Diazepam (Valium, Diastat)

When is diazepam used ?

Most seizure medicines are given to prevent seizures from beginning. But some people with epilepsy experience intermittent periods of unusually increased seizure activity (often called clusters). Clusters may occur even when the person is being treated with doses of seizure medicines that are normally adequate. Because seizure clusters can be harmful, diazepam may be prescribed for people who have experienced such clusters. It is kept handy so that if another cluster begins, a caregiver can attempt to stop it by giving diazepam. The seizures thus can often be stopped more quickly than if the person had to wait for emergency personnel to arrive or had to be taken to the emergency room.

Usually, diazepam is administered by a caregiver as a rectal gel. Occasionally, for those patients with prolonged auras or periods between seizures in a cluster who can take a pill, oral valium might be used. However, the rectal route, while unappealing to many adults, allows the medication to be absorbed much more rapidly into the bloodstream, thus reaching the brain and targeting the seizure more quickly.

Another use of diazepam involves the prevention of seizures that may accompany a fever, called febrile seizures. Some people, particularly children, are prone to frequent and prolonged seizures whenever they have a relatively high fever. For these patients, the doctor may suggest keeping diazepam at home and using it whenever the patient’s temperature reaches a certain point to prevent these febrile seizures.

What are the most common side effects of diazepam ?

Side effects of diazepam are rarely a problem. As a benzodiazepine, diazepam has similar side effects to other benzodiazepines used in epilepsy including Clobazam, Clonazepam and Lorazepam. Benzodiazepines are tranquilizers (sedatives) that prevent or stop seizures by slowing down the central nervous system, making abnormal electrical activity less likely. As a result, common symptoms include:

  • Fatigue and sleepiness
  • dizziness
  • unsteadiness or poor coordination
  • slowed speech
  • impaired attention and memory
  • irritability
  • hyperactivity (in children)
  • drooling (in children)
  • depression (usually in adults)
  • nausea and/or diarrhea
  • loss of appetite

Sleepiness and other common side effects above are more likely to be a problem if the patient is using other substances or medications with a similar effect, such as alcohol, phenobarbital, other benzodiazepines, or some painkillers and antidepressants. These effects may also be increased in patients who take Depakote or Depakene. However, since diazepam is usually used in the setting of acute seizures, sleepiness, slowed speech and other side effects are likely at least partly due to effects of the seizures themselves. Depending on how severe these symptoms are, they should be reported to the doctor as perhaps the dose of diazepam in seizure emergencies should be adjusted.

What are the most serious side effects of diazepam ?

Serious side effects are rare in people taking diazepam. However, people given diazepam intravenously (by injection) in the emergency department or hospital may occasionally need help with breathing, especially if they have a condition such as asthma or pneumonia or if they have used another medication such as phenobarbital. This kind of problem is extremely rare when rectal diazepam is used, though the risk increases with multiple and higher doses. Nevertheless, caregivers should be alert for signs of problems with breathing after administering diazepam (including a marked decrease in the rate of breathing or a change in the color of the skin) and should summon help if necessary. If the seizure has stopped but no breathing can be seen for more than 8 to 10 seconds, call emergency medical personnel or 911.

An important concern when people with epilepsy take benzodiazepines regularly is the risk that seizures will become more frequent or more severe if the medicine is reduced or stopped. Tolerance, the need for higher doses to achieve the same effect, is also a common problem. But since diazepam is not used regularly, issues of withdrawal and tolerance are much less likely to arise than with medications that are used every day.

It is not unusual for many people with epilepsy to feel sleepy, dizzy, or uncoordinated for a time after diazepam has been used. They should avoid doing things that could be dangerous, like riding a bicycle.

Who should not take diazepam ?

Diazepam should not be given to people who have an eye condition called acute narrow angle glaucoma. People with open angle glaucoma may use it. If you have glaucoma, confirm the type with your eye doctor.

Extra caution is needed when considering the use of diazepam for seniors or those with liver or kidney disease. These people require longer to clear the medication from the body, so if diazepam is given to them too often, the level can become high and cause unwanted effects like drowsiness, unsteadiness, or breathing problems.