Instructions for use DIAZEPAM 2 mg, 5 mg, 10 mg

Effect on the body

The mechanism of action of diazepam is its stimulation of benzodiazepine receptors with simultaneous activation of GABA receptors and inhibition in synapses that regulate the emotional sphere, including the thalamus, hypothalamus, reticular formation and limbic system of the brain. Thanks to this effect, when using Diazepam, you can get several effects at once. Its ability to regulate the central nervous system gives the following results:

• Soothing. The sedative effect is to relieve anxiety and restlessness, reduce the body’s reactivity to external stimuli, and drowsiness. When using the drug in maximum quantities, inability to concentrate and absent-mindedness may occur. Overdose causes amnesia.
• Anxiolytic. A person’s anxiety level decreases, fears and tension go away.
• Hypnotic. Inhibiting arousal in the brain and eliminating excessive arousal helps a person normalize sleep and ensures falling asleep quickly.
• Anticonvulsant. The muscle relaxant effect of the substance blocks the conduction of impulses along interneurons located in the spinal cord. This allows you to stop seizures and reduce limb tremors.

The drug helps increase the pain threshold, reduces the need for peripheral tissues for oxygen, and eliminates syndromes caused by activation of the autonomic nervous system. All the main effects of Diazepam have a beneficial effect during the treatment of chronic alcoholism. It makes it much easier to survive the signs of withdrawal, stopping most of its symptoms. The medicine helps eliminate hand tremors, psychomotor agitation, anxiety, unmotivated aggression, convulsive syndrome, hallucinosis and reduces the severity of signs of alcoholic delirium.

Use during pregnancy and breastfeeding

Contraindicated for use during pregnancy (especially the first trimester) and during breastfeeding.

Diazepam has a toxic effect on the fetus and increases the risk of birth defects when used in the first trimester of pregnancy. Taking therapeutic doses later in pregnancy may cause depression of the fetal central nervous system. Chronic use during pregnancy can lead to physical dependence - possible withdrawal symptoms in the newborn. The use of diazepam in doses above 30 mg within 15 hours before or during labor can cause respiratory depression in the newborn (before apnea), decreased muscle tone, decreased blood pressure, hypothermia, and weak sucking (“floppy baby syndrome”).

Indications for use of "Diazepam"

To get the desired result, you need to take the drug as prescribed. You should not use the drug without the advice of a doctor, since Diazepam causes many negative effects and leads to addiction.

Recommended Dosages

According to the instructions, the dosage of Diazepam for an adult is from 4 to 15 mg per day. It is necessary to take the drug by dividing the total dosage into two doses. Parenteral administration is 10-20 mg, and its frequency is determined by a specialist. Withdrawal syndrome is relieved by using a tranquilizer 10 mg up to 4 times a day. After which it is recommended to switch to a maintenance dose of 5 mg 2-4 times a day.

Contraindications

The drug has many side effects. And in some cases its use is contraindicated. "Diazepam" is not recommended for treatment in the following situations and diseases:

• glaucoma without aqueous outflow (angle-closure)
• functional failure of the kidneys and liver
• respiratory disorders
• muscular asthenia
• sudden drop in blood pressure, shock
• loss of consciousness
• organic changes in the brain
• drug overdose and alcohol poisoning
• treatment with drugs that have a depressant effect on the nervous system
• intolerance to the active substance and additional components
• pregnancy and breastfeeding

Side effects

Before starting treatment, you should carefully read the instructions. Some patients may experience side effects when using Diazepam:

• severe drowsiness
• weakness, lack of activity
• myasthenia gravis
• bronchospasm
• drop in blood pressure
• hiccups (with rapid intravenous administration)
• dry mouth
• breathing disorder
• decreased potency in men (disappears after discontinuation of the drug)
• paradoxical arousal
• nausea, vomiting and intestinal upset
• hyperprolactinemia

If, after taking or administering the drug, negative symptoms are observed or intolerance is detected, you should immediately consult a doctor. It may be necessary to reduce the dose or reconsider treatment in favor of another tranquilizer.

Interaction with alcohol and other drugs

Treatment should never be combined with alcohol. If you take strong drinks at the same time as Diazepam, the likelihood of developing an adverse reaction increases significantly even with a minimum dosage. Intoxication occurs faster, pronounced inhibition of brain structures leads to loss of consciousness and a life-threatening condition.

