1. About diazepam
Diazepam belongs to a group of medicines called benzodiazepines.
It's used to treat anxiety, muscle spasms and fits (seizures). It's also used in hospital to reduce alcohol withdrawal symptoms, such as sweating or difficulty sleeping.
It can also be taken to help you relax before an operation or other medical or dental treatments. This is known as a "pre-med".
Diazepam is available on prescription only.
It comes as tablets, a liquid that you swallow, or in a rectal tube (medicine that's squeezed into your anus). It can also be given as an injection in hospital.
2. Key facts
- The most common side effect is feeling drowsy.
- You're not recommended to use diazepam for longer than 4 weeks.
- If you take diazepam and feel sleepy, do not drive or use tools or machines.
- Do not drink alcohol while taking diazepam. It can make you sleep very deeply. You may have breathing problems and difficulty waking up.
- Diazepam is known by the brand names Diazemuls, Stesolid Rectal tubes, Diazepam Rectubes and Diazepam Desitin. It's also known as Valium, but this brand is not available in the UK anymore.
3. Who can and can't take diazepam
Diazepam tablets and liquid can be taken by adults aged 18 years and over.
It can also be taken by children aged 1 month or older for muscle spasms.
Diazepam rectal tubes can be used by adults and children.
It's not suitable for everyone. To make sure it's safe for you, tell your doctor before starting diazepam if you:
- have had an allergic reaction to diazepam or any other medicine in the past
- have liver or kidney problems
- have (myasthenia gravis), a condition that causes muscle weakness
- have (sleep apnoea), a condition that causes breathing problems when you're asleep
- have depression or thoughts of harming yourself or suicide
- have been diagnosed with personality disorder
- have (or have had) problems with alcohol or drugs
- have recently had a loss or bereavement
- have (arteriosclerosis), a condition that affects the blood flow to your brain
- have low levels of a protein called albumin in your blood
- are trying to get pregnant, are already pregnant or breastfeeding
- are over 65
- are going to be put to sleep (have a general anaesthetic) for an operation or other medical treatment
4. How and when to take it
Diazepam rectal tubes (or rectal diazepam) can be used if you or your child is having a fit.
If you have been prescribed rectal tubes, it's important that a family member, friend or carer knows how to give you this medicine.
If you're having a fit, they also need to know how long to wait before giving you rectal diazepam.
Your doctor will decide the right dose for you or your child according to your weight, age and general health.
Tablets and liquid
Take diazepam tablets or liquid with a drink of water. You can take them with or without food.
You'll usually take your medicine 1 to 3 times a day.
Your doctor will decide the right dose for you. It's important to take diazepam exactly as your doctor tells you to.
The usual dose for:
- anxiety - is 2mg taken 3 times a day. This can be increased to 5mg to 10mg 3 times a day.
- sleep problems (related to anxiety) - is 5mg to 15mg taken once a day at bedtime.
- muscle spasms in adults - is 2mg to 15 mg a day. This can be given as 1mg twice a day and go up to 5mg 3 times a day. The dose can be increased up to 20mg 3 times a day if needed.
- muscle spasm in children (aged 1 month to 17 years) - varies depending on age. It's usually given twice a day, with 10 to 12 hours between each dose.
Your dose might be lower if you're over 65 or have kidney, liver or severe breathing problems.
What if I forget to take it?
If you're taking diazepam regularly and forget to take a dose, take the missed dose as soon as you remember, unless it's nearly time for your next dose.
In this case, just leave out the missed dose and take your next dose as normal.
Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.
What if I take too much?
The amount of diazepam that can lead to an overdose varies from person to person.
Urgent advice: Call your doctor or go to A&E straight away if you take too much diazepam
If you take too much diazepam by accident, you may experience symptoms including:
- poor co-ordination or trouble speaking
- feeling sleepy
- a slow or irregular heartbeat
- uncontrolled eye movements
- muscle weakness
- feeling overexcited
If you need to go to A&E, do not drive yourself. Get someone else to drive you or call for an ambulance.
Take the diazepam packet, or the leaflet inside it, plus any remaining medicine with you.
5. Side effects
Like all medicines, diazepam can cause side effects in some people, but many people have no side effects or only minor ones.
Common side effects
These common side effects happen in more than 1 in 100 people.
If you get these side effects, keep taking the medicine and speak to your doctor:
- feeling sleepy or drowsy
- problems with your co-ordination or controlling your movements
- shaky hands (tremors)
Serious side effects
It happens rarely, but some people have serious side effects when taking diazepam.
Tell a doctor straight away if:
- your breathing becomes very slow or shallow
- your skin or the whites of your eyes turn yellow
- you find it difficult to remember things (amnesia)
- you see or hear things that are not there (hallucinations)
- you think things that are not true (delusions)
- you keep falling over
On very rare occasions, some people may experience unusual mood changes. These can become serious and are more likely to happen in children or if you're over 65.
