessary; however, consider that residual active metabolites may persist
Use extreme caution in individuals with chronic lung disease or unstable cardiovascular status
Administer IV slowly; administer IM if IV administration impossible
OR
0.2-0.5 mg/kg PR; round up dose to nearest 2.5 mg increment; not to exceed 20 mg as single dose
Cardioversion
5-15 mg IV within 5-10 min prior to procedure to relieve anxiety and tension and to reduce recall of procedure
Dosage Modifications
Renal impairment:
- Oral: Data not available
- No dose adjustment recommended unless administered for prolonged period; decrease dose in prolonged periods
- Rectal gel: Not studied; use caution
- Intranasal spray: Not studied
Hepatic impairment
- Rectal gel: Not studied; use caution
- Intranasal spray: Not studied
- Prescribing information describes literature review showing diazepam 0.1-0.15 mg/kg IV had prolonged half-life by 2- to 5-fold in patients with alcoholic cirrhosis
-
Oral administration
- Mild to moderate: Use with caution and consider dose adjustment; average half-life is increased in mild and moderate cirrhosis; average increase has been variously reported from 2-fold to 5-fold, with individual half-lives over 500 hr reported
Severe: Contraindicated
Dosing Considerations
Adjust dose periodically to reflect changes in patient’s age or weight
May use 2.5-mg dose as a partial replacement dose for patients who may expel a portion of first dose
Long-term (>4 months) effectiveness of diazepam has not been assessed by systematic clinical studies
Periodically reassess the efficacy for each patient
Once acute symptomatology has been properly controlled with diazepam injection, the patient may be placed on oral therapy if further treatment required
Discontinuation or dosage reduction
- Use a gradual taper to discontinue diazepam tablets or reduce dosage to avoid withdrawal reactions
- If any withdrawal reaction develops, consider pausing taper or increasing dose to previous tapered dosage level; subsequently decrease dose more slowly
Seizures (Orphan)
Intermittent use to control bouts of increased seizure activity or Dravet syndrome by various administrative routes
Orphan sponsors
- SC: Xeris Pharmaceuticals, Inc, .3208 Red River Street, Suite 300, Austin, Texas 78705
- Autoinjector: Meridian Medical Technologies, Inc., 6350 Stevens Forest Rd, Suite 301, Columbia, Maryland 21046
Dosage Forms & Strengths
tablet: Schedule IV
- 2mg
- 5mg
- 10mg
oral solution: Schedule IV
- 1mg/1mL
- 5mg/mL
rectal gel (Diastsat Acudial): Schedule IV
- 2.5mg/0.5mL
- 10mg/2mL
- 20mg/4mL
injectable solution: Schedule IV
- 5mg/mL
intramuscular device: Schedule IV
- 5mg/mL
intranasal spray (Valtoco): Schedule IV
- 5mg/0.1mL
- 7.5mg/0.1mL
- 10mg/0.1mL
Sedative/Muscle Relaxant
Indicated for spasm associated with local pathology, cerebral palsy, and tetanus
<6 months: Not recommended
Potentially toxic dose in patients <6 years: >0.5 mg/kg
>6 years
- 1-2.5 mg PO q6-8hr; increase gradually as needed and tolerated
- 0.12-0.8 mg/kg/day PO divided q6-8hr, not to exceed 10 mg/dose OR
- 5-10 mg or 0.04-0.2 mg/kg IV/IM q3-4hr; no more than 0.6 mg/kg within 8 hours; respiratory assistance should be available
Seizure Disorder
Indicated for treatment of intermittent, stereotypic episodes of frequent seizure activity (ie, seizure clusters, acute repetitive seizures) distinct from a patient’s usual seizure pattern in patients with epilepsy aged ≥2 years (rectal gel) or ≥6 years (intranasal)
<2 years: Safety and efficacy not established
Diazepam gel (rectal)
- Rectal gel is measured in 2.5-mg increments from 2.5-20 mg/dose; calculate dose and round upward to next measurable dose
- May prescribe second dose of diazepam rectal gel; when required, may be given 4-12 hr after first dose
-
2-6 years (0.5 mg/kg PR) weight-based dosing
- 6-10 kg: 5 mg
- 11-15 kg: 7.5 mg
- 16-20 kg: 10 mg
- 21-25 kg: 12.5 mg
- 26-30 kg: 15 mg
- 31-35 kg: 17.5 mg
- 36-44 kg: 20 mg
-