When using the drug, it is necessary to take into account the peculiarities of its interaction with other drugs. Otherwise, overdose symptoms and negative reactions may be increased or sharply decreased:

• the likelihood of side effects increases with the use of anticoagulants and beta blockers
• the use of sleeping pills increases drowsiness and lethargy
• the use of muscle relaxants can lead to severe weakness and potentiation of the effect of the tranquilizer
• joint treatment with antipsychotics increases their effectiveness
• Taking antidepressants neutralizes the effects of anxiolytics

The use of benzodiazepines in acute psychoneurological syndromes at the prehospital stage

Among the most common psychoneurological syndromes in emergency medical practice are epileptic seizures and convulsive states, withdrawal syndrome and delirium in alcoholism and other drug addictions, conditions accompanied by anxiety, fear and increased muscle tone, uncontrollable vomiting and premedication.

Epileptic seizures and convulsive states

A number of numerous endogenous and exogenous factors can lead to the occurrence of seizures:

• infections;
• intoxication;
• injuries;
• diseases of the central nervous system (CNS);
• metabolic disorders;
• genetic predisposition, etc.

Seizures are a typical manifestation of epilepsy, but their presence does not always indicate this disease. The cause of the development of seizures can be hypoxia, microcirculation disorders and a number of other reasons.

To initiate a convulsive attack, the presence of a group of neurons capable of generating a pronounced explosive discharge, as well as a GABAergic inhibitory system, is required. The transmission of convulsive discharge depends on excitatory glutamatergic synapses. There is evidence that amino acid neurotransmitters (glutamate, aspartate) cause irritation of neurons by acting on specific cellular receptors.

Seizures can come from regions of neuronal death, and these regions themselves can contribute to the development of new hyperexcitable synapses that cause paroxysms.

Convulsions are the main clinical manifestation of eclampsia (from the Greek ekiampsis - outbreak) - gestosis of maximum severity. Eclampsia is accompanied by impaired consciousness, arterial hypertension, edema, and proteinuria. Eclampsia usually develops in the third trimester of pregnancy or within 24 hours after delivery. If seizures appear more than 48 hours after birth, eclampsia is unlikely (CNS pathology must be excluded). Pathomorphologically, eclampsia is cerebral edema, plethora, thrombosis, and hemorrhage.

Convulsive seizures during eclampsia develop in a certain sequence. First, small fibrillar contractions of the facial muscles appear (15–30 s), then tonic convulsions of the entire skeletal muscles with loss of consciousness (15–20 s), which are replaced by clonic convulsions of the muscles of the trunk, upper and lower extremities and, finally, short-term or prolonged coma. Consciousness returns gradually. In especially severe cases, eclampsia can occur without seizures (comatose form). Eclampsia often manifests itself with a small number of seizures and is not accompanied by high blood pressure. During and after seizures, the patient may die from pulmonary edema, cerebral hemorrhage, asphyxia; the fetus often dies in utero from hypoxia. The prognosis depends on the number and duration of seizures or the duration of coma, so the first priority in the treatment of eclampsia is to relieve seizures.

In emergency medicine, diazepam is the drug of choice for the relief of convulsive seizures and status epilepticus.

The mechanism of anticonvulsant (antiepileptic) action of diazepam is the result of activation of inhibitory processes in the brain, realized through gamma-aminobutyric acid (GABA): diazepam, disrupting the binding of certain proteins to benzodiazepine receptors, causes their disinhibition, which leads to activation of GABAergic receptors and increased effects GABA.

For convulsions and convulsive conditions, diazepam is administered intravenously slowly over 3 minutes at a dose of 5–10 mg (if necessary, the drug is repeated after 10–15 minutes until a total single dose of 30 mg is reached).

With long-term use of barbiturates (for example, in patients with epilepsy), stimulation of the liver enzyme system is observed, therefore, when administered in combination, the metabolism of all benzodiazepine derivatives (including diazepam) is accelerated. Accordingly, when providing emergency care to patients with epilepsy, which often requires combined pharmacotherapy with barbiturates and benzodiazepines, the likelihood of such metabolic changes should be taken into account and drug doses should be adjusted as necessary.