Tell your doctor if you notice any of these side effects:
- talking too much or feeling overexcited
- feeling agitated or restless
- feeling irritable or aggressive
Serious allergic reaction
In rare cases, diazepam may cause a serious allergic reaction (anaphylaxis).
Urgent advice: Contact a doctor straight away if:
- you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
- you're wheezing
- you get tightness in the chest or throat
- you have trouble breathing or talking
- your mouth, face, lips, tongue or throat start swelling
These are warning signs of a serious allergic reaction.
A serious allergic reaction is an emergency.
These are not all the side effects of diazepam.
For a full list, see the leaflet inside your medicine packet.
You can report any suspected side effect to the UK safety scheme.
6. How to cope with side effects
If you feel sleepy or drowsy, do not drive or use tools or machinery until you feel better. Do not drink any alcohol.
This side effect should get better as your body gets used to the medicine.
If your symptoms do not improve after a week, speak to a doctor as you may need a lower dose.
If you experience any other side effect, speak to your doctor.
7. Pregnancy and breastfeeding
There's not enough information to know if diazepam is safe to use in pregnancy. But it can give your newborn baby withdrawal symptoms.
If you become pregnant while taking diazepam, speak to your doctor.
You may need to keep taking diazepam during pregnancy as it's important for you to remain well.
Your doctor can explain the risks and the benefits of taking diazepam, and will help you choose the best treatment for you and your baby.
If your doctor or health visitor says your baby is healthy, diazepam can be used during breastfeeding as long as you're only taking a low dose of diazepam occasionally or for a very short time.
Diazepam passes into breast milk. If you take diazepam for a long time or in high doses, it can build up in your milk. This can make your baby drowsy or tired and can make it difficult for them to feed.
If you're breastfeeding or planning to breastfeed, talk to your doctor or pharmacist, as other medicines might be better while breastfeeding, although this will depend on what the diazepam is being used for.
If you do take diazepam while you're breastfeeding and you notice that your baby's not feeding as well as usual, seems unusually sleepy, has unusual breathing, or you have any other concerns about them, talk to your health visitor or doctor as soon as possible.
Non-urgent advice: Tell your doctor if you're:
- trying to get pregnant
8. Cautions with other medicines
Some medicines interfere with the way diazepam works and increase the chances of you having side effects.
Before you start taking diazepam, tell your doctor if you're taking :
- antipsychotics used to treat mental health problems
- antidepressants used to treat depression
- anticonvulsants used to treat epilepsy
- hypnotics used to treat anxiety or sleep problems
- drowsy or sedating antihistamines, such as chlorphenamine or promethazine
- strong painkillers, such as codeine, methadone, morphine, oxycodone, pethidine or tramadol
- HIV medicines, such as ritonavir, atazanavir, efavirenz or saquinavir
- antifungal medicines, such as fluconazole
- proton pump inhibitors (PPIs) – medicines for reducing stomach acid, such as omeprazole or esomeprazole
- muscle relaxants, such as baclofen and tizanidine
- disulfiram, a medicine for alcohol addiction
- isoniazid, a medicine for tuberculosis
- rifampicin, a medicine for bacterial infections
- theophylline, a medicine for asthma and other breathing problems
Mixing diazepam with herbal remedies or supplements
There's very little information about taking herbal remedies and supplements with diazepam.
Do not take herbal medicines for anxiety or insomnia, such as valerian or passionflower, with diazepam.
They can increase the drowsy effects of diazepam and may also have other side effects.
For safety, tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements.
9. Common questions
How does diazepam work?
Diazepam belongs to a group of medicines called benzodiazepines.
It works by increasing the levels of a calming chemical in your brain.
Depending on your health condition, this can make you feel drowsy, relieve anxiety, stop seizures or relax tense muscles.
How long does diazepam take to work?
Diazepam will work quite quickly or more slowly depending on what you're taking it for:
- fits - diazepam rectal tubes should start to work within 10 minutes.
- anxiety - you should start to feel a bit better within a few hours, but it may take a week or two for you to feel the full effects.
- muscle spasms - you should begin to feel less pain after 15 minutes. Your muscles will start to relax when you have been taking diazepam regularly for a few days.
How long will I take it for?
Diazepam is usually only recommended for a short period of time of up to 4 weeks.
If you're prescribed diazepam for more than 4 weeks, your dose may be reduced gradually to prevent withdrawal symptoms.
Is it safe to take long term?
It's usual to take diazepam for no longer than 2 to 4 weeks.
If you're prescribed diazepam for more than 4 weeks, your dose may be reduced gradually when coming off it to prevent withdrawal symptoms.
Is diazepam addictive?
Diazepam is not likely to be addictive if you take it at a low dose for a short time (2 to 4 weeks).
You're more likely to get addicted if you have, or previously had, problems with alcohol or drugs.
You should take diazepam tablets for as short a period of time as possible.
What will happen when I want to come off diazepam?
