Diazepam (Valium®)

This article provides a comprehensive review of diazepam, including its indications, benefits, side effects, and interactions. It also covers important information regarding misuse, dependence, addiction, and withdrawal.

Key Takeaways:

• Diazepam is a common benzodiazepine medication used for anxiety disorders, seizures, alcohol withdrawal, and other conditions. It works by increasing GABA, which relaxes the brain and nervous system.
• Diazepam works rapidly, but its effects may diminish over time in some cases. Long-term use increases the risk of dependence and addiction, especially if it is misused.
• There are many possible side effects and interactions with diazepam, some of which may be severe or life-threatening. Careful consideration is essential to make sure diazepam is used safely, while minimizing risk as much as possible.

Understanding Diazepam

Diazepam is a prescription benzodiazepine medication. It first appeared for use in the United States in 1963.

Like other benzodiazepines, diazepam acts as a central nervous system (CNS) depressant, which slows down CNS activity and promotes system-wide calming and relaxing effects. It is often used for anxiety disorders, seizures, and alcohol withdrawal, among other conditions. It is a fast-acting, long-acting benzodiazepine with peak effects after 1 to 1.5 hours, and an average half-life of around 48 hours. ^[1]

How it Works

Diazepam increases the effects of GABA in the CNS by binding to GABA receptors, which in turn helps calm down the brain and nervous system. As a result, diazepam promotes mental calmness, anxiety reduction, and muscular relaxation. ^[1]

Brand Names

The most common brand name of diazepam is Valium®. Other brand names for diazepam are: ^[2]

• Valtoco®
• Diastat®
• Diazepam Intensol®
• Diastat AcuDial®
• Libervant®
• Diastat Pediatric®

Conditions Diazepam is Used to Treat

Diazepam is approved to treat several conditions, including: ^{[1] [3]}

• Management of anxiety disorders
• Short-term relief of anxiety symptoms
• Preoperative anxiety
• Alcohol withdrawal syndrome (AWS) (symptom relief)
• Spasticity caused by:
• Upper motor neuron disorders (e.g. cerebral palsy and paraplegia)
• Athetosis
• Stiff-man syndrome
• Inflammation of muscles or joints
• Trauma
• Management of refractory epilepsy

In situations of anxiety, diazepam may help relieve a variety of symptoms, such as tension, fear, agitation, excessive worry, trouble sleeping, and excitation. It may also help control aggression in certain anxiety-related states, as well as anxiety caused by highly stressful situations. It is not typically used for regular, “every-day” anxiety, but instead, anxiety that is severe and disruptive to daily functioning and well-being. ^{[3] [4]}

Within AWS, diazepam may help control several symptoms, including acute agitation, tremor, confusion, and hallucinations. ^[3]

Other diazepam uses include as an adjunct therapy for: ^[1]

• Muscle spasm
• Severe, recurrent seizures

Off-Label Uses

Diazepam is sometimes used off-label for several conditions and symptoms, such as: ^[1]

• Sedation within the ICU
• Insomnia (shorter acting benzodiazepines preferred)
• Short-term spasticity for children with cerebral palsy

How Commonly Prescribed Is It?

Diazepam is one of the most commonly prescribed benzodiazepines, and one of the most commonly prescribed medications in general, although rates have fallen over the last few decades. The most recent estimates from 2023 show that there are nearly 1 million people prescribed diazepam in the United States alone, with just under 3 million total prescriptions in that same year. ^[5]

Diazepam Side Effects

There are many possible side effects of diazepam. The most commonly reported side effects of diazepam are: ^{[1] [3]}

• Drowsiness
• Sedation
• Fatigue
• Muscle weakness
• Ataxia: This is poor muscle control that causes clumsy movements, such as:
• Difficulty with walking and balance
• Problems with speech and swallowing
• Involuntary eye movements

Other relatively common side effects of diazepam include: ^{[1] [2] [3] [6]}

• Dizziness
• Lightheadedness
• Confusion
• Depression
• Irritability
• Disinhibition
• May also cause inappropriate behaviors
• Tremor
• Urinary retention
• Incontinence
• Nausea
• Constipation
• Changes in libido
• Dystonia: Involuntary muscle contractions that cause twisting or repetitive movements
• Double vision
• Rash
• Menstrual irregularities
• Dry mouth
• Hypersalivation

This list may not contain all possible side effects. Contact your doctor as soon as possible if you notice these or any other side effects after taking diazepam.