Withdrawal syndrome and delirium in alcoholism and other drug addictions

Pathogenetically, withdrawal syndrome is an attempt by the body, using its own resources, in the absence of a psychoactive substance (alcohol or drug), to reproduce the conditions corresponding to the state of intoxication, that is, the conditions necessary for the satisfactory functioning of the body.

The biochemical processes that were rearranged during the development of increased tolerance to ethanol continue to occur as before, while the opposing effects of increased ethanol concentrations disappear (when its intake is discontinued).

As a result, a sharp disruption of the autonomic nervous system occurs, manifested in excessive activation of its sympathetic department while weakening the cholinergic effects. In addition, central inhibition is weakened in the central nervous system, which is clinically expressed in the development of tachycardia, hypertension, vasospasms (causing severe headaches, heart pain), severe agitation, accompanied by aggressiveness and a subjective feeling of anxiety.

With long-term drug use, a deficiency of neurotransmitters can develop, which in itself threatens the functioning of the body. The mechanism for compensating for this phenomenon is the enhanced synthesis of catecholamines and the suppression of the activity of enzymes of their metabolism. During abstinence, increased release of catecholamines from the depot does not occur, but their accelerated synthesis remains. Due to changes in enzyme activity, dopamine accumulates in biological fluids and tissues. It is this process that determines the development of the main clinical signs of withdrawal syndrome - high anxiety, tension, agitation, increased blood pressure, increased heart rate, the appearance of other autonomic disorders, and sleep disturbances.

There is reliable evidence about the commonality of the mechanism of action of depressants. The common link is GABA, the main inhibitory neurotransmitter of the brain. Alcohol, barbiturates, non-barbiturate sedatives and, of course, benzodiazepines have similar effects at equivalent dosages. There is cross-tolerance between them; they can reinforce each other. There is also cross-dependence, since an appropriate dose of any depressant can be used to reduce withdrawal symptoms caused by any other.

Thus, the use of benzodiazepine tranquilizers, the interaction of which with receptors leads to an increase in the effectiveness of endogenous GABA, in alcohol withdrawal syndrome is pathogenetically justified.

One of the main drugs for the treatment of alcohol withdrawal syndrome and alcoholic delirium is diazepam. The most significant pharmacological properties of the drug for the practice of treating alcohol pathology are anxiolytic, hypnotic and anticonvulsant effects. It should be noted that, despite the favorable spectrum of activity of the drug, monotherapy for alcohol disorders with diazepam is usually not effective enough. However, its use against the background of established drug addiction is highly effective in all conditions accompanied by anxiety, agitation, insomnia, and increased paroxysmal readiness. In the latter case, the drug is used for seizures caused by the effects of cocaine, prescribing diazepam along with short-acting barbiturates (hexobarbital and sodium thiopental).

Diazepam is administered at an initial dose of 10 mg IV, then 5-10 mg (every 3-4 hours), maintenance treatment - IV drip (100 mg in 500 ml of 0.9% sodium chloride solution or 5% r -ra glucose) at an average dose of 2.5–5 mg/hour.

For patients with opioid addiction, diazepam is a subjectively significant drug present in the area of ​​illicit trafficking in psychoactive drugs. Drug addicts can use it for self-medication in attempts to overcome tolerance to opioids, and also (in recent years, relatively rarely) as a component that prolongs the main psychotropic effects of artisanal derivatives of the sleeping pill poppy. When taken together with diacetylmorphine (heroin), diazepam increases the risk of overdose of the latter.

The combination of diazepam and alcohol (ethanol = ethyl alcohol) is dangerous due to the possibility of potentiating the effect of central nervous system depression. Patients with alcoholism develop cross-tolerance and possible cross-dependence on ethanol and diazepam.

Diazepam has a local irritant effect. Intravenous administration of diazepam to patients with alcoholism, even in low doses (NB!) can cause respiratory arrest.

Conditions accompanied by anxiety and fear

“Normal” (physiological) anxiety is the most important adaptive mechanism, without which human existence itself is impossible. The emergence and regulation of anxiety is ensured by the complex interaction of a number of mediator systems: catecholaminergic, serotonergic, endocrine. The interaction between excitatory amines (glutamate, aspartate) and the GABAergic system is of greatest importance for the regulation of neuronal activity. A shift in the balance towards excitatory amines leads to an increase in the level of neuronal activity, the emergence of anxiety, and arousal. An inappropriately severe anxiety reaction to a traumatic situation may occur if the person has a low threshold for anxiety response. A possible reason for this may be insufficient activity of the GABAergic system and, in particular, the GABA-benzodiazepine receptor complex. In patients with generalized anxiety disorder, a reduced number of benzodiazepine receptors was found in the temporal lobes of the brain (T. Tiihinen et al., 1997). In turn, D. Nutt and A. Malizia (2001) believe that inhibition of GABAergic transmission is an important mechanism leading to the occurrence of an excessive anxiety reaction.

