Diazepam belongs to a group of medicines called benzodiazepines. It is only available on prescription.
Diazepam is used to treat:
- anxiety
- insomnia
- muscle spasms
- fits (seizures), such as epilepsy.
- alcohol withdrawal symptoms, such as sweating or difficulty sleeping
It is sometimes used to help you relax before a medical operation. This is known as a pre-med.
Types of diazepam
Diazepam comes in tablets or a rectal tube (medicine that's squeezed into your bottom).
It can also be given as an injection in hospital.
Brand names include:
- Anxicalm
- Diazemuls
- Stesolid rectal tubes
It's also known as Valium, but this brand is not available in Ireland anymore.
Check if you can take diazepam
Diazepam is usually suitable for adults age 18 and over.
It may not be suitable if you're over age 65. Or you may be prescribed a lower dose, because there can be an increased risk of side effects.
Your GP may prescribe diazepam (rectal tube) for muscle spasms in children age 1 month and older.
Diazepam may not be suitable if you:
- had an allergic reaction to diazepam or other medicines in the past
- have liver or kidney problems
- have difficulty breathing or are breathless
- have obsessions or phobias (a fear of a particular object or situation)
- have a condition that causes muscle weakness (myasthenia gravis)
- have a condition that causes breathing problems during sleep (sleep apnoea)
- have depression or thoughts of harming yourself
- have a personality disorder
- have current or past problems with alcohol or drugs
- recently had a loss or bereavement
- have a condition that affects the blood flow to your brain (arteriosclerosis)
- have low levels of a protein called albumin
- are going to be put to sleep (have a general anaesthetic) for an operation or other medical treatment
- are pregnant, trying to get pregnant or are breastfeeding
Pregnancy and diazepam
Ask your GP or pharmacist for advice before taking diazepam if you're:
- pregnant
- think you might be pregnant
- planning to have a baby
If you already take diazepam, you may need to keep taking it to remain well.
Your GP can explain the risks and benefits and will help you choose the best treatment for you and your baby.
Breastfeeding and diazepam
You usually should not breastfeed while taking diazepam. But your GP, midwife or public health nurse will let you know if it's safe for your baby.
If your baby is healthy it can be used in a low dose for a short time. Larger amounts can build up in your breast milk and make your baby too tired to feed.
Do not share a bed with your baby until you have finished taking diazepam.
If you take diazepam while you are breastfeeding, make sure your baby is feeding, sleeping and breathing normally.
Talk to your GP or public health nurse as soon as possible if you have concerns.
Contraception and fertility
Diazepam does not affect contraception including the combined pill or emergency contraception.
Some contraceptive pills can keep diazepam in your body for longer and increase its effect. You can also get bleeding in between your periods if you take diazepam and contraceptive pills together.
There is currently no evidence to suggest that taking diazepam will reduce fertility in either men or women.
When you start taking diazepam
Diazepam is usually taken 1 to 3 times a day. Your GP will prescribe the best dose for you. It's important to take your dose exactly as your GP says.
If you are unsure, read the patient information leaflet that comes with your medicine or ask your GP or pharmacist.
Non-urgent advice: Find your patient information leaflet
Your patient information leaflet is the leaflet that comes with your medicine. You can find a digital version of the leaflet online.
You should take diazepam tablets for a short time. It is usually only recommended for use up to 4 weeks.
How long it takes for diazepam to work
How long it takes for diazepam to start to work will depend on what you are taking it for.
Fits (seizures)
Rectal tubes should start to work within 10 minutes.
Anxiety
You should start to feel a bit better in a few hours. But it may take up to 2 weeks to feel the full effect.
Muscle spasms
You should begin to feel less pain after 15 minutes. But it may take longer to feel the full effect.
How and when to take it
Always take diazepam exactly as your GP tells you. Check with your GP or pharmacist if you are not sure.
Rectal tube
Diazepam rectal tubes can be used if you or your child is having a fit.
If the medicine is for you, ask your GP or pharmacist to show a family member or friend how and when to use it.
Tablets
Take diazepam tablets with water. You can take them with or without food.
If you forget to take it
If you take diazepam regularly, take the missed dose as soon as you remember. But if it's nearly time for the next one, skip this dose. Take your next one as normal.
Never take:
- 2 doses at the same time
- an extra dose to make up for a forgotten one
If you take too much
The amount of diazepam that is too much for someone varies from person to person. You may need to go to the emergency department (ED).
Emergency action required: Phone 112 or 999, or go to your nearest emergency department (ED) if:
- you've taken more than your prescribed dose of diazepam, even if you feel OK
It's especially important to get emergency help if you've taken more than your prescribed dose and you:
- are breathing very slow or shallow
- have poor coordination
- feel confused
- have slurred speech or trouble speaking
- feel sleepy
- have a slow or irregular heartbeat
- have uncontrolled eye movements
- feel your muscles are weak
- feel over excited
Do not drive yourself to the ED. Get someone else to drive or call for an ambulance.
Bring the diazepam packet or leaflet and any remaining medicine with you.
Side effects
Keep taking the medicine but talk to your GP if side effects get worse or do not go away after a few days.
Common side effects
There are things you can do to manage common side effects.