6-12 years (0.3 mg/kg PR) weight-based dosing
- 10-16 kg: 5 mg
- 17-25 kg: 7.5 mg
- 26-33 kg: 10 mg
- 34-41 kg: 12.5 mg
- 42-50 kg: 15 mg
- 51-58 kg: 17.5 mg
- 59-74 kg: 20 mg
-
≥12 years (0.2 mg/kg PR) weight-based dosing
- 14-25 kg: 5 mg
- 26-37 kg: 7.5 mg
- 38-50 kg: 10 mg
- 51-62 kg: 12.5 mg
- 63-75 kg: 15 mg
- 76-87 kg: 17.5 mg
- 88-111 kg: 20 mg
Intranasal spray
- <6 years: Safety and efficacy not established
- Administer intranasally as a single dose
-
6-11 years (0.3 mg/kg) weight-based dosing
- 10-18 kg: 5 mg (one 5-mg device); 1 spray in 1 nostril
- 19-37 kg: 10 mg (one 10-mg device); 1 spray in 1 nostril
- 38-55 kg: 15 mg (two 7.5-mg devices); 1 spray in each nostril
- 56-74 kg: 20 mg (two 10-mg devices); 1 spray in each nostril
-
≥12 years (0.2 mg/kg) weight-based dosing
- 14-27 kg: 5 mg (one 5-mg device); 1 spray in 1 nostril
- 28-50 kg: 10 mg (one 10-mg device); 1 spray in 1 nostril
- 51-75 kg: 15 mg (two 7.5-mg devices); 1 spray in each nostril
- ≥76 kg: 20 mg (two 10-mg devices); 1 spray in each nostril
-
Second dose and maximum dose
- Second dose: When required, may be administered after at least 4 hr after initial dose; if the second dose is administered, use a new blister pack of diazepam intranasal
- Maximum dosage: Not to exceed 2 doses to treat a single episode
- Treatment frequency: Do not use for more than 1 episode q5days and no more than 5 episodes/month
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
- >30 days – 5 years: 0.2-0.5 mg slowly q2-5 min up to 5 mg maximum (IV preferred); children ≥5 years, 1 mg q2-5 min up to a maximum of 10 mg (slow IV administration preferred); repeat in 2 to 4 hr if necessary; EEG monitoring of the seizure may be helpful
- >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
Dosage Modifications
Renal impairment
Rectal gel: Not studied; use caution
Intranasal spray: Not studied
Oral: Data not available
Hepatic impairment
Rectal gel: Not studied; use caution
Intranasal spray: Not studied
Prescribing information describes literature review showing diazepam 0.1-0.15 mg/kg IV had prolonged half-life by 2- to 5-fold in patients with alcoholic cirrhosis
-
Oral administration
- Mild to moderate: Use with caution; average half-life increased in mild and moderate cirrhosis; average increase has been reported from 2-fold to 5-fold, with individual half-lives over 500 hr
- Severe: Contraindicated
Dosing Considerations
Long-term (>4 months) effectiveness of diazepam has not been assessed by systematic clinical studies
Periodically reassess the efficacy of each patient
Intranasal spray
- Not approved for use in neonates or infants
- Prolonged CNS depression observed with neonates treated with diazepam
- Serious adverse reactions including fatal reactions and gasping syndrome occurred in premature neonates and low-birth-weight infants who received drugs containing benzyl alcohol as a preservative (diazepam intranasal contains benzyl alcohol 10.5 mg/0.1mL)
Reduce hazardous risks in children with slow IV dosing
- Administer drug slowing to obtain maximal clinical effect with minimum dose, and thereby, reduced risk of hazardous side effects (eg, apnea, prolonged somnolence)
- Administer slowly over 3-min period (not to exceed 0.25 mg/kg)
- May repeat dose after 15-30 minutes
- If symptom relief not obtained after 3rd administration, adjunctive therapy appropriate for the condition is recommended
Discontinuation or dosage reduction
- Use a gradual taper to discontinue diazepam tablets or reduce dosage to avoid withdrawal reactions
- If any withdrawal reaction develops, consider pausing taper or increasing dose to previous tapered dosage level; subsequently decrease dose more slowly
Dosing Considerations
Due to long-acting metabolite, not considered a drug of choice in the elderly; associated with falls
Rectal gel: Use lower dose
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
Serious - Use Alternative (35)
- 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.
