Diazepam (Diazepam)
Also sold as: Calmpose, Valium, Diapin, Placidox, Paxum
Pregnancy
Cat D
Lactation
Avoid
Schedule
X
Forms
Tablets 2mg, 5mg, 10mg +3
Indications
- Anxiety disorders (short-term)
- Acute alcohol withdrawal syndrome (delirium tremens prevention and treatment)
- Skeletal muscle spasm
- Status epilepticus (IV — first or second-line)
- Febrile seizures in children (rectal)
- Pre-medication before surgery/procedures
- Tetanus (adjunct — muscle relaxation)
- Acute vertigo (vestibular sedation)
Adult Dosing
Anxiety (oral)
2–10mg
Three times daily (TDS); maximum 30mg/day in outpatients
Alcohol withdrawal syndrome
10mg
Three to four times daily for 24 hours, then reduce by 25% per day over 4–7 days
Fixed-dose tapering preferred over symptom-triggered for severe alcohol withdrawal (delirium tremens risk). Long half-life of diazepam provides smooth self-tapering effect.
Muscle spasm
5–10mg
Three times daily; maximum 30mg/day
Status epilepticus (IV)
5–10mg IV (max 20mg per episode)
IV at 2mg/min; may repeat after 10–15 minutes
Risk of respiratory depression; resuscitation equipment essential. Lorazepam preferred IV due to shorter duration of anticonvulsant action and no active metabolites.
Pre-anaesthetic medication
10–20mg oral or 5–10mg IV
1 hour before procedure (oral) or immediately before (IV)
Pediatric Dosing
Rectal diazepam commonly used in India for febrile seizures in children — caregiver can administer at home before hospital. IV use under hospital supervision with respiratory monitoring. Long half-life — accumulation risk with repeated dosing in neonates.
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| Renal impairment | No specific dose adjustment required; active metabolites may accumulate in severe renal impairment — monitor for excessive sedation |
Hepatic Adjustment
Use with caution in hepatic impairment — diazepam undergoes extensive hepatic metabolism (CYP2C19, CYP3A4). Half-life markedly prolonged. Lorazepam or oxazepam preferred in liver disease. Reduce dose and extend dosing interval.
Pregnancy & Lactation
Pregnancy: Category D
Category D — Fetal risk confirmed. Floppy infant syndrome, neonatal withdrawal with chronic prenatal use. Possible (controversial) oral cleft risk in first trimester. Single-dose IV use for maternal status epilepticus may be unavoidable. Avoid chronic use throughout pregnancy.
Lactation: Avoid
Diazepam and active metabolites excreted in breast milk for extended periods (long half-life). Neonatal sedation, poor feeding, weight loss reported. Avoid breastfeeding during regular diazepam use.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Opioids and CNS depressants (alcohol, antipsychotics, antihistamines, barbiturates) | FDA BLACK BOX WARNING: Concurrent use causes additive CNS and respiratory depression. Risk of respiratory arrest and death. Opioid + benzodiazepine combination is a leading cause of overdose death. | Major |
| CYP3A4 / CYP2C19 inhibitors (fluconazole, omeprazole, fluvoxamine, isoniazid) | Reduce hepatic metabolism of diazepam — markedly increase diazepam half-life and sedation. Use lower doses and monitor. | Moderate |
| CYP inducers (rifampicin, phenytoin, carbamazepine) | Accelerate diazepam metabolism — significantly reduced therapeutic effect | Moderate |
| Clozapine (IV route) | IV diazepam + clozapine: cardiorespiratory arrest reported. Avoid combination. | Major |
| Muscle relaxants (baclofen, methocarbamol) | Additive skeletal muscle relaxation and CNS depression | Moderate |
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Side Effects
Common
- Sedation and drowsiness (most common)
- Ataxia and coordination problems
- Muscle weakness
- Cognitive blunting and memory impairment
- Dizziness
- Fatigue and depression (with long-term use)
Serious / Discontinue If
- Physical dependence and severe withdrawal syndrome (seizures, psychosis, delirium — potentially life-threatening on abrupt discontinuation)
- Respiratory depression (especially IV use, high doses, opioid co-use)
- Paradoxical excitement and aggression (especially elderly, children, those with personality disorders)
- Anterograde amnesia
- Thrombophlebitis with IV administration (propylene glycol)
Contraindications
- Acute respiratory insufficiency
- Sleep apnoea syndrome
- Severe hepatic impairment
- Myasthenia gravis
- Hypersensitivity to diazepam or any benzodiazepine
- Acute narrow-angle glaucoma
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Calmpose 5mg | Ranbaxy Laboratories (Sun Pharma) | 10 tab ₹18 |
| Calmpose 10mg | Ranbaxy Laboratories (Sun Pharma) | 10 tab ₹25 |
| Diapin 5mg | Cipla Ltd. | 10 tab ₹20 |
| Placidox 5mg | Sun Pharmaceutical Industries | 10 tab ₹16 |
| Calmpose Injection 5mg/ml | Ranbaxy Laboratories (Sun Pharma) | 2ml amp ₹45 |
Monitoring Required
- Respiratory function — continuous monitoring with IV diazepam (flumazenil reversal agent should be available)
- Level of sedation score
- Blood pressure — hypotension risk with IV use
- Signs of dependence at every prescription renewal — limit to 2–4 weeks for anxiety
- CIWA-Ar score if used for alcohol withdrawal (reassess every 1–2 hours)
- Accumulation in elderly and hepatic impairment — long half-life leads to cumulative sedation
Patient Counseling Points
- LONG HALF-LIFE: Diazepam stays in your body for many days (up to a week or more). Effects can accumulate with repeated doses — do not take extra doses.
- ALCOHOL WITHDRAWAL: If using for alcohol withdrawal, do not drink any alcohol — fatal CNS depression can occur.
- DEPENDENCE: Physical dependence develops within 2–4 weeks of regular use. Never stop suddenly — seizures can occur. Always taper slowly under medical supervision.
- SCHEDULE X: Prescription required each time; cannot be dispensed without a valid prescription.
- DRIVING: Do not drive, operate machinery, or consume alcohol for at least 24–48 hours after any dose.
- RECTAL USE FOR FEBRILE SEIZURES: Parents — administer rectally at onset of seizure, then call emergency services. Do not give more than one dose without medical advice.
- Report any unusual aggression, excitement, or confusion — paradoxical reactions are possible
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Clinically reviewed by: Dr. Pradeep Chauhan, MD Internal Medicine, DM Neurology — PGIMER Chandigarh
Last reviewed: 2026-04-01
References
- Indian National Formulary (INF) 2023 — Diazepam monograph
- CDSCO Schedule X List — Diazepam
- WHO Essential Medicines List 2023 — Diazepam (anticonvulsant and anxiolytic)
- Goodman & Gilman's Pharmacological Basis of Therapeutics, 13th ed.
- American Society of Addiction Medicine (ASAM) Clinical Practice Guideline — Alcohol Withdrawal Management 2020
- FDA Black Box Warning — Opioid + benzodiazepine combination 2020