Valium 

Valium

You can take Valium by mouth in the form of tablets with 2, 5, or 10 mg of diazepam. In addition to the active ingredient diazepam, each tablet has the following inactive ingredients: anhydrous lactose, corn starch, pregelatinized starch, calcium stearate, and the following dyes: 5-mg tablets have FD&C Yellow No. 6 and D&C Yellow No. 10; 10-mg tablets have FD&C Blue No. 1. Valium 2-mg tablets

Precautions

 In general, if Valium is to be taken with other mind-altering drugs or seizure medicines, drugs, the pharmacology of the drugs to be used should be carefully thought out. This is especially true for phenothiazines, narcotics, barbiturates, MAO inhibitors, and other antidepressants, which are known to make diazepam work better.

Patients who are severely depressed or who show signs of latent depression or anxiety that goes along with depression should take the usual precautions. They should also be aware that suicidal thoughts may be present and that they may need to be protected.

Psychiatric and strange things have been known to happen when people take benzodiazepines. Should this happen, you should stop taking the drug. Children and old people are more likely to have these reactions. Due to the risk of slowed breathing, people with chronic respiratory insufficiency should take a lower dose.

If a person has a history of abusing alcohol or drugs, they should be very careful when taking benzodiazepines. In patients who are weak, the dose should be kept to the smallest amount that works to prevent ataxia or too much sedation (2 mg to 2.5 mg once or twice a day at first, then gradually increased as needed and tolerated).

After taking Valium for a long time, your body may stop responding as well to the effects of benzodiazepines.

What Patients Need to Know

To make sure that benzodiazepines are used safely and effectively, patients should be told that they can cause both mental and physical dependence, so they should talk to their doctor before increasing the dose or stopping the drug all of a sudden. The risk of becoming dependent on a drug or alcohol goes up as the length of treatment goes on. The risk is also higher for people who have used drugs or alcohol in the past.

Patients taking Valium shouldn't drink alcohol or take other drugs that slow down the central nervous system (CNS) at the same time. As with most drugs that affect the central nervous system (CNS), people who take Valium shouldn't do dangerous jobs that require full mental alertness, like operating heavy machinery or driving a car.

How Drugs Interact

When both benzodiazepines and opioids are used at the same time, the risk of respiratory depression goes up because the two drugs act on different sites in the CNS that control breathing. The GABAA sites are where benzodiazepines interact, while mu receptors are where opioids interact most. When benzodiazepines and opioids are taken together, the benzodiazepines could make the opioid-caused depression of breathing even worse. Limit the amount and length of time you take benzodiazepines and opioids together, and keep a close eye on your patients to make sure they don't fall asleep or have trouble breathing.

If Valium is to be taken with other drugs that affect the central nervous system, the pharmacology of both drugs should be carefully considered. This is especially true for drugs like phenothiazines, antipsychotics, anxiolytics/sedatives, hypnotics, anticonvulsants, narcotic analgesics, anesthetics, sedative antihistamines, narcotics, barbiturates, MAO inhibitors.

Because it makes you sleepy, you shouldn't use it at the same time as alcohol.

When antacids are given at the same time as diazepam, the peak levels of diazepam are 30% lower. However, there is no change in how much is absorbed. The slower rate of absorption seems to be the cause of the lower peak concentrations. On average, it takes 20 to 25 minutes longer to reach peak concentrations when antacids are taken at the same time. But this difference did not show up in the statistics.

Compounds That Stop Some Liver Enzymes From Working

There is a possible interaction between diazepam and chemicals that stop certain enzymes in the liver from working, especially cytochrome P450 3A and 2C19. Data show that these compounds change the way diazepam works in the body, which could lead to a deeper and longer sleep. At the moment, we know that cimetidine, ketoconazole, fluvoxamine, fluoxetine, and omeprazole can cause this reaction.

There have also been reports that diazepam makes it harder for the body to get rid of phenytoin. Cancer, birth defects, and infertility can all be caused by chemicals. In studies where diazepam was given in the diet to mice and rats at a dose of 75 mg/kg/day (about 6 and 12 times the maximum recommended human dose [MRHD=1 mg/kg/day] on a mg/m2 basis, respectively), liver tumors were more common in males of both species after 80 and 104 weeks. The information we have now is not enough to know if diazepam can cause mutations. In studies with rats, giving them an oral dose of 100 mg/kg/day (about 16 times the MRHD on a mg/m2 basis) before mating, during pregnancy, and while they were nursing decreased the number of pregnancies and the number of babies that lived. At a dose of 80 mg/kg/day, which is about 13 times the MRHD based on mg/m2, there were no negative effects on fertility or the viability of the offspring.