benzhydrocodone/acetaminophen and diazepam both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate - buprenorphine subdermal implant
buprenorphine subdermal implant and diazepam both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- 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.
- fexinidazole
fexinidazole will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.
- 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.
- levoketoconazole
levoketoconazole 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.
- olopatadine intranasal
diazepam and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- 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 (269)
- 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.
- acrivastine
acrivastine and diazepam both increase sedation. Use Caution/Monitor.
- alfentanil
diazepam and alfentanil both increase sedation. Use Caution/Monitor.
- alprazolam
alprazolam and diazepam both increase sedation. Use Caution/Monitor.
- amisulpride
amisulpride 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.
- asenapine
asenapine and diazepam both increase sedation. Use Caution/Monitor.
- asenapine transdermal
asenapine transdermal and diazepam both increase sedation. 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.
- atogepant
diazepam will increase the level or effect of atogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- avapritinib
diazepam will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
avapritinib and diazepam both increase sedation. 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.
- belzutifan
belzutifan will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information.
- 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.
- brexpiprazole
brexpiprazole and diazepam both increase sedation. Use Caution/Monitor.
- brimonidine
brimonidine and diazepam both increase sedation. Use Caution/Monitor.
- brivaracetam
brivaracetam and diazepam both increase 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. - ceritinib
ceritinib will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. 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.
- daridorexant
diazepam and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- 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.
- difelikefalin
difelikefalin and diazepam both increase sedation. Use Caution/Monitor.
- 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.
- fexinidazole
fexinidazole will increase the level or effect of diazepam by affecting hepatic enzyme CYP2C19 metabolism. 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.
- fosaprepitant
fosaprepitant will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- 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.
- ganaxolone
diazepam and ganaxolone both increase sedation. Use Caution/Monitor.
- 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.
- isavuconazonium sulfate
diazepam will increase the level or effect of isavuconazonium sulfate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- 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.
- larotrectinib
larotrectinib will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong or moderate CYP3A4 inhibitors may decrease rate of diazepam elimination, thereby increasing adverse reactions to diazepam.
- 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. - lenacapavir
lenacapavir will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lencapavir (a moderate CYP3A4 inhibitor) may increase CYP3A4 substrates initiated within 9 months after last SC dose of lenacapavir, which may increase potential risk of adverse reactions of CYP3A4 substrates.
- 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. - mavacamten
diazepam will increase the level or effect of mavacamten by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Inititiation of weak CYP2C19 inhibitors may require decreased mavacamten dose.
- 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.
- methylphenidate transdermal
methylphenidate transdermal will increase the level or effect of diazepam by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.
- 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.
- 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 (DSC)
ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC) 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.
- sparsentan
sparsentan will decrease the level or effect of diazepam by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Sparsentan (a CYP2C19 inducer) decreases exposure of CYP2C19 substrates and reduces efficacy related to these substrates.
- 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 (44)
- 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.
- acetazolamide
acetazolamide will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- anastrozole
anastrozole will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- 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.
- cyclophosphamide
cyclophosphamide will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. 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.
- ruxolitinib topical
diazepam will increase the level or effect of ruxolitinib topical 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. - serdexmethylphenidate/dexmethylphenidate
serdexmethylphenidate/dexmethylphenidate increases effects of diazepam by decreasing metabolism. Minor/Significance Unknown.
- 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.