Panic attacks are sudden episodes of severe anxiety that typically begin unexpectedly and without warning or apparent cause. The attacks usually last from a minute to an hour and occur on average two to four times a week. In some cases, attacks disappear for a long time, and then return again for no apparent reason. The severity of attacks can vary significantly, even within the same person. Panic attacks may not cause death, but they can cause suffering and significantly reduce quality of life.

Factors that directly provoke the development of panic attacks include:

• psychogenic: - a situation of conflict climax (divorce, explanation with a spouse, leaving the family); - acute stressors (death of loved ones, illness or accident); — abstract factors operating through the mechanism of identification or opposition (films, books, etc.);
• physiological: - hormonal changes (pregnancy, childbirth, end of lactation, menopause); - onset of sexual activity, taking hormonal medications, abortion; — menstrual cycle (its irregularities, the last phase of the cycle);
• others: - alcohol abuse; — meteorological factors; - excessive physical activity.

An inexplicable, painful attack of fear or anxiety for the patient is combined with various vegetative (somatic) symptoms. A panic attack is diagnosed when there is paroxysmal fear, often accompanied by a feeling of impending doom or anxiety and/or a feeling of internal tension with symptoms associated with panic.

Four or more of the following symptoms must be present:

• cardiopalmus;
• sweating;
• chills, tremors, feeling of internal trembling;
• feeling of lack of air or suffocation;
• pain or discomfort in the left side of the chest;
• nausea or abdominal discomfort, loose stools;
• feeling dizzy, unsteady or unsteady when walking, feeling lightheaded or lightheaded;
• phenomena of derealization and/or depersonalization;
• fear of death, fear of going crazy or committing an uncontrollable act;
• numbness or tingling sensation (paresthesia) in the limbs;
• sensation of waves of heat or cold passing through the body.

The most common somatic diseases accompanied by anxiety, agitation and fear encountered in the practice of an emergency physician are acute myocardial infarction, angina pectoris, and hypertensive crisis. Of course, the primary task is to relieve pain, measures aimed at stabilizing hemodynamics and eliminating hypoxia, however, the creation of psycho-emotional peace is of no small importance, which makes it necessary to use psychotropic drugs.

Benzodiazepine tranquilizers remain the most effective method for relieving anxiety disorders. The anxiolytic effect is associated, on the one hand, with their inhibitory effect on the reticular formation of the brainstem and the cerebral cortex, and on the other, with the activation of the GABAergic system. Fears that their use leads to the formation of drug dependence have turned out to be excessive and unjustifiably limit the use of benzodiazepines (D. Williams, A. McBride, 1998).

The initial dose of diazepam for anxiety and fear is 5–10 mg, repeated administration is possible after 3–4 hours.

Conditions accompanied by increased muscle tone

Tetanus. Tetanus spores germinate into a vegetative form that produces tetanus toxins - tetanospasmin and tetanolysin (tetanohemolysin). Tetanospasmin initially acts on peripheral nerves, causing local tetanic muscle contractions. The toxin is fixed on the surface of the nerve cell, penetrates it and, through retrograde axonal transport, enters the cells of the central nervous system. The mechanism of action is associated with the suppression of the release of inhibitory neurotransmitters, in particular glycine and GABA in central and peripheral synapses, as well as with the effect on synaptobrevin and cellubrevin. With tetanus, interneurons of polysynaptic reflex arcs are affected, which removes all types of inhibition. Excitation impulses continuously flow to the muscles, causing their tonic tension. Tetanic convulsions occur periodically. At the same time, damage to vital parts of the brain is observed, especially the respiratory and cardiovascular centers and the nuclei of the vagus nerve.

Diazepam is used in the complex therapy of tetanus to relieve tetanus (from the Greek tetanos - numbness, convulsion) - a state of prolonged contraction, maximum muscle tension, which occurs when individual nerve impulses arrive at it with such a frequency that relaxation between successive single contractions does not occur.

