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Effects vary widely by individual, dose, and context.
The physical effects of diazepam can be broken down into several components which progressively intensify proportional to dosage.
The cognitive effects of diazepam can be broken down into several components which progressively intensify proportional to dosage. The general head space of diazepam is described by many as one of intense sedation and decreased inhibition. It contains a large number of typical depressant cognitive effects. Paradoxical reactions to benzodiazepines such as increased seizures (in epileptics), aggression, increased anxiety, violent behavior, loss of impulse control, irritability and suicidal behavior sometimes occur (although they are rare in the general population, with an incidence rate below 1%). These paradoxical effects occur with greater frequency in recreational abusers, individuals with mental disorders, children, and patients on high-dosage regimes.
These combinations are considered extremely harmful and should always be avoided. Reactions to these drugs taken in combination are highly unpredictable and have a potential to cause death.
There is considerable risk of physical harm when taking these combinations, they should be avoided where possible.
These combinations are not usually physically harmful, but may produce undesirable effects, such as physical discomfort or overstimulation. Extreme use may cause physical health issues. Synergistic effects may be unpredictable. Care should be taken when choosing to use this combination.
Diazepam has a high risk of misuse and psychological dependence. The FDA requires boxed warnings describing risks of abuse, misuse, and addiction. Recreational users, particularly those using stimulants, may escalate dosage from 2 to 25 times the therapeutic dose. Between 50 and 64% of rats will self-administer diazepam in experimental settings.
Physical dependence develops readily with regular use, with approximately one-third of individuals who take benzodiazepines for longer than four weeks becoming dependent. Withdrawal can be life-threatening, particularly after extended use at high doses, and may include seizures, psychosis, tremors, sweating, nausea, and hallucinations. Gradual dose reduction under medical supervision is essential; abrupt discontinuation is dangerous.
Diazepam is relatively safe in overdose when taken alone, though high doses cause coma and respiratory depression requiring medical intervention. Two documented patients survived 500mg and 2000mg overdoses respectively with only moderately-deep comas, discharged within 48 hours without major complications. However, overdoses combined with alcohol, opioids, or other CNS depressants may be fatal.
| Species | Route | Value |
|---|---|---|
| mouse | oral | 720 mg/kg |
| rat | oral | 1240 mg/kg |
Chronic use may cause cognitive impairment including memory deficits that can persist for six months or longer after discontinuation; it remains unclear whether these effects are permanent in some individuals.
Respiratory depression can occur at high doses or in overdose, and is more serious in patients with sleep apnea or chronic obstructive airway disease; severe cases may progress to respiratory arrest.
Psychosis is a rare but documented withdrawal symptom following cessation of chronic use. Hallucinations and severe psychiatric symptoms may occur during withdrawal. Paradoxical reactions including excitement, agitation, rage, and in extreme cases suicidal tendencies have been reported during use, more commonly in children, the elderly, and those with substance use history.
Seizures are a serious risk during withdrawal from chronic use and can be life-threatening if discontinuation is too rapid. Paradoxically, frequent use in those with epilepsy may increase seizure risk. Withdrawal-related seizures necessitate medically supervised gradual dose tapering.
Diazepam was the second benzodiazepine developed by chemist Leo Sternbach at Hoffmann-La Roche's facility in Nutley, New Jersey, following his earlier creation of chlordiazepoxide (marketed as Librium), which had received approval for medical use in 1960. Sternbach patented diazepam in 1959, and it…
Approved prescription medication with various formulations marketed including oral tablets in multiple strengths and rectal gel preparations.
Available exclusively through medical prescription. First launched in 1963 and has been one of the most widely prescribed medicines. Since its patent expired in 1985, it has been marketed under numerous brand names.
Available as a prescription medication. Marketed both as a standalone product and in combination formulations with other active ingredients such as metamizole sodium.
Classified as both 'Approved' and 'Illicit' indicating legitimate medical use alongside controlled substance status. Multiple prescription formulations are marketed including oral tablets, rectal gels (Diastat), and injectable solutions for intramuscular and intravenous administration.
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