Adverse Effects
1-10%
Ataxia (3%)
Somnolence (>1%)
Rectal gel
- Diarrhea (4%)
- Rash (3%)
- Incoordination (3%)
- Euphoria (3%)
- Dizziness (3%)
- Asthma (2%l)
Intranasal
- Nasal discomfort (6%)
- Nasal congestion (3%)
- Epistaxis (3%)
- Dysgeusia (2%)
Frequency Not Defined
Hypotension
Fatigue
Muscle weakness
Respiratory depression
Urinary retention
Depression
Incontinence
Blurred vision
Dysarthria
Headache
Skin rash
Changes in salivation
Drowsiness
Venous thrombosis
Confusion
Hypoactivity
Slurred speech
Syncope
Tremor
Vertigo
Constipation
Nausea
Changes in libido
Bradycardia
Cardiovascular collapse
Diplopia
Nystagmus
Urticaria
Paradoxical reactions, including acute hyperexcited states, anxiety, hallucinations, increased muscle spasticity, insomnia, rage, sleep disturbances and stimulation
Peroral endoscopic procedures: Coughing, depressed respiration, dyspnea, hyperventilation, laryngospasm, and pain in throat or chest
Serious
- Neutropenia
- Jaundice
- Local effects: Pain, swelling, thrombophlebitis, carpal tunnel syndrome, tissue necrosis
- Phlebitis if too rapid IV push
Oral
- Central nervous system: Confusion, depression, dysarthria, headache, slurred speech, tremor, vertigo
- Gastrointestinal system: Constipation, nausea, gastrointestinal disturbances
- Special senses: Blurred vision, diplopia, dizziness
- Cardiovascular system: Hypotension
- Psychiatric and paradoxical reactions: Stimulation, restlessness, acute hyperexcited states, anxiety, agitation, aggressiveness, irritability, rage, hallucinations, psychoses, delusions, increased muscle spasticity, insomnia, sleep disturbances, and nightmares. Inappropriate behavior and other adverse behavioral effects have been reported when using benzodiazepines.
- Urogenital system: Incontinence, changes in libido, urinary retention
- Skin and appendages: Skin reactions
- Laboratories: Elevated transaminases and alkaline phosphatase
- Other: Changes in salivation, including dry mouth, hypersalivation
- Antegrade amnesia may occur using therapeutic dosages, the risk increasing at higher dosages; amnestic effects may be associated with inappropriate behavior
- Minor changes in EEG patterns, usually low-voltage fast activity, have been observed in patients during and after diazepam therapy and are of no known significance
- Because of isolated reports of neutropenia and jaundice, periodic blood counts and liver function tests are advisable during long-term therapy
Postmarketing Reports
Injury, poisoning, and procedural complications: Falls and fractures in benzodiazepine users; risk is increased in those taking concomitant sedatives (including alcohol), and in the elderly
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 narrow-angle glaucoma and open-angle glaucoma unless patients receiving appropriate therapy
Cautions
Efficacy and safety of parenteral diazepam has not been established in neonate (30 days or less of age); prolonged central nervous system depression has been observed in neonates, apparently due to inability to biotransform diazepam into inactive metabolites; benzyl alcohol has been reported to be associated with a fatal gasping syndrome in premature infants
Not recommended for chronic, daily use as an anticonvulsant because of potential for development of tolerance to diazepam; chronic daily use of diazepam may increase frequency and/or severity of tonic-clonic seizures, requiring an increase in dosage of standard anticonvulsant medication; in such cases, abrupt withdrawal of chronic diazepam may also be associated with a temporary increase in the frequency and/or severity of seizures
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
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
Risk of abuse, misuse, and addiction
- 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)
- Benzodiazepines may increase risks of abuse, misuse, and addiction, which can lead to overdose or death
- Abuse and misuse of benzodiazepines often (but not always) involve use of doses greater than the maximum recommended dosage and commonly involve concomitant use of other medications, alcohol, and/or illicit substances, which is associated with an increased frequency of serious adverse outcomes, including respiratory depression, overdose, or death
- 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
- Counsel about risks and proper use along with monitoring for signs and symptoms of abuse, misuse, and addiction, particularly in patients at elevated risk of abuse; do not exceed recommended dosing frequency
Propylene glycol toxicity
- Propylene glycol toxicity reported in patients treated with diazepam injection at doses significantly greater than recommended when it was being used to treat alcohol withdrawal symptoms at doses >900 mg/day
- Propylene glycol toxicity is associated with an anion gap metabolic acidosis, serum hyperosmolality, and increased lactate
- Can cause acute tubular necrosis (which can progress to multiorgan failure), mental status changes, hypotension, seizures, and cardiac arrhythmias
- Patients at high risk for propylene glycol toxicity include those with renal dysfunction, hepatic dysfunction, impaired alcohol dehydrogenase enzymes, or other comorbidities (eg, history of alcoholism)