The muscle-relaxing effect of diazepam is due to the suppression of polysynaptic spinal reflexes and stimulation of GABAergic systems.

For tetanus, diazepam is administered at a dose of 0.1–0.3 mg/kg IV every 1–4 hours, up to 4–10 mg/kg/day.

Uncontrollable vomiting . Regulation of the gag reflex is carried out with the participation of diverse neuro-reflex links. The main afferent pathway of the reflex arc is the sensory fibers of the vagus nerve. The vomiting center, located in the medulla oblongata near the sensitive nucleus of the vagus nerve, is part of the reticular formation and is coordinated by influences coming from the cerebral cortex, vestibular labyrinth and cerebellum. The efferent pathway of the gag reflex is the phrenic and vagus nerves; various neurotransmitters are involved, among which gamma-aminobutyric acid is essential.

The main mechanisms for the development of vomiting: neuro-reflex, central, conditioned reflex, vomiting of pregnant women.

Most often, nausea and vomiting develop along the neuro-reflex pathway and are the result of excitation of the vomiting center under the influence of impulses arriving along the sensory fibers of the vagus nerve from the esophagus, stomach, intestines, biliary and urinary tracts, uterus, peritoneum in response to stretching of the walls of these organs or exposure to certain substances.

Vomiting of central origin can develop due to a toxic effect on the vomiting center (carbon monoxide poisoning, digitalis preparations, apomorphine, chemotherapy, alkalosis, infections), due to its mechanical irritation (concussion, hemorrhage, inflammation of the meninges, increased intracranial pressure), ischemia (impairment blood circulation in the vertebrobasilar region). Vomiting against the background of increased intracranial pressure is characterized by headaches, photophobia and absence of nausea. The occurrence of nausea is more closely related to impaired motility of the stomach and intestines. Vomiting of central origin also includes cases of its occurrence under the influence of pathological impulses coming from the organ of hearing and balance.

Benzodiazepines, in particular diazepam, act on the main links in the pathogenesis of vomiting (suppress the activity of the reticular formation, excite GABA receptors, suppress parasympathetic and vestibular paroxysms), are most widely used in the treatment of conditioned reflex vomiting, and are also included in treatment regimens for vomiting that develops background of chemotherapy and radiation therapy of malignant tumors.

For indomitable vomiting, diazepam is administered intravenously or intramuscularly at an initial dose of 10 mg, followed by a possible increase to a total single dose of 30 mg.

Possible side effects when using diazepam

From the side of the central nervous system . Possible: drowsiness, fatigue, dizziness (especially pronounced in the first days of use), apathy, decreased libido, slowed motor reactions, memory impairment. This is due to the effect on the limbic system: the spontaneous activity of hippocampal neurons is suppressed, the impulse aftereffect in the limbic system and hypothalamus is suppressed, and the activating influence of the reticular formation of the brain stem is suppressed. It is realized due to the interaction of the drug with benzodiazepine receptors in the central nervous system, which in turn are closely related to GABA-A receptors. When the drug interacts with the benzodiazepine receptor, allosteric activation of GABA-A receptors occurs, the affinity of GABA for GABA-A receptors increases, as a result of which the inhibitory effect of GABA is enhanced. Side effects on the central nervous system are usually dose-dependent. In elderly people, especially with cerebrovascular diseases, as well as patients with organic cerebral insufficiency, diazepam can cause a state of confusion. Diazepam can be addictive with the formation of drug dependence, which is especially important for people who have some experience in using psychoactive substances to change their mental state (alcoholics, drug and substance abusers).

From the cardiovascular system . Under the influence of diazepam, the cellular uptake of adenosine may increase with an increase in the negative chronotropic and dromotropic effects of the latter on the myocardium. Due to the negative dromotropic effect, diazepam has a weak antiarrhythmic effect. In addition, the drug inhibits myocardial contractility, which leads to a decrease in cardiac output. This is probably due to its muscle relaxant effect. Rarely, when taking the drug, hypotension occurs, which is probably due to some inhibitory effect on the vasomotor center of the medulla oblongata. In addition, there is probably a direct vasodilating effect on resistive vessels, including the coronary arteries, which is due to inhibition of adrenergic systems.