Dangerous and Rare Side Effects

There are also several rarer diazepam side effects, some of which may be dangerous or potentially life-threatening. This includes: ^{[1] [3] [6]}

• Respiratory depression: This involves slowed or shallow breathing. If severe, it can potentially be fatal.
• Cardiovascular collapse: This involves sudden dysfunction in the cardiovascular system, leading to lack of blood flow to vital organs. It can be life-threatening.
• Bradycardia (low heart rate)
• Hypotension (low blood pressure)
• Syncope (fainting)
• Suicidality: Diazepam may increase the risk of suicidal thoughts or behaviors, especially in individuals with a history of severe depression.
• Memory impairment

In addition, diazepam less frequently causes paradoxical reactions, which may involve any of the following symptoms: ^{[1] [3]}

• Restlessness
• Hyperexcitability
• Stimulation
• Increased muscles spasms
• Hallucinations
• Delusions
• Insomnia and sleep disturbances
• Nightmares
• Anxiety
• Aggression, irritability, agitation, and/or rage

Some people also report complex sleep behaviors when using diazepam, such as driving, eating, having sex, or talking on the phone while asleep. They often have no recollection of these events after waking up. ^[6]

All of these side effects should be reported to your doctor immediately if they occur.

Misuse, Dependence, and Addiction

Diazepam is listed as a Schedule IV controlled substance by the Drug Enforcement Agency DEA’s Controlled Substances Act. This is due to its potential for abuse, dependence, and addiction. ^[3]

Physical and/or psychological dependence can develop, even when diazepam is taken as prescribed. Diazepam is most likely to cause dependence and tolerance when it is taken for a long period of time and/or with high doses. ^{[1] [3] [6]}

There is also a risk of addiction with diazepam, which is mainly due to the calming and relaxing effects that can be very pleasurable and reinforcing. The risk of addiction is increased in individuals who misuse diazepam, such as taking a higher dose than prescribed or combining it with other medications. ^[3]

Physical and psychological dependence are not the same as addiction. It’s important to speak to your healthcare if you are concerned about the possible development of these effects.

Precautions

There are several precautions to consider with the use of diazepam. This includes specific precautions for the following populations: ^[1]

• Pregnant women: Use is generally not recommended unless the benefits clearly outweigh the risks. Diazepam during pregnancy may increase the risk of birth defects and pregnancy complications.
• Breastfeeding women: Use is not recommended
• Elderly adults: Use with caution. A lower dose is typically required
• Individuals with the following conditions:
• Psychosis: Avoid using
• History of severe depression: Use only very cautiously, if at all. Increased risk of suicidality
• Chronic respiratory depression: A lower dose should be used
• History of alcohol or drug abuse: Extreme caution when using, if used at all
• Renal (kidney) and hepatic (liver) impairment: The lowest effective dose should be used

Diazepam is contraindicated for individuals with: ^{[1] [3]}

• Hypersensitivity to diazepam
• Severe respiratory insufficiency
• Myasthenia gravis
• Sleep apnea
• Severe hepatic insufficiency
• Acute narrow-angle glaucoma

Considerations and Risks

Diazepam can cause drowsiness and sedation, which may make it unsafe to drive, operate machinery, or perform complex tasks. These risks may be greater in older adults due to decreased drug clearance ability. Do not use diazepam in these situations until you know how it affects you and you receive your doctor’s approval to do so. ^[3]

Diazepam is more likely to cause dependence when it is used for a longer period of time and at higher doses. It is essential to find the lowest possible dose of diazepam and only use it as long as is truly necessary.

Taking more diazepam than prescribed can lead to overdose, which can be life-threatening. This risk is increased when combined with opioids, alcohol, or other drugs. Overdosing on diazepam requires immediate medical attention. ^{[1] [3]}

Drug Interactions

There is a significant risk when diazepam is combined with opioid medications, such as codeine, hydrocodone, and fentanyl. Taking diazepam with opioids increases the risk of: ^{[1] [3]}

• Profound sedation
• Severe respiratory depression
• Coma
• Death

Beyond opioids, diazepam interacts with many other drugs and medications, including: ^{[1] [3] [6]}

• Phenothiazines and other antipsychotics (e.g. chlorpromazine, thioridazine)
• Other benzodiazepines (e.g. alprazolam, clonazepam)
• Sedatives and sleep medications (e.g. zolpidem, eszopiclone)
• Anticonvulsants (e.g. carbamazepine, topiramate)
• Sedative antihistamines (e.g. diphenhydramine)
• Barbiturates (e.g. phenobarbital, amobarbital)
• Monoamine oxidase inhibitors (MAOIs) (e.g. phenelzine, selegiline)
• Selective-serotonin reuptake inhibitors (SSRIs) (e.g. fluoxetine, fluvoxamine)
• Tricyclic antidepressants (e.g. amitriptyline, imipramine)
• Certain antifungals (e.g. ketoconazole, itraconazole)
• Certain antibiotics (e.g. clarithromycin, erythromycin)
• Certain antivirals (e.g. ritonavir, atazanavir)

This list does not provide all possible drug interactions. Always tell your doctor all medications you currently take or have taken in the past.