Drug interactions overview
- Substrate of CYP2C19 and CYP3A4
-
Opioids
- Limit dosage and duration if concomitantly used; monitor closely for respiratory depression and sedation
- Coadministration of benzodiazepines and opioids increases risk of respiratory depression
-
CNS depressants or alcohol
- Coadministration of other CNS depressants or alcohol consumption may potentiate CNS-depressant effects of diazepam
-
CYP2C19 or CYP3A4 inhibitors
- May decrease rate of diazepam elimination, thereby increasing adverse reactions to diazepam
-
CYP2C19 or CYP3A4 inducers
- May increase rate of diazepam elimination; therefore, efficacy of diazepam may be decreased
-
CYP2C19 or CYP3A4 substrates
- Diazepam may interfere with metabolism of substrates for CYP2C19 and CYP3A4 leading to a potential drug-drug interaction
Pregnancy & Lactation
Pregnancy
There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to AEDs, such as diazepam injection, during pregnancy; healthcare providers are encouraged to recommend that pregnant patient receiving therapy enroll in North American Antiepileptic Drug (NAAED) Pregnancy Registry by calling 1-888- 233-2334 or online at http://www.aedpregnancyregistry.org/
Infants born to mothers using benzodiazepines late in pregnancy reported to experience symptoms of sedation and/or neonatal withdrawal
Advise pregnant females that use of this medication late in pregnancy can result in sedation (respiratory depression, lethargy, hypotonia) and/or withdrawal symptoms (hyperreflexia, irritability, restlessness, tremors, inconsolable crying, and feeding difficulties) in newborns
Available data from published observational studies of pregnant women exposed to benzodiazepines do not report a clear association with benzodiazepines and major birth defects
Neonatal withdrawal and floppy infant syndrome
- Neonatal withdrawal syndrome and symptoms suggestive of floppy infant syndrome associated with administration of benzodiazepines during the later stages of pregnancy and peripartum period have been reported
- Benzodiazepines cross the placenta and may produce respiratory depression, hypotonia, and sedation in neonates; monitor neonates exposed to therapy during pregnancy or labor for signs of sedation, respiratory depression, hypotonia, and feeding problems; monitor neonates exposed to therapy during pregnancy for signs of withdrawal; manage these neonates accordingly
Animal data
- Produced increased incidences of fetal malformations in mice and hamsters when given orally at single doses ≥100 mg/kg (approximately 20 times maximum recommended adult dose [0.4 mg/kg/day] or greater on mg/m2 basis)
- Cleft palate and exencephaly are the most common and consistently reported malformations produced in these species by administration of high, maternally-toxic doses of diazepam during organogenesis
- Administration of benzodiazepines or other drugs that enhance GABAergic inhibition to neonatal rats has been reported to result in widespread apoptotic neurodegeneration in the developing brain at plasma concentrations relevant for seizure control in humans
- The window of vulnerability to these changes in rats (postnatal days 0-14) includes a period of brain development that takes place during the third trimester of pregnancy in humans
Lactation
Present in breastmilk
Because diazepam and its metabolites may be present in human breast milk for prolonged periods of time after acute use, patients should be advised not to breastfeed for an appropriate period of time after receiving treatment
There are no data specifically for diazepam intranasal
Reports of sedation, poor feeding and poor weight gain in infants exposed to diazepam through breast milk; there are no data on effects of diazepam on milk production
Instruct patients to inform their healthcare provider if they are breastfeeding or plan to breastfeed; instruct breastfeeding patients to monitor their infants for excessive sedation, poor feeding and poor weight gain, and to seek medical attention if they notice these signs
Consider developmental and health benefits of breastfeeding along with the mother's clinical need for therapy and any potential adverse effects on breastfed infant therapy or from the underlying maternal condition
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.Pharmacology
Mechanism of Action
Although precise mechanism in antiseizure effects is unknown, animal and in vitro studies suggest that it acts to suppress seizures through interaction with γ-aminobutyric acid (GABA) receptors of the A-type (GABAA ); GABA, the major inhibitory neurotransmitter in central nervous system (CNS), acts at this receptor to open membrane channel allowing chloride ions to flow into neurons; entry of chloride ions causes an inhibitory potential that reduces ability of neurons to depolarize to threshold potential necessary to produce action potentials; excessive depolarization of neurons is implicated in the generation and spread of seizures; it is believed that diazepam enhances the actions of GABA by causing GABA to bind more tightly to the GABAA receptor.
