[45310] NOTE: Not recommended as a first-line agent due to sodium benzoate and benzoic acid in the injection. Monitor patients for decreased pressor effect if these agents are administered concomitantly. If parental diazepam is used with an opiate agonist, reduce the opiate agonist dosage by at least 1/3. Amobarbital: (Moderate) Additive CNS and/or respiratory depression may occur. Patients receiving benzodiazepines that are metabolized by these isoenzymes may experience decreased benzodiazepine serum concentrations if administered concurrently with efavirenz. Prescribe the lowest effective dosage; avoid or minimize concomitant use of CNS depressants and other substances associated with abuse, misuse, and addiction (e.g., opioid analgesics, stimulants); and advise patients on the proper disposal of unused drug. Diazepam is a CYP2C9, CYP2C19, and CYP3A4 substrate. 0.1 to 0.15 mg/kg/dose IV every 10 minutes as needed. Avoid prescribing opiate cough medications in patients taking benzodiazepines. If diazepam tablets are to be combined with other centrally acting agents, careful consideration should be given to the pharmacology of the agents employed particularly with compounds that may potentiate or be potentiated by the action of diazepam tablets, such as phenothiazines, antipsychotics, anxiolytics/sedatives, hypnotics, anticonvulsants, narcotic analgesics, anesthetics, sedative antihistamines, narcotics, barbiturates, MAO inhibitors and other antidepressants. Educate patients about the risks and symptoms of respiratory depression and sedation. Respiratory assistance should be available. In the presence of food, mean lag times are approximately 45 minutes as compared with 15 minutes when fasting. Ceritinib: (Moderate) Monitor for an increase in sedation and respiratory depression if coadministration of diazepam with ceritinib is necessary. Side effects most commonly reported were drowsiness, fatigue, muscle weakness, and ataxia. Instruct patients to inform their healthcare provider if they are pregnant. 2 to 5 mg IM or IV for moderate anxiety disorders and symptoms of anxiety; repeat in 3 to 4 hours if necessary. Diphenhydramine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Diazepam is a benzodiazepine derivative. If an opiate agonist is initiated in a patient taking a benzodiazepine, use a lower initial dose of the opiate and titrate to clinical response. Educate patients about the risks and symptoms of respiratory depression and sedation. Lonafarnib: (Moderate) Monitor for an increase in diazepam-related adverse reactions, including sedation and respiratory depression, if coadministration with lonafarnib is necessary. eCollection 2017. 2 mg to 2.5 mg, 1 or 2 times daily initially; increase gradually as needed and tolerated. This can be taken as 1mg twice a day and can go up to 5mg taken 3 times a day. Anxiety or tension associated with the stress of everyday life usually does not require treatment with an anxiolytic. If a benzodiazepine is prescribed for an indication other than epilepsy in a patient taking an opiate agonist, use a lower initial dose of the benzodiazepine and titrate to clinical response. Aspirin, ASA; Carisoprodol; Codeine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Educate patients about the risks and symptoms of respiratory depression and sedation. Acetaminophen; Caffeine: (Minor) Patients taking benzodiazepines for insomnia should not use caffeine-containing products prior to going to bed as these products may antagonize the sedative effects of the benzodiazepine. Do not administer diazepam injection to patients in coma or shock. Data indicate that these compounds influence the pharmacokinetics of diazepam and may lead to increased and prolonged sedation. Because diazepam can cause drowsiness and a decreased level of consciousness, there is a higher risk of falls, particularly in the elderly, with the potential for subsequent severe injuries. Diazepam is a substrate for CYP3A4. Diazepam and its metabolites cross the blood-brain and placental barriers and are also found in breast milk in concentrations approximately one tenth of those in maternal plasma (days 3 to 9 post-partum). Unauthorized use of these marks is strictly prohibited. Ombitasvir; Paritaprevir; Ritonavir: (Moderate) Systemic exposure of diazepam and its metabolite, nordiazepam, were decreased when a single 2 mg dose was administered concurrently with ombitasvir; paritaprevir; ritonavir. Diazepam is a CYP2C9, CYP2C19, and CYP3A4 substrate. Zaleplon: (Major) Monitor for excessive sedation and somnolence during coadministration of zaleplon and benzodiazepines. Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Modafinil: (Moderate) Modafinil has demonstrated an inhibition of the CYP2C19 hepatic microsomal isoenzyme at pharmacologically relevant concentrations. Diazepam is present in breastmilk. Diazepam is a CYP3A substrate and taurursodiol is a CYP3A inducer. Chemically, diazepam is 7-Chloro-1,3-dihydro-1-methyl-5-phenyl-2 H -1,4-benzodiazepin-2-one. Ribociclib; Letrozole: (Moderate) Monitor for an increase in diazepam-related adverse reactions if coadministration with ribociclib is necessary; decrease the dose of diazepam if necessary. (Minor) Patients taking benzodiazepines for insomnia should not use caffeine-containing products prior to going to bed as these products may antagonize the sedative effects of the benzodiazepine. Diazepam is a CYP3A4 substrate and viloxazine is a CYP3A4 inhibitor. Use of more than 2 hypnotics should be avoided due to the additive CNS depressant and complex sleep-related behaviors that may occur. Mylan Pharmaceuticals Inc. Because of varied responses to CNS-acting drugs, initiate therapy with lowest dose and increase as required. There is also an increase in Tmax to about 2.5 hours in the presence of food as compared with 1.25 hours when fasting. If concurrent use is necessary, monitor for excessive sedation and somnolence. Diazepam is a CYP3A substrate and mitapivat is a weak CYP3A inducer. For extended-release tablets, start with morphine 15 mg PO every 12 hours, and for extended-release capsules, start with 30 mg PO every 24 hours or less. Diazepam is primarily metabolized by CYP2C19 and CYP3A4, and to a lesser extent by CYP2B6 and CYP2C9. May give a second dose 4 to 12 hours after the first dose if needed. Acetaminophen; Chlorpheniramine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Benzodiazepines act at the level of the limbic, thalamic, and hypothalamic regions of the CNS and can produce any level of CNS depression required including sedation, hypnosis, skeletal muscle relaxation, and anticonvulsant activity. Use caution with this combination. Please choose the category that best describes you. Max: 15 mg. 10 to 20 mg IV or 10 mg IM as a single dose, initially, then 5 to 10 mg IV or IM in 3 hours if needed. If parental diazepam is used with a mixed opiate agonist/antagonist, reduce the mixed opiate agonist/antagonist dosage by at least 1/3. Concurrent use may decrease diazepam exposure. Death is more often associated with polysubstance use (especially benzodiazepines with other CNS depressants such as opioids and alcohol). In addition, efavirenz inhibits CYP2C9 in vitro; diazepam is also metabolized via this isoenzyme. If the patient is hyperdynamic and agitated after diazepam 200 mg within 3 hours, consider phenobarbital or propofol. Chronic daily use of diazepam may increase the frequency and/or severity of tonic-clonic seizures, requiring an increase in the dosage of standard anticonvulsant medication. Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. Educate patients about the risks and symptoms of respiratory depression and sedation. Concomitant use of benzodiazepiones, including diazepam tablets, and opioids may result in profound sedation, respiratory depression, coma, and death. Tramadol; Acetaminophen: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. If parental diazepam is used with an opiate agonist, reduce the opiate agonist dosage by at least 1/3. Geriatric Patients, or in the presence of debilitating disease. Concurrent use may increase diazepam exposure. In young healthy males, the volume of distribution at steady-state is 0.8 to 1.0 L/kg. If concurrent use is necessary, monitor for excessive sedation and somnolence. Epilepsy and many other illnesses for which AEDs are prescribed are themselves associated with an increased risk of suicidal thoughts and behavior. If a benzodiazepine is prescribed for an indication other than epilepsy in a patient taking a mixed opiate agonist/antagonist, use a lower initial dose of the benzodiazepine and titrate to clinical response. Avanafil (Stendra). Diazepam is a CYP3A substrate and erythromycin is a CYP3A inhibitor. Methyldopa can potentiate the effects of CNS depressants such as barbiturates, benzodiazepines, opiate agonists, or phenothiazines when administered concomitantly. Diazepam is a CYP2C19 substrate and omeprazole is a CYP2C19 inhibitor. Additionally, barbiturates may increase the metabolism of diazepam. Taking diazepam tablets with certain other medicines can cause side effects or affect how well diazepam tablets or the other medicines work. Abuse and misuse of benzodiazepines often (but not always) involve the use of doses greater than the maximum recommended dosage and commonly involve concomitant use of other medications, alcohol, and/or illicit substances, which is associated with an increased frequency of serious adverse outcomes, including respiratory depression, overdose, or death. Minocycline: (Minor) Injectable minocycline contains magnesium sulfate heptahydrate. Butabarbital: (Moderate) Additive CNS and/or respiratory depression may occur. Educate patients about the risks and symptoms of respiratory depression and sedation. If a benzodiazepine is prescribed for an indication other than epilepsy in a patient taking an opiate agonist, use a lower initial dose of the benzodiazepine and titrate to clinical response. Levonorgestrel; Ethinyl Estradiol: (Minor) Ethinyl estradiol may inhibit the clearance of benzodiazepines that undergo oxidation, thereby increasing serum concentrations of concomitantly administered benzodiazepines. In acute conditions the injection may be repeated within one hour although an interval of 3 to 4 hours is usually satisfactory. Acetaminophen; Diphenhydramine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Manage these neonates accordingly (see WARNINGS: Neonatal Sedation and Withdrawal Syndrome). Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. 0.1 to 0.3 mg/kg/dose (Usual Max: 10 mg/dose) IV every 1 to 6 hours as needed. Isoniazid, INH; Rifampin: (Major) Rifampin is a potent inducer of the hepatic isoenzyme CYP3A4, one of the pathways responsible for the hepatic metabolism of diazepam. Oral diazepam tablets may be used adjunctively in convulsive disorders, although it has not proved useful as the sole therapy. They are available as follows: Storage: Store at 20 to 25C (68 to 77F). Cleft palate and encephalopathy are the most common and consistently reported malformations produced in these . Since definitive controlled trial data are lacking, phenytoin concentrations should be monitored more closely when diazepam is added or discontinued. [46130] If occasional maternal therapy with a benzodiazepine is required, lorazepam or oxazepam may be reasonable alternatives for some patients. Amiodarone: (Moderate) Monitor for an increase in diazepam-related adverse reactions, including sedation and respiratory depression, if coadministration with amiodarone is necessary. Buprenorphine; Naloxone: (Major) Concomitant use of mixed opiate agonists/antagonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Injectable diazepam consists of the following ingredients37: 40% propylene glycol l0% ethyl alcohol Diazepam is metabolized by CYP3A4, CYP2C9, and CYP2C19. Gastrointest Endosc. The physician should periodically reassess the usefulness of the drug for the individual patient. Diazepam is a CYP2C19 and CYP3A substrate and fluconazole is a CYP2C19 and CYP3A inhibitor. Maprotiline: (Moderate) Benzodiazepines or other CNS depressants should be combined cautiously with maprotiline because they could cause additive depressant effects and possible respiratory depression or hypotension. Levocetirizine: (Moderate) Concurrent use of cetirizine/levocetirizine with benzodiazepines should generally be avoided. Monitor patients who take benzodiazepines with another CNS depressant for symptoms of excess sedation. In children 3-8 years old the mean half-life of diazepam has been reported to be 18 hours. Everolimus: (Moderate) Monitor for an increase in diazepam-related adverse reactions, including sedation and respiratory depression, if coadministration with everolimus is necessary. To view updated drug label links, paste the RSS feed address (URL) shown below into a RSS reader, or use a browser which supports RSS feeds, such as Safari for Mac OS X. Calcium Carbonate: (Moderate) The coadministration of diazepam with antacids results in delayed diazepam absorption due to the fact that antacids delay gastric emptying. Additionally, avoid coadministration with other CNS depressants, especially opioids, unless no other alternatives are available as coadministration significantly increases the risk for profound sedation, respiratory depression, coma, and death. Amoxapine: (Moderate) Amoxapine may enhance the response to the effects of benzodiazepines and other CNS depressants. If the decision is made to use flumazenil, it should be used as an adjunct to, not as a substitute for, supportive management of benzodiazepine overdosage. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. and transmitted securely. Diazepam is a CYP3A4 and CYP2B6 substrate. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Titrate by 0.1 mg/kg/hour if symptoms persist as long as respiratory rate is maintained at an adequate rate based on age. Overall, 131 treatment-emergent adverse events (TEAEs) were considered mild (42 subjects . 1998 Jun;47(6):455-60. doi: 10.1016/s0016-5107(98)70244-5. Diazepam is a CYP3A substrate and spironolactone is a CYP3A inhibitor. The site is secure. Concurrent use may result in additive CNS depression. Ivacaftor is a CYP3A inhibitor, and diazepam is a CYP3A substrate. Diazepam is a CYP2C19 substrate and citalopram is a CYP2C19 inhibitor. If an opiate agonist is initiated in a patient taking a benzodiazepine, use a lower initial dose of the opiate and titrate to clinical response. Cobicistat is a strong inhibitor of CYP3A4, an isoenzyme partially responsible for the metabolism of diazepam. Use caution with this combination. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. In a clinical trial, there was clear evidence for a transitory pharmacodynamic interaction between melatonin and another hypnotic agent one hour following co-dosing. Tucatinib: (Moderate) Monitor for an increase in diazepam-related adverse reactions if coadministration with tucatinib is necessary; decrease the dose of diazepam if necessary. Last updated on Nov 2, 2022. To prevent this interaction, it would be prudent to avoid taking oral diazepam with grapefruit juice. The structural formula is as follows: Diazepam is available for oral administration as tablets containing 2 mg, 5 mg or 10 mg diazepam, USP. Sevoflurane: (Moderate) Concomitant administration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. The data currently available are inadequate to determine the mutagenic potential of diazepam. Educate patients about the risks and symptoms of respiratory depression and sedation. PHARMACIST: Dispense the accompanyingMedication Guide to each patient. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. If parental diazepam is used with an opiate agonist, reduce the opiate agonist dosage by at least 1/3. Use caution with this combination. approximately 30 minutes before the procedure. Use of diazepam tablets late in pregnancy can result in sedation (respiratory depression, lethargy, hypotonia) and/or withdrawal symptoms (hyperreflexia, irritability, restlessness, tremors, inconsolable crying, and feeding difficulties) in the neonate (see PRECAUTIONS: Pregnancy). Acute withdrawal signs and symptoms associated with benzodiazepines have included abnormal involuntary movements, anxiety, blurred vision, depersonalization, depression, derealization, dizziness, fatigue, gastrointestinal adverse reactions (e.g., nausea, vomiting, diarrhea, weight loss, decreased appetite), headache, hyperacusis, hypertension, irritability, insomnia, memory impairment, muscle pain and stiffness, panic attacks, photophobia, restlessness, tachycardia, and tremor. Patients receiving benzodiazepines that are metabolized by these isoenzymes may experience decreased benzodiazepine serum concentrations if administered concurrently with efavirenz. [43932] Monitor breastfed infants exposed to nasal diazepam through breast milk for sedation, poor feeding, and poor weight gain. EEG monitoring of the seizure may be helpful. Acetaminophen; Aspirin, ASA; Caffeine: (Minor) Patients taking benzodiazepines for insomnia should not use caffeine-containing products prior to going to bed as these products may antagonize the sedative effects of the benzodiazepine. Aluminum Hydroxide; Magnesium Trisilicate: (Moderate) The coadministration of diazepam with antacids results in delayed diazepam absorption due to the fact that antacids delay gastric emptying. At present, this reaction is known to occur with cimetidine, ketoconazole, fluvoxamine, fluoxetine, and omeprazole. Monitor for diazepam-related adverse effects during coadministration with elagolix. Concurrent use may increase diazepam exposure. The cost of midazolam was substantially higher than diazepam. Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide: (Moderate) The plasma concentrations of diazepam may be elevated when administered concurrently with cobicistat. If parental diazepam is used with an opiate agonist, reduce the opiate agonist dosage by at least 1/3. Nevirapine: (Moderate) Monitor patients for decreased efficacy of diazepam if coadministration with nevirapine is necessary. this version. Dosage adjustments may be necessary when administered together because of potentially additive CNS effects. You may report side effects to FDA at 1-800-FDA-1088. Tezacaftor; Ivacaftor: (Moderate) Use caution when administering ivacaftor and diazepam concurrently because patients may be at increased risk for adverse effects from diazepam. Rifabutin: (Moderate) Rifabutin induces hepatic isoenzymes CYP3A4 and CYP2C8/9. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Quetiapine: (Moderate) Monitor for excessive sedation and somnolence during coadministration of diazepam and quetiapine. [1] Medical use Voriconazole is a strong CYP3A4. Caution should be used when asenapine is given in combination with other centrally-acting medications including anxiolytics, sedatives, and hypnotics (including barbiturates), buprenorphine, buprenorphine; naloxone, butorphanol, dronabinol, THC, nabilone, nalbuphine, opiate agonists, pentazocine, acetaminophen; pentazocine, aspirin, ASA; pentazocine, and pentazocine; naloxone. Diazepam is a substrate of CYP3A4. If morphine is initiated in a patient taking a benzodiazepine, reduce initial dosages and titrate to clinical response. While diazepam clearance may be inhibited, diazepam pharmacodynamics are not always affected. Diazepam plasma exposures (Cmax and AUC) increased approximately proportional to dose from 5 to 20 mg. government site. [28712] [41506] [43931] According to the Beers Criteria, benzodiazepines are considered potentially inappropriate medications (PIMs) in geriatric patients and avoidance is generally recommended, although some agents may be appropriate for seizure disorders, rapid eye movement sleep disorders, benzodiazepine or ethanol withdrawal, severe generalized anxiety disorder, or peri-procedural anesthesia. Valium is available as a generic drug. Use caution with this combination. Anxiety Indicated for management of anxiety disorders or for short-term relief of the symptoms of anxiety 2-10 mg PO q6-12hr, OR 2-5 mg IV/IM q3-4hr if necessary, for moderate anxiety disorders;. Minocycline contains magnesium sulfate heptahydrate consistently reported malformations produced in these ( 6 ):455-60. doi: (. Are available as follows: Storage: Store at 20 to 25C ( to... Would be prudent to avoid taking oral diazepam with ceritinib is necessary monitor. 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