diazepam

Adjunctive therapy

Brands: VALIUM

Last reviewed 2025-12-28

Reviewed by PsychMed Editorial Team.

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Quick answers

What is diazepam?
Diazepam (brand Valium) is a long-acting benzodiazepine used for anxiety, alcohol withdrawal, muscle spasm, and seizure-related indications (label varies by product). In psychiatric practice it may be used as a short-term bridge for severe anxiety or agitation when rapid relief is required.
What is VALIUM?
VALIUM is a brand name for diazepam.
What is VALIUM (diazepam) used for?
Label indications include: Anxiety disorders (label); also used for alcohol withdrawal, muscle spasm, and seizures (label varies by product).
What drug class is VALIUM (diazepam)?
Benzodiazepine; positive allosteric modulator of GABA-A receptors.
What strengths does VALIUM (diazepam) come in?
Tablets: commonly 2 mg, 5 mg, 10 mg.

Snapshot

Class: Adjunctive therapy
Common US brands: VALIUM
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2025-12-28

Label indications

Anxiety disorders (label); also used for alcohol withdrawal, muscle spasm, and seizures (label varies by product).

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Clinical Highlights

Diazepam (brand Valium) is a long-acting benzodiazepine used for anxiety, alcohol withdrawal, muscle spasm, and seizure-related indications (label varies by product). In psychiatric practice it may be used as a short-term bridge for severe anxiety or agitation when rapid relief is required. Long half-life and active metabolites can provide smoother coverage but also increase accumulation, next-day impairment, and fall risk—key concerns in older adults and in serious mental illness with polypharmacy.

Because of its long duration, diazepam is sometimes used as part of a structured taper strategy from shorter-acting benzodiazepines; however, it still carries substantial misuse and overdose risk and is typically paired with clear monitoring and stop plans.
Dependence, tolerance, and withdrawal risks often require clear goals, limited duration, and taper plans from the outset.
Generally avoided or used with extreme caution in older adults, significant liver disease, untreated sleep apnea/COPD, and with concurrent opioids or alcohol; the safety risks of carryover sedation and falls can outweigh any benefit.
The compare view, diazepam evidence feed, and diazepam print page can help contextualize alternatives and support safe-use counseling.
Product labels include anxiety disorders and may also include alcohol withdrawal, muscle spasm, and seizure-related indications; the indication is ideally matched to the clinical setting and monitoring capacity.
Generic tablets are widely available and inexpensive, which makes explicit guardrails (quantity limits, follow-up cadence, taper plans) especially important.

Dosing & Formulations

Tablets: commonly 2 mg, 5 mg, 10 mg. Anxiety (label ranges vary): the lowest effective dose is typically used in divided doses; dose escalation is generally avoided without a clear, time-limited plan.

Alcohol withdrawal and seizure protocols vary by setting; coordination with medical teams and close monitoring of vitals and sedation are typical.
Tapering is typically planned for courses beyond a few weeks, and abrupt discontinuation is generally avoided to reduce withdrawal and seizures.
Long half-life and active metabolites mean slow accumulation and slow washout; rapid dose changes are generally avoided, and tapers are often planned over weeks to months when use has been prolonged.

Monitoring & Risks

Boxed warning: Concomitant use with opioids may result in profound sedation, respiratory depression, coma, and death. Sedation and psychomotor slowing can increase fall risk and impair driving/operating machinery; next-day impairment is common with long half-life.

Cognitive impairment and anterograde amnesia: dose dependent; higher risk in older adults.
Dependence and withdrawal: slow tapering and monitoring for rebound anxiety or seizures are common after chronic use.
Paradoxical disinhibition (irritability, agitation) can occur; worsening symptoms typically prompts reassessment and discontinuation rather than escalation.

Drug Interactions

Additive CNS and respiratory depression with alcohol, opioids, antihistamines, and sedating antipsychotics increases overdose risk and is generally avoided when possible; overdose counseling is commonly included. CYP3A4 and CYP2C19 inhibitors can increase exposure (e.g., azoles, macrolides); inducers may reduce effect—clinical response is monitored.

Stacking with other sedative-hypnotics increases overdose risk and is generally avoided; if combinations are unavoidable, lower dosing, closer follow-up, and a single-prescriber plan are commonly used to reduce risk.

Practice Notes

Often used for targeted indications with explicit time limits and a taper plan documented at initiation. Prescription monitoring data review and screening for substance use disorders are common when benzodiazepines are used.

Non-benzodiazepine long-term anxiety strategies (SSRIs/SNRIs, psychotherapy) are generally preferred, and diazepam necessity is revisited frequently.
When used in withdrawal or taper pathways, coordination with medical teams and defined success metrics (sleep, panic, functioning) support discontinuation once the acute goal is met rather than indefinite continuation.

References

Valium (diazepam) prescribing information — DailyMed (2025)
ASAM guideline on benzodiazepines — Journal of Addiction Medicine (2020)
Evidence Based Pharmacological Treatment OF Anxiety Disorders — Depression and Anxiety (2014)
Guidelines FOR THE Pharmacological Treatment OF Anxiety Disorders, Obsessive Compulsive Disorder AND Posttraumatic Stress Disorder IN Primary Care — International Journal of Psychiatry in Clinical Practice (2012)