Diazepam is mainly used to treat anxiety, insomnia, and symptoms of acute alcohol
withdrawal. It is also used as a premedication for inducing sedation,
anxiolysis or amnesia before certain medical procedures (e.g., endoscopy).
Intravenous
diazepam or lorazepam are first line treatments for status epilepticus;
However, lorazepam has advantages over diazepam, including a higher rate of
terminating seizures and a more prolonged anticonvulsant effect. Diazepam is
rarely used for the long-term treatment of epilepsy because tolerance to its
anticonvulsant effects usually develops within six to 12 months of treatment,
effectively rendering it useless for that purpose. Diazepam is used for the
emergency treatment of eclampsia, when IV magnesium sulfate and blood pressure
control measures have failed. Benzodiazepines do not have any pain-relieving
properties of themselves and are generally recommended to be avoided in
individuals with pain. However, benzodiazepines such as diazepam can be used
for their muscle-relaxant properties to alleviate pain caused by muscle spasms
and various dystonias, including blepharospasm. Tolerance often develops to the
muscle relaxant effects of benzodiazepines such as diazepam. Baclofen or
tizanidine is sometimes used as an alternative to diazepam. Tizanidine has been
found to be equally effective as other antispasmodic drugs and have superior
tolerability than baclofen and diazepam.
The
anticonvulsant effects of diazepam can help in the treatment of seizures due to
a drug overdose or chemical toxicity as a result of exposure to sarin, VX,
soman (or other organophosphate poisons; See #CANA), lindane, chloroquine,
physostigmine, or pyrethroids Diazepam is sometimes used intermittently for the
prophylaxis of febrile seizures which occur as a result of a high fever in
children and neonates under five years of age. Long-term use of diazepam for
the management of epilepsy is not recommended; however, a subgroup individuals
with treatment resistant epilepsy benefit from long-term benzodiazepines and
for such individuals clorazepate has been recommended due to its slower onset
of tolerance to the anticonvulsant effects.
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