Valium is a benzodiazepine with properties of being a sedative, hypnotic, anxiolytic, anticonvulsant, amnestic and muscle relaxant drug. Valium is generally used to treat short term moderate to severe anxiety or insomnia. The drug has been shown to lead to the development of tolerance, physiological and psychological dependency when used for long periods.
Uses of Valium
- Acute agitation
- Acute delirium tremens
Valium is a useful for the relief of muscle spasms, spasticity caused by neurological disorders (e.g. cerebral palsy and paraplegia), stiff-man syndrome; and tetanus.
Valium is very useful in the treatment of status epilepticus and recalcitrant recurrent convulsive seizures.
Valium is a useful premedication for relief of anxiety and apprehension in patients who are to undergo surgical procedures. Intravenous administration takes effect within a few seconds to relieve the anxiety.
Side Effects of Valium Include:
- CNS: lethargy, fatigue, difficulty walking, mental confusion, depression, difficulty with speech, headache, dizziness, tremor and sleepiness
- GI: constipation, nausea, vomiting
- GU: loss of bladder control, impotence, failure to maintain erection
- Heart: slow heart rate, low blood pressure and shock.
- HEENT: altered vision, double vision,
- Skin: skin rash, urticaria.
- Other: hiccups, mouth dryness, liver problems
Sometimes an inpidual will develop paradoxical reactions to valium which may include:
- Increased muscle spasticity
All inpiduals who take long term valium should have their liver function regularly monitored.
Valium Abuse Potential
Although valium is invaluable in the treatment of anxiety disorders, it has the potential for abuse and may cause dependence or addiction. It is important to distinguish between addiction and normal physical dependence. A number of valium abusers also abuse other illicit drugs. Valium is usually a secondary drug of abuse and used mainly to potentiate the “high” obtained from other drugs. However, even legitimate and therapeutic usage of valium is associated with an inherent risk of addiction and physical or psychological dependence.
Withdrawal symptoms of valium include:
- Abdominal and muscle cramps
The symptoms typically occur after sudden discontinuance of diazepam. The more severe withdrawal symptoms have usually been limited to those patients who had received excessive doses over an extended period of time. Generally milder withdrawal symptoms (e.g., dysphoria and insomnia) have been reported following abrupt discontinuance of valium taken continuously for several months.
Therefore, after prolonged therapy with valium, abrupt discontinuation should generally be avoided and a gradual dosage tapering schedule followed. Addiction-prone inpiduals (such as drug addicts or alcoholics) should be under careful surveillance when receiving diazepam or other psychotropic agents because of the predisposition of such patients to habituation and dependence.
Valium should be injected with a great deal of caution in the elderly and in those with difficulty breathing. Concomitant use of valium with alcohol, other CNS depressants and barbiturates can cause respiratory arrest.
When Valium is used in combination with any narcotic, the dosage of both valium and the narcotic should be started at the lowest dose and slowly titrated based on symptoms. In some cases the use of a narcotic may be curtailed. Resuscitative equipment including that necessary to support respiration should be readily available.
Valium users should be cautioned against engaging in hazardous occupations requiring complete mental alertness, such as operating machinery or driving a motor vehicle. The impairment is worsened by consumption of alcohol, because both act as central nervous system depressants. The effects of long-acting benzodiazepines can also linger over to the following day.
Tolerance progresses too many of the therapeutic effects of valium rapidly with daily or frequent use. Generally, tolerance to the hypnotic and sedative effects occurs within days, however, tolerance to the anxiolytic effects of valium rarely, if ever, occurs.
Long-term valium usage generally leads to some form of tolerance or dependence. It is estimated that up to 50 percent of patients prescribed diazepam for six months at therapeutic dosages are physically dependent. Withdrawal symptoms due to abrupt discontinuation may include:
- Panic attacks
- Fast heart rate/palpitations
- Tremors or hyperactivity
- Loss of appetite
- Agitation and mental clouding
Therefore, any inpidual on long-term or high dosage of valium should be slowly and carefully weaned off the drug, preferably under medical supervision by a physician who is a specialist in addiction medicine. Withdrawal symptoms can usually be avoided or minimized by use of a long half-life benzodiazepine and very gradually tapering off the drug over a period of many weeks or even months.
Onset of the withdrawal syndrome from long half-life benzodiazepines might be delayed, although withdrawal from short-acting benzodiazepines often presents early. Some of the withdrawal symptoms are identical to the symptoms for which the medication was originally prescribed. The ability to determine the difference between relapse and rebound is very important during the withdrawal phase.
Over dosage of valium, particularly when combined with alcohol, may lead to coma, or respiratory arrest. The antidote for all benzodiazepines is flumazenil, a benzodiazepine antagonist, which is occasionally used empirically in patients presenting with unexplained loss of consciousness in an emergency room setting. As with all overdose situations the physician must be aware of the possibility that multiple substances were ingested by the patient.
Nearly all medically used benzodiazepines are Schedule IV in the USA under the Federal Controlled Substances Act. Even though valium is a commonly prescribed class of drugs, the Medicare Prescription Drug, Improvement, and Modernization Act specifically states that insurance companies that provide Medicare Part D plans are not allowed to cover benzodiazepines.
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