Pregnancy Category D 

Safety and effectiveness have not been tested on children younger than 6 months.

It is recommended that the dose be limited to the smallest amount that works to prevent ataxia or oversedation in older patients (2 mg to 2.5 mg once or twice a day at first, and then slowly increased as needed and tolerated). In healthy older men who took diazepam for a long time, the drug and its main byproduct, desmethyldiazepam, built up in their bodies in large amounts. The kidneys get rid of a lot of this drug's metabolites, and people with poor kidney function may be more likely to have dangerous side effects. Because older people are more likely to have less kidney function, care should be taken when choosing doses, and it may be helpful to keep an eye on renal function.

Patients with cirrhosis have been shown to have less clearance and protein binding and more volume of distribution and half-life. In these people, the average half-life has been found to be 2 to 5 times longer. The active metabolite desmethyldiazepam has also been said to leave the body slowly. Hepatic encephalopathy is often linked to benzodiazepines. People with hepatic fibrosis and both acute and chronic hepatitis have been found to have longer half-lives (see CLINICAL 

Pharmacology

Most of the time, people felt sleepy, tired, had weak muscles, or had trouble walking. There have also been reports of the following:

Central Nervous System: confusion, depression, slurred speech, headache, tremor, and vertigo, constipation, nausea, and other problems with the digestive system.

Special Senses: blurred vision, diplopia, dizziness

Heart and blood vessels: low blood pressure

Strange and psychiatric Reactions include stimulation, restlessness, acute hyperexcited states, anxiety, agitation, aggression, irritability, rage, hallucinations, psychoses, delusions, increased muscle spasticity, insomnia, sleep disturbances, and nightmares. Benzodiazepines have been linked to inappropriate behavior and other bad effects on behavior. If these things happen, you should stop taking the drug. Children and old people are more likely to get them.

Urogenital System: leaking urine, changes in libido, and holding urine in

Skin and Limbs: how the skin reacts transaminases and alkaline phosphatase were high in the labs. Changes in salivation, such as dry mouth or too much salivation may occur. Therapeutic doses can cause antegrade amnesia, and the risk goes up with higher doses. When someone has amnesia, they might act in a bad way.

During and after Valium treatment, small changes in EEG patterns, usually fast low-voltage activity, have been seen, but no one knows what they mean. Because of a small number of reports of neutropenia and jaundice, long-term therapy should include regular blood counts and liver function tests.

Post-Marketing Experience: Injuries, Poisons, and Complications from Procedures: People who take benzodiazepines have been said to fall and break bones. The risk is higher for older people and people who take sedatives (like alcohol) at the same time.

Drug Abuse And Dependence

Under the Controlled Substances Act of 1970, diazepam is on Schedule IV, which means it is subject to strict rules. People have been known to abuse and become dependent on benzodiazepines.

People who are prone to addiction, like drug addicts or alcoholics, should be closely watched when they take diazepam or other psychotropic drugs. This is because these people are more likely to get used to them and become dependent on them. Once your body has become physically dependent on benzodiazepines, you will have withdrawal symptoms when you stop taking them. The risk is bigger for people who are on therapy for a long time.

When diazepam is stopped suddenly, it can cause withdrawal symptoms that are similar to those caused by alcohol and barbiturates.

Some of these withdrawal symptoms include tremors, stomach and muscle cramps, vomiting, sweating, headaches, muscle pain, extreme anxiety, tension, restlessness, confusion, and irritability. In severe cases, these symptoms may happen: derealization, depersonalization, hyperacusis, numbness and tingling in the extremities, hypersensitivity to light, noise, and physical contact, hallucinations, or epileptic seizures. Patients who had taken too much of the drug for a long time and in too high of doses usually only had the worst withdrawal symptoms. When benzodiazepines have been taken continuously at therapeutic levels for several months, abruptly stopping them can cause milder withdrawal symptoms, such as sadness and trouble sleeping. So, abruptly stopping treatment after a long time should usually be avoided, and a schedule for gradually lowering the dose should be followed.

Even at therapeutic doses, long-term use can lead to physical dependence. If you stop the therapy, you may experience withdrawal or rebound effects.