From the gastrointestinal tract (GIT). Dry mouth is associated with the anticholinergic effect of the drug, a decrease in saliva production. Due to the loss of the protective function of saliva, in rare cases, the development of candidal stomatitis is possible. Impaired gastrointestinal motility and passage of food through the intestines lead in rare cases to the development of atonic constipation. This is probably due to the anticholinergic (muscle relaxant) effect of the drug. The drug undergoes oxidative metabolism in the liver, therefore, in patients with impaired liver function (old age, alcoholic hepatitis, previous viral hepatitis), an increase in the level of transaminases and alkaline phosphatase in the blood serum, as well as the appearance of jaundice, is extremely rare.

From the urinary system . Dysuria may develop, and urinary retention occurs extremely rarely, which is explained by the muscle relaxant effect.

From the reproductive system - decreased libido (usually with long-term use).

On the part of the respiratory system, slight respiratory depression is possible due to the inhibitory effect of the drug on the respiratory center of the medulla oblongata. This effect predominantly develops in patients with COPD and only with parenteral administration of the drug. Therefore, diazepam should be used with caution in obstructive pulmonary diseases, especially in combination with dysfunction of the cardiovascular system.

Overdose of benzodiazepine tranquilizers

In case of overdose of diazepam, lorazepam, alprazolam, phenazepam, etc., an antidote is used - a specific benzodiazepine receptor antagonist - flumazenil (Mazicon, Romazicon, Anexat).

Flumazenil is available in ampoules of 5 and 10 ml for intravenous administration in the form of a 0.01% solution (0.1 mg per 1 ml). The drug is effective only in case of poisoning (overdose) with benzodiazepine drugs. Flumazenil is used in a 5% dextrose solution or 0.9% sodium chloride solution, the initial dose is 0.2–0.3 mg, then the doses are incrementally increased, 0.1 mg every minute to a total dose of 2 mg (Figure).

In case of severe benzodiazepine poisoning accompanied by coma, flumazenil - in the absence of a positive effect (restoration of consciousness), the drug can be repeated within a few minutes, the maximum single dose is 2 mg.

Side effects of large (more than 10 mg) doses of flumazenil include nausea, vomiting, and anxiety. Contraindications to the administration of the drug: combined poisoning with benzodiazepine derivatives and tricyclic antidepressants, overdose of benzodiazepines in patients with epilepsy (convulsive conditions are possible).

The number of side effects can be significantly reduced or even avoided altogether if treatment is started with the smallest doses and gradually increased. Most side effects appear at the beginning of treatment and then gradually subside as treatment continues.

Main contraindications to the use of diazepam

Such conditions can be divided according to the main effects of the drug (

.):

1. Depressant effect on the central nervous system: • coma; • state of alcoholic intoxication of varying severity; • acute intoxication with drugs that have a depressant effect on the central nervous system (narcotic, hypnotic and psychotropic drugs); • shock; • children up to 30 days inclusive.
2. The ability to cause drug dependence: • phenomena of dependence on drugs, alcohol (with the exception of the treatment of alcohol withdrawal syndrome and delirium).
3. The ability to cause respiratory depression: • severe chronic obstructive pulmonary diseases (risk of progression of respiratory failure); • acute respiratory failure; • sleep apnea syndrome.
4. Muscle relaxant effect: • severe myasthenia gravis; • angle-closure glaucoma.
5. Teratogenic effect: • pregnancy (especially the 1st and 3rd trimesters).
6. Individual sensitivity: • hypersensitivity to the drug.

V. G. Moskvichev , Candidate of Medical Sciences, Associate Professor V. S. Filimonov Z. B. Dotkaeva A. L. Vertkin , Doctor of Medical Sciences, Professor NNPO Emergency Medical Care, MGMSU , Moscow

Application in the treatment of alcoholism

Indications for the use of Diazepam in the treatment of chronic alcoholism are the development of delirium and severe withdrawal syndrome. The person’s condition at this moment becomes severe, as there is a failure in the central regulatory system responsible for mood and emotions. Severe stimulation of brain structures is accompanied by life-threatening symptoms.

