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Valium is a benzodiazepine class of drug, with sedative, hypnotic, anxiolytic, anticonvulsant, amnestic and muscle relaxant properties. Valium was first introduced in 1963 and is currently avaialble as diazepam. The drug was a modification of the first benzodiazepine, librium, and today is used in the treatment of anxiety. Valium has totally replaced the barbiturates as the drug of choice for decreasing anxiety. Valium has a relatively lower abuse potential and relatively fewer adverse reactions. Valium is considered a minor tranquilizer. For the past 40 years, valium has been most often used for the short-term relief of moderate-severe, disabling anxiety or insomnia.

Long-term use can be associated with the development of tolerance, physiological and psychological dependency. Valium is believed to interact with the GABA receptor; GABAA; the activation of which decreases neuronal activity. Dosing Valium can be taken orally, administered intravenously or even rectally. Valium is usually taken before bedtime and has few residual effects. However, rebound insomnia may occur and may cause anxiety while awake. In the elderly and in those patients with liver and kidney problems, accumulation of valium can occur. It has a long half-life in the body lasting about 36-48 hours. The recommended starting dose is 5 mg per day and one can go up to 10-15 mg per day. Valium is a Schedule IV drug in the USA under the Federal Controlled Substances Act.

It is only available with a prescription from a physician. Therapeutic Uses Valium is indicated in the management of short term anxiety disorders. Anxiety associated with the stresses of daily life is not an indication for valium consumption. In hospitals, valium is frequently used to treat the agitation and delirium tremens that may occur after acute alcohol withdrawal. It is also useful in the relief of skeletal muscle spasms, spasticity (such as in cerebral palsy) and for use in status epilepticus. The drug should be periodically assessed by the physician to determine if it is clinically useful to the patient. Side Effects The side effects of valium are obvious. Drowsiness, lethargy, gait problems mental confusion, vertigo and impaired judgement are common side effects. Since valium impairs mental judgement, it is recommended that individuals not drive vehicles or operate any machinery while taking the drug. The side effects of valium are augmented by consumption of alcohol or other central nervous depressants. In fact, consuming valium with alcohol can result in a potentially fatal overdose. When valium is used as an adjunct in the treatment of seizures, an increase in dosage of the primary anti seizure drug may be required. The concomitant administration of valium and anti-convulsants may precipitate an increase in certain seizure activity, specifically tonic-clonic seizures. In individuals who take valium for prolonged periods, frequent liver function tests should be done and the dose of valium adjusted if there is liver impairment. The possibility of liver damage should always be considered, especially in individuals using valium and other over the counter analgesics and/or alcohol. Some individuals may have a paradoxical reaction to valium and have worseing of their anxiety and suicidal thoughts. Initial monitoring of all patients during the start of therapy is recommended. Withdrawal of Valium Valium should never be stopped abruptly after long term use. Withdrawal symptoms, similar in signs and symptoms to those observed with barbiturates and alcohol (eg, insomnia, diaphoresis, tachycardia, hypertension, convulsions, psychosis, tremor, cramps, vomiting and hyperanxiety) do occur when valium is abruptly discontinued. Onset of the withdrawal syndrome after prolonged heavy use of valium might be delayed, although withdrawal from short duration use 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.

The more severe withdrawal symptoms have usually been linked to those patients who have been taking high doses of valium for a prolonged period of time. Generally milder withdrawal symptoms (eg dysphoria and insomnia) have been reported following abrupt withdrawal of valium taken continuously for several months. Consequently, after long term therapy, abrupt discontinuation should generally be avoided and a gradual dose tapering regimen followed. Addiction prone individuals should be under careful surveillance when receiving valium because of their predisposition to habituation and dependence. Withdrawal can be 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.

Dependence and Tolerance Tolerance to valium can develop 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 dependence. Studies show that up to 50 percent of patients prescribed valium for 6 months or more, become physically dependent to the drug. Abuse Potential Although valium is extremely effective in the management of anxiety disorders, it has the potential for abuse and may cause physical dependence or addiction. Intentional abusers of valium usually have other substance abuse problems. Valium is usually a secondary drug of abuse, used mainly to potentiate the high received from another drug or to diminish the adverse effects of other drugs. However, even legitimate, therapeutic usage of valium carries with it an innate risk of addiction and physical/psychological dependence. Intoxication Overdosage of valium, particularly when combined with alcohol, may lead to coma, but does not cause severe electrolyte/biochemical changes and therefore carries a relatively good prognosis if the amount ingested was not sufficient to cause death. Valium overdose presents with lethargy, somnolence, confusion, coma and decreased reflexes. Blood pressure and respiration can decrease dramatically. In acute overdose, general supportive measures should be undertaken. The stomach should be lavaged and IV fluids administered. Airway control should be obtained if there is evidence of respiratory difficulty.

The antidote for valium overdose is flumazenil, a specific benzodiazepine antagonist, which is occasionally used empirically in all patients presenting with unexplained coma in emergency rooms. All essential supportive measures should be available prior to administration of any benzodiazepine antagonist in order to protect the patient from both the withdrawal effects and possible complications arising from simultaneous utilization of chemically unrelated drugs.