Diazepam

How it works

It potentiates the inhibitory neurotransmitter GABA at the GABA-A receptor, increasing the frequency of chloride channel opening to produce anxiolytic, sedative, anticonvulsant and muscle-relaxant effects.

Prescribing in practice

• Risk of dependence, tolerance and withdrawal restricts use to the shortest possible duration; avoid abrupt cessation and taper gradually.
• Combination with opioids or other CNS depressants markedly increases the risk of profound sedation, respiratory depression and death.
• Use cautiously in the elderly, in respiratory impairment and in hepatic impairment, where the prolonged half-life increases accumulation.

Monitoring

Monitor for excessive sedation, signs of dependence and respiratory depression, particularly in the elderly and those on other CNS depressants.

Counselling the patient

• May impair driving and skilled tasks, especially when combined with alcohol.
• Do not stop suddenly after regular use as withdrawal symptoms can occur.
• Avoid alcohol and other sedating medicines while taking this drug.

Evidence & guidelines

Benzodiazepine use is well established, and NICE guidance recommends restricting it to short-term use because of dependence risk.