The mechanism of action of Diazepam is to reduce the excitability of nerve cells. This helps to relieve all the main symptoms and eliminates:

• anxiety
• psychomotor agitation
• sleep disturbance

The drug helps increase the pain threshold, reduces the need for peripheral tissues for oxygen, and eliminates syndromes caused by activation of the autonomic nervous system. All the main effects of Diazepam have a beneficial effect during the treatment of chronic alcoholism. It makes it much easier to survive the signs of withdrawal, stopping most of its symptoms. The medicine eliminates hand tremors, unmotivated aggression, convulsive syndrome, and hallucinosis.

For acute psychotic manifestations in an alcoholic during the withdrawal period, the drug is best administered intravenously or intramuscularly. This allows you to quickly fix the problem. At home, it is recommended to use rectal administration. Oral administration is not always appropriate, especially when nausea and vomiting occur.

Diazepam (tablets, solution) prescription in Latin

Recipe for Diazepam in Latin:

An example of how to correctly write out a prescription for Seduxen (diazepam) in Latin in tablets and ampoules - a drug from the anxiolytic group, used to sedate patients with psychomotor agitation, dispensed with a prescription in the form 148-u/1-88.

Recipe for diazepam tablets in Latin

Recipe in Latin for diazepam - 0.5% solution in ampoules

The information is intended for specialists and students of medical universities. Do not self-medicate; consult a doctor for qualified help.

General information:

Active substance

: Diazepam (INN)
Pharmacological group
: Anxiolytics
Prescription form
: N 148-1/u-88
Trade names
:

• Ralanium
• Sibazol
• Seduxen
• Relium
• Diazepex
• Diazepam
• Valium Roche
• Apaurin
• Relanium
• Diapam
• Diazepabene

Diazepam is available with prescription 148-1/u-88. Contraindicated in acute kidney disease, liver disease, severe myasthenia gravis, glaucoma, severe hypercapnia, pregnancy in the first trimester, as well as in case of individual hypersensitivity.

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Drug interactions

When used simultaneously with drugs that have a depressant effect on the central nervous system (including neuroleptics, sedatives, hypnotics, opioid analgesics, anesthetics), the depressant effect on the central nervous system, on the respiratory center, and severe arterial hypotension increases.

When used simultaneously with tricyclic antidepressants (including amitriptyline), it is possible to enhance the inhibitory effect on the central nervous system, increase the concentration of antidepressants and enhance the cholinergic effect.

In patients receiving long-term centrally acting antihypertensive drugs, beta-blockers, anticoagulants, cardiac glycosides, the degree and mechanisms of drug interaction are unpredictable.

When used simultaneously with muscle relaxants, the effect of muscle relaxants is enhanced and the risk of apnea increases.

When used simultaneously with oral contraceptives, the effects of diazepam may be enhanced. The risk of breakthrough bleeding increases.

When used simultaneously with bupivacaine, it is possible to increase the concentration of bupivacaine in the blood plasma; with diclofenac - increased dizziness is possible; with isoniazid - decreased excretion of diazepam from the body.

Drugs that cause induction of liver enzymes, incl. antiepileptic drugs (carbamazepine, phenytoin) can accelerate the elimination of diazepam.

When used simultaneously with caffeine, the sedative and possibly anxiolytic effect of diazepam is reduced.

When used simultaneously with clozapine, severe arterial hypotension, respiratory depression, and loss of consciousness are possible; with levodopa - it is possible to suppress the antiparkinsonian effect; with lithium carbonate - a case of the development of a coma has been described; with metoprolol - a decrease in visual acuity and worsening psychomotor reactions are possible.

When used simultaneously with paracetamol, it is possible to reduce the excretion of diazepam and its metabolite (desmethyldiazepam); with risperidone - cases of the development of NMS have been described.

When used simultaneously with rifampicin, the excretion of diazepam increases due to a significant increase in its metabolism under the influence of rifampicin.

Theophylline in low doses distorts the sedative effect of diazepam.

When used simultaneously in rare cases, diazepam suppresses metabolism and enhances the effect of phenytoin. Phenobarbital and phenytoin may accelerate the metabolism of diazepam.

When used concomitantly, fluvoxamine increases plasma concentrations and side effects of diazepam.

When used simultaneously with cimetidine, omeprazole, disulfiram, it is possible to increase the intensity and duration of action of diazepam.

When taking ethanol and ethanol-containing drugs simultaneously, the inhibitory effect on the central nervous system (mainly on the respiratory center) increases, and pathological intoxication syndrome may also occur.

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