Absorption
Bioavailability: 90% (PR); 97% (intranasal)
Duration: Variable, dependent on dose and frequency (PO [hypnotic action]); 15-60 min (IV [sedative action])
Peak plasma time: 1-1.5 hr (PO), 5-90 min (PR); 1.5 hr (intranasal)
Peak plasma concentration: 373 ng/mL (initial at 45 min); 447 ng/mL (second peak at 70 min)
Effect of food (Oral)
- With presence of food: Increased peak plasma time by 1.25 hr; average decrease in Cmax of 20% and 27% decreased in AUC
Distribution
Protein bound: 98% (PO); 95-98% (intranasal)
Vd (steady state): 0.8-1 L/kg
Metabolism
Metabolized by hepatic P450 enzymes CYP2C19, CYP3A4
Metabolites: N-desmethyldiazepam, 3-hydroxdiazepam, oxazepam
Active metabolites: N-desmethyldiazepam and temazepam, which are both further metabolized to oxazepam; largely eliminated by glucuronidation
Elimination
Half-life
- 20-70 hr (active metabolite); 49.2 hr (10-mg intranasal dose)
- N-desmethyldiazepam: Up to 100 hr
Renal clearance: 20-30 mL/min
Excretion: Urine
Pharmacogenomics
Clearance: 20-30 mL/min (young adults)
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
IM Administration
Inject deeply into the muscle
Oral Administration
Dilute oral concentrate with water/juice/carbonated beverages or mix with semisolid foods
Take tablets as prescribed
Advise patients to avoid driving or operating heavy machinery until patient is aware of the effects of the drug
Oral solution: 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
Intranasal Administration
For intranasal use only
No device assembly required; ready-to-use nasal spray device; do not open individual blister packs or test nasal spray devices before use
Do not use if nasal spray unit appears damaged
Each single-dose nasal spray device sprays 1 time and cannot be reused
Nasal spray delivers its entire contents upon activation
Before use, instruct individual administering diazepam intranasal on how to identify seizure clusters and how to appropriately administer the product
Prescribing the drug
- A decision to prescribe diazepam rectal gel involves more than the diagnosis and selection of correct dose
- The prescriber must be convinced from historical reports and/or personal observations that the patient exhibits identifiable characteristics of seizure cluster that can be distinguished from the patient’s usual seizure activity by the caregiver who will be responsible for administering diazepam rectal gel
- As diazepam rectal gel is only intended for adjunctive use, the prescriber must ensure that the patient is receiving an optimal regimen of standard anti-epileptic drug treatment and is, nevertheless, continuing to experience these characteristic episodes
- Since a non-health professional will be obliged to identify episodes suitable for treatment, make the decision to administer treatment upon that identification, administer the drug, monitor the patient, and assess the adequacy of the response to treatment; a major component of the prescribing process involves the necessary instruction of this individual
- The prescriber and caregiver must have a common understanding of what is and is not an episode of seizures that is appropriate for treatment, the timing of administration in relation to the onset of the episode, the mechanics of administering the drug, how and what to observe following administration, and what would constitute an outcome requiring immediate and direct medical attention
Storage
Tablets
- Store in tightly closed container between 68-77ºF (20-25ºC) and out of the light
- Keep diazepam tablets and all medicines out of reach of children
Injection solution
- Store at 20-25ºC (68-77ºF); protect from light
Rectal gel
- Store at 25ºC (77ºF)
Intranasal spray
- Store at 20-25ºC (68-77ºF); excursions permitted from 15-30ºC (59-86ºF)
- Do not freeze
- Protect from light
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| Valium oral - | 5 mg tablet |  | |
| Valium oral - | 10 mg tablet |  | |
| Valium oral - | 2 mg tablet |  | |
| diazepam injection - | 5 mg/mL solution |  | |
| diazepam injection - | 5 mg/mL solution |  | |
| diazepam injection - | 5 mg/mL vial |  | |
| 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 |  | |
| Diastat AcuDial rectal - | 12.5-15-17.5-20 mg kit |  | |
| Diastat AcuDial rectal - | 5-7.5-10 mg kit |  | |
| diazepam oral - | 10 mg tablet |  | |