Other Interactions

Diazepam interacts strongly with alcohol. Taking alcohol with diazepam increases the risk of respiratory depression and sedation, and can cause coma or death in severe instances. ^{[1] [3]}

Diazepam may also interact with: ^[7]

• Cannabis/THC
• Certain herbal supplements for anxiety and/or sleep:
• Valerian
• Passionflower
• Lemon balm
• Kava
• St. John’s wort
• Grapefruit and grapefruit juice

In addition to prescription medications, tell your doctor everything else you take, including vitamins, herbal supplements, and over-the-counter medicines.

Diazepam Dosage

There are several forms of diazepam, including oral tablets, intramuscular injections (IM), intravenous injections (IV), and rectal gel. The oral tablets provide the most reliable absorption and controlled release, and are the most common form. ^[1]

The oral tablets are available in the following strengths: ^[2]

• 2 mg
• 5 mg
• 10 mg

Listed below are common doses for various indications: ^[1]

• Anxiety: Total dose of 2 to 10 mg per day as oral tablets, divided into 2 to 4 doses.
• Alcohol withdrawal: Initial dose of 10 mg as IM or IV
• Alternatively, an oral dose of 10 mg every 6 to 8 hours within the first 24 hours, then 5 mg every 6 to 8 hours as needed thereafter
• Muscle spasms: 2 to 10 mg per day as oral tablets, divided into 2 to 4 doses
• Alternatively, 5 to 10 mg is administered parenterally, followed by another dose 3 to 4 hours later
• Preoperative anxiety: 10 mg IM before surgery
• Seizures: 2 to 10 mg per day as oral tablets, divided into 2 to 4 doses
• May also be administered rectally in some cases at 0.2 mg/kg
• Muscle relaxant: 2 to 10 mg per day as oral tablets, divided into 3 to 4 doses

Diazepam Cessation and Withdrawal

Cessation of diazepam requires medical supervision, in which your doctor will create a tapering schedule that gradually lowers the dose of diazepam over time. Suddenly stopping diazepam may lead to uncomfortable and potentially dangerous withdrawal symptoms, especially if you’ve been taking diazepam long-term. ^{[2] [3]}

Withdrawal symptoms can happen any time the dose of diazepam is lowered, even when under medical supervision. You may experience the following symptoms: ^{[1] [3] [6] [8]}

• Muscle cramps
• Vomiting
• Sweating
• Shaking
• Tremor
• Extreme anxiety
• Insomnia
• Rapid heart rate
• Elevated blood pressure
• Tension
• Restlessness
• Confusion
• Irritability

Severe withdrawal symptoms may also include: ^{[1] [3]}

• Depersonalization and derealization
• Hypersensitivity to light, noise, and touch
• Hallucinations
• Epileptic seizures
• Numbness and tingling of extremities
• Hyperacusis (hearing sensitivity in which sounds are perceived as uncomfortably or unbearably loud)

Diazepam and Integrated Therapy

Diazepam is often integrated with other therapies to form a more comprehensive treatment plan, especially in cases of anxiety, addiction, and other mental health-related conditions. Common therapies integrated with diazepam include psychotherapy and medication.

Psychotherapy holds significant value because it helps individuals adopt healthier thoughts, emotions, and behaviors, as well as specific skills, such as stress management and emotional regulation. This can lead to a reduction in anxiety and distress, while improving life quality and ability to function. Furthermore, psychotherapy provides long-lasting effects and is much safer overall, which makes it a good long-term option in situations of persistent anxiety and mental health concerns.

Diazepam may also be used in combination with other medications, particularly SSRIs. SSRIs are generally considered safer for long-term use, although they generally take a few weeks to work. Thus, when both medications are integrated, diazepam can help provide immediate symptom reduction, and it is then gradually tapered off while the SSRIs begin to take effect. ^[9]

Diazepam FAQs

Listed below are commonly asked questions about the use of diazepam.

Can diazepam be dangerous?

Yes, diazepam can be dangerous, especially when it is taken at a higher dose than prescribed or when combined with alcohol, opioids, or other drugs. There are many possible side effects and interactions, some of which are potentially life-threatening.

Is diazepam a controlled substance?

Yes, diazepam is listed as a Schedule IV controlled substance under the DEA’s Controlled Substances Act.

Can you take diazepam for sleep?

Diazepam may be prescribed off-label for sleep, although it is not first-line for this. It also helps with anxiety, which could help with sleep as well. Do not take diazepam for sleep unless you’re specifically instructed to do so.

How long does diazepam last?

When taken orally, diazepam starts to exert its effects after 15 to 60 minutes, and you may feel the effects for up to 12 hours.

Author

Jack Cincotta

Jack Cincotta holds a M.S. degree in Psychology. He is also a board-certified holistic health practitioner through AADP and an AFPA-certified holistic health coach and nutritionist.

Activity History - Last updated: March 19, 2026, Published date: March 19, 2026

---

Reviewer

David MilesPharmD

David is a seasoned Pharmacist, natural medicines expert, medical reviewer, and pastor.

Activity History - Medically reviewed on March 27, 2026 and last checked on March 19, 2026