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Currently viewing BNF. Forms available from special-order manufacturers include: oral suspension, oral solution, suppository. The MHRA reminds healthcare professionals that benzodiazepines and benzodiazepine-like drugs co-prescribed with opioids can produce additive CNS depressant effects, thereby increasing the risk of sedation, respiratory depression, coma, and death. Healthcare professionals are advised to only co-prescribe if there is no alternative and, if necessary, the lowest possible doses should be given for the shortest duration. Patients should be closely monitored for signs of respiratory depression at initiation of treatment and when there is any change in prescribing, such as dose adjustments or new interactions. If methadone is co-prescribed with a benzodiazepine or benzodiazepine-like drug, the respiratory depressant effect of methadone may be delayed; patients should be monitored for at least 2 weeks after initiation or changes in prescribing. Patients should be informed of the signs and symptoms of respiratory depression and sedation, and advised to seek urgent medical attention should these occur. Benzodiazepines should only be administered for anaesthesia by, or under the direct supervision of, personnel experienced in their use, with adequate training in anaesthesia and airway management. Acute pulmonary insufficiency; marked neuromuscular respiratory weakness; not for use alone to treat chronic psychosis in adults ; not for use alone to treat depression or anxiety associated with depression in adults ; obsessional states; phobic states; sleep apnoea syndrome; unstable myasthenia gravis. Avoid injections containing benzyl alcohol in neonates; chronic psychosis in adults ; CNS depression; compromised airway; hyperkinesis; respiratory depression. Avoid prolonged use and abrupt withdrawal thereafter ; debilitated patients reduce dose in adults ; elderly reduce dose in adults ; history of alcohol dependence or abuse; history of drug dependence or abuse; myasthenia gravis; personality disorder within the fearful group—dependent, avoidant, obsessive-compulsive may increase risk of dependence; respiratory disease. A paradoxical increase in hostility and aggression may be reported by patients taking benzodiazepines. The effects range from talkativeness and excitement to aggressive and antisocial acts. Adjustment of the dose up or down sometimes attenuates the impulses. Increased anxiety and perceptual disorders are other paradoxical effects. Potentially inappropriate:. Muscle weakness; organic brain changes; parenteral administration close observation required until full recovery from sedation. High risk of venous thrombophlebitis with intravenous use reduced by using an emulsion formulation. When given intravenously facilities for reversing respiratory depression with mechanical ventilation must be immediately available. Alertness decreased; anxiety; ataxia more common in elderly ; confusion more common in elderly ; depression; dizziness; drowsiness; dysarthria; fatigue; headache; hypotension; mood altered; muscle weakness; nausea; respiratory depression particularly with high dose and intravenous use—facilities for its treatment are essential ; sleep disorders; tremor; vision disorders; withdrawal syndrome. Agitation more common in children and elderly ; anterograde amnesia; behaviour abnormal; hallucination; libido disorder; rash. Aggression more common in children and elderly ; blood disorder; delusions; jaundice; paradoxical drug reaction; restlessness with sedative and peri-operative use ; urinary retention. Benzodiazepines taken alone cause drowsiness, ataxia, dysarthria, nystagmus, and occasionally respiratory depression, and coma. For details on the management of poisoning, see Benzodiazepines, under Emergency treatment of poisoning. Appetite abnormal; concentration impaired; gastrointestinal disorder; movement disorders; muscle spasms; palpitations; sensory disorder; vomiting. Bradycardia; bronchial secretion increased; cardiac arrest; dry mouth; gynaecomastia; heart failure; leucopenia; loss of consciousness; memory loss; respiratory arrest; sexual dysfunction; syncope; urinary incontinence; vertigo. Chest pain in adults ; embolism and thrombosis in adults ; fall in adults ; increased risk of dementia in adults ; psychiatric disorders in adults ; soft tissue necrosis in adults ; urticaria in adults. Risk of neonatal withdrawal symptoms when used during pregnancy. Avoid regular use and use only if there is a clear indication such as seizure control. High doses administered during late pregnancy or labour may cause neonatal hypothermia, hypotonia, and respiratory depression. Women who have seizures in the second half of pregnancy should be assessed for eclampsia before any change is made to antiepileptic treatment. Status epilepticus should be treated according to the standard protocol. All pregnant women with epilepsy, whether taking medication or not, should be encouraged to notify the UK Epilepsy and Pregnancy Register Tel: In general, manufacturers advise caution in mild to moderate impairment; avoid in severe impairment. In general, manufacturers advise dose reduction in mild to moderate impairment, adjust dose according to response. In general, manufacturers