If you have been taking a high dose or have been taking it for a long time, your doctor will probably recommend reducing your dose gradually.
If you suddenly stop taking it, you may occasionally experience some side effects, such as:
- feeling nervous or irritable
The risk of these side effects can be reduced by gradually reducing your dose.
Are there other medicines for anxiety and for fits?
There are different types of medicines for treating anxiety or fits.
For anxiety, depending on your symptoms, you may need a medicine to treat your physical symptoms, as well as your psychological ones.
For fits, a medicine called midazolam can be used. It comes as a pre-filled syringe and is given inside the mouth between the cheek and the gum (buccal cavity).
This can be used instead of rectal diazepam, which is inserted into the anus.
You can discuss the different options with your doctor. They'll help you decide which medicine is best for you.
Can I take diazepam before surgery?
Diazepam can be given as a pre-med to relax you before an operation or dental treatment that may be uncomfortable or make you feel anxious.
It's important to tell your doctor or dentist if you're already taking diazepam.
Tell your doctor that you take diazepam if you're going to be put to sleep (using a general anaesthetic) or having any kind of major operation.
Can I drink alcohol with it?
Do not drink alcohol while you're on diazepam. Alcohol can increase the effects of diazepam. It can make you go into a very deep sleep.
There's a risk you will not be able to breathe properly, and may have difficulty waking up.
Will recreational drugs affect it?
Using cannabis, heroin or methadone with diazepam will increase the drowsy effects of diazepam. It can make you go into a very deep sleep.
There's a risk you will not be able to breathe properly, and you may have difficulty waking up.
Using cocaine or other stimulants like MDMA (ecstasy) and amphetamines with diazepam can also lead to drowsiness.
Talk to your doctor if you think you might use recreational drugs while taking diazepam.
Are there foods and drinks I should avoid?
Grapefruit juice may increase the amount of diazepam in your blood. It's a good idea to avoid grapefruit or grapefruit juice while taking diazepam.
Caffeine is a stimulant and may reduce the calming effects of diazepam. It's best not to have drinks like coffee, tea and cola because they contain caffeine.
Do not drink alcohol while you're on diazepam. Alcohol can increase the effects of diazepam and make you go into a very deep sleep.
There's a risk you will not be able to breathe properly, and you may have difficulty waking up.
Will it affect my contraception?
Diazepam will not affect any contraception, including the combined pill and emergency contraception.
Some contraceptive pills can keep diazepam in your body for longer and increase its effect.
You can also get bleeding in between your periods if you take diazepam and contraceptive pills together.
But your contraceptive protection will still work.
Will it affect my fertility?
There's no firm evidence to suggest that taking diazepam will reduce fertility in either men or women.
If you're trying to get pregnant, or you're having problems getting pregnant while on diazepam, speak to your doctor.
Can I drive or ride a bike while I'm taking it?
Do not drive a car or ride a bike if diazepam makes you sleepy during the daytime, gives you blurred vision, or makes you feel dizzy, clumsy or unable to concentrate or make decisions.
This may be more likely when you first start taking diazepam, but could happen at any time (for example, when starting another medicine).
It's an offence to drive a car if your ability to drive safely is affected.
It's your responsibility to decide if it's safe to drive. If you're in any doubt, do not drive.
Even if your ability to drive is not affected, the police have the right to request a saliva sample to check how much diazepam is in your body.
GOV.UK has more information on the law on drugs and driving.
Talk to your doctor or pharmacist if you're unsure whether it's safe for you to drive while taking diazepam.
Can I operate machinery or tools while I'm taking it?
Do not operate machinery if you experience any side effects, such as feeling sleepy, being forgetful, or poor co-ordination.
Can I take diazepam with me if I'm travelling abroad?
It depends on which country you're travelling to. Different countries have different rules and regulations for diazepam.
It's important to plan ahead and find out whether you can take your medicine abroad. It's best to only take the amount that you need while abroad.
You can contact the embassy for the country you're visiting. The GOV.UK website has a full list of foreign embassies in the UK.
Can lifestyle changes help?
If you have anxiety, there are some lifestyle changes you can make to help ease symptoms:
- try a book or online course on anxiety
- exercise regularly
- learn to relax
- avoid caffeine
- avoid smoking and alcohol
- contact support groups run by charities like Anxiety UK, Mind and Rethink Mental Illness
If you're having trouble sleeping, there are some things you can do to help yourself get a good night's sleep:
- set regular times for going to bed and waking up
- relax before bedtime – try taking a warm bath or listening to calming music
- use thick curtains or blinds, an eye mask and earplugs to stop you being woken up by light and noise
- avoid caffeine, cigarettes (or e-cigarettes), alcohol, heavy meals and exercise for a few hours before going to bed
- do not watch TV or use phones, tablets or computers just before going to bed
- do not nap during the day
- write a list of your worries, and any ideas about how to solve them, before you go to bed to help you forget about them until the morning