| diazepam oral - | 5 mg tablet |  | |
| diazepam oral - | 5 mg tablet |  | |
| diazepam oral - | 10 mg tablet |  | |
| diazepam oral - | 2 mg tablet |  | |
| diazepam oral - | 10 mg tablet |  | |
| diazepam oral - | 10 mg tablet |  | |
| diazepam oral - | 2 mg tablet |  | |
| diazepam oral - | 5 mg tablet |  | |
| diazepam oral - | 5 mg tablet |  | |
| diazepam oral - | 5 mg tablet |  | |
| diazepam oral - | 2 mg tablet |  | |
| diazepam oral - | 2 mg tablet |  | |
| diazepam oral - | 10 mg tablet |  | |
| diazepam oral - | 5 mg/mL liquid |  | |
| diazepam oral - | 2 mg tablet |  | |
| diazepam oral - | 5 mg/5 mL (1 mg/mL) solution |  | |
| Diastat rectal - | 2.5 mg kit |  | |
| diazepam rectal - | 12.5-15-17.5-20 mg kit |  | |
| diazepam rectal - | 5-7.5-10 mg kit |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
diazepam injection
DIAZEPAM - INJECTION
(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. Using 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 use the smallest dose of diazepam that works, and use it for the shortest possible time. Be sure you know how to use 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, muscle spasms, and alcohol withdrawal. The injection form is used when prompt relief is desired or when the medication cannot be taken by mouth.This medication is also used for the short-term treatment of serious seizures that do not stop (status epilepticus). It is not for ongoing daily use to prevent seizures.Diazepam is also used before a surgery or procedure to cause drowsiness, decrease anxiety, and to help the patient forget what happened during the surgery/procedure.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.This medication is given by injection into a vein or deep into a muscle as directed by your doctor. You should be closely monitored for several hours after receiving this medication.If you are using this medication at home, learn all preparation and usage instructions from your health care professional. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn how to store and discard medical supplies safely.The dosage is based on your medical condition, age, and response to treatment. Giving the medication too fast into a vein can cause serious side effects. If giving this medication into a vein, inject it slowly into a large vein. Do not inject this medication into an artery or into the skin.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.
SIDE EFFECTS: See also Warning section.Drowsiness, dizziness, blurred vision, unsteadiness, or pain/burning/redness at the injection site may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor 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), fainting, slow/fast/irregular heartbeat.Get medical help right away if you have any very serious side effects, including: slow/shallow breathing, chest pain.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 using 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, heart disease, liver disease, kidney disease, brain problems that could affect breathing (such as decreased consciousness, head injury).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).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).Tell your doctor if you are pregnant or plan to become pregnant. You should not become pregnant while using diazepam. Diazepam may harm an unborn baby. Newborn babies of mothers who receive this medication late in pregnancy may have symptoms such as slow/shallow breathing, nonstop crying, shaking, or trouble feeding. If you become pregnant, talk to your doctor right away about the risks and benefits of this medication.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 section.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 used 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.
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.
MISSED DOSE: Not applicable. This medication is not usually given on a regular schedule.
STORAGE: Store at room temperature away from light and moisture. Do not refrigerate or freeze. Do not store in the bathroom. 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.
Information last revised February 2023. Copyright(c) 2023 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.
Formulary
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.