Feeling sleepy or drowsy
Do not drive, cycle or use tools or machinery until you feel better. Do not drink any alcohol. This side effect should get better as your body gets used to the medicine. If your symptoms do not improve after a week, speak to a doctor as you may need a lower dose.
Confusion
Keep taking the medicine and speak to your doctor.
Problems with coordination
Keep taking the medicine and speak to your doctor.
Shaky hands (tremors)
Keep taking the medicine and speak to your doctor.
Serious side effects
Serious side effects from taking diazepam are rare.
Urgent advice: Contact your GP straight away if you:
- have yellowing of your skin or the whites of your eyes
- find it difficult to remember things
- see or hear things that are not there (hallucinations)
- think things that are not true (delusions)
- keep falling over
- are talking more than usual or feeling overexcited, agitated, restless, irritable or aggressive - this is more common in children or if you're over 65
Serious allergic reaction
It's rare that diazepam causes a serious allergic reaction (anaphylaxis).
Emergency action required: Call 112 or 999 or go to an ED if:
- you get a rash that's itchy, red, swollen or blistered
- you're wheezing
- you get tightness in your chest or throat
- you have trouble breathing or talking
- your mouth, face, lips, tongue or throat start swelling
See the patient information leaflet that comes with your medicine for a full list of side effects.
Non-urgent advice: Find your patient information leaflet
Your patient information leaflet is the leaflet that comes with your medicine. You can find a digital version of the leaflet online.
Report side effects
You can report any suspected side effects to the Health Products Regulatory Authority (HPRA): report an issue - hpra.ie
Addiction
There is a risk you might become addicted to diazepam. But the risk is small if you take a low dose for 2 to 4 weeks.
Addiction is more likely if you have past or current problems with alcohol or drugs.
Long-term use
Usually, you should not take diazepam for longer than 4 weeks. Do not stop taking your medicine without talking to your GP.
Coming off diazepam
If you have been taking a high dose or have been taking diazepam for a long time, your GP may reduce your dose gradually.
If you suddenly stop taking it, you may get some side effects such as:
- confusion
- anxiety and depression
- panic attacks
- palpitations
- loss of appetite
- insomnia
- fits
- feeling nervous or irritable
- sweating
- diarrhoea
Food and drink
Avoid grapefruit juice as it may increase the amount of diazepam in your blood.
Also avoid caffeine drinks, such as tea, coffee, cola and energy drinks. Caffeine is a stimulant so it may reduce the calming effects of diazepam.
Driving and operating machinery
Do not drive a car, ride a bike or operate machinery if you're taking diazepam.
Diazepam may:
- make you sleepy
- give you blurred vision
- make it difficult to concentrate or make decisions
These effects may continue for several days even after you stop taking diazepam.
Taking diazepam with other medicines
Tell your GP or pharmacist that you are on diazepam before you take any new medicines.
Before you take diazepam for the first time, tell your GP or pharmacist if you:
- are taking any other medicines
- have recently taken any medicine
- might take any other medicines in the near future
This includes medicines you can get without a prescription.
Check with your GP if you're already taking:
- antipsychotics for mental health problems
- anticonvulsants or other medicines for epilepsy
- antidepressants
- oral contraceptives (the pill)
- corticosteroids
- levodopa - for Parkinson’s disease
- medicines for stomach problems
- hypnotics for anxiety or sleep problems
- antihistamines that make you sleepy such as chlorphenamine or promethazine
- strong painkillers such as codeine, methadone, morphine, oxycodone, pethidine or tramadol
- HIV medicines such as ritonavir, atazanavir, efavirenz or saquinavir
- antifungal medicines such as fluconazole
- muscle relaxants such as baclofen and tizanidine
- rifampicin for bacterial infections
- theophylline for asthma or other breathing problems
- isoniazid for tuberculosis (TB)
- disulfiram for alcohol addiction
Herbal remedies or supplements
Do not take herbal medicines for anxiety or insomnia, such as valerian or passionflower.
They can increase the drowsy effects of diazepam and may have other side effects.
Similar medicines
If diazepam does not work or gives you side effects, your GP may suggest you try different medicines for treating anxiety or fits.
For anxiety your GP may recommend a type of antidepressants called selective serotonin reuptake inhibitors (SSRI). For example, sertraline, paroxetine or escitalopram.
For fits, you may be prescribed midazolam. It comes as a pre-filled syringe and is given inside the mouth between the cheek and the gum.
You can use it instead of rectal diazepam.
Alcohol
Do not drink alcohol while you're on diazepam. You may go into a very deep sleep.
There's a risk you will not be able to breathe properly and may have difficulty waking up.
Recreational drugs
Using some recreational drugs with diazepam can increase diazepam's drowsy effect.
These include:
- cannabis
- heroin
- methadone
- cocaine
- simulants like MDMA (ecstacy) and amphetamines
There's a risk you:
- will not be able to breathe properly or you stop breathing
- go into a very deep sleep and have difficulty waking up
Talk to your GP about taking recreational drugs while taking diazepam.
Fact check
This content was fact checked by a pharmacist, a GP, and the National Medication Safety Programme (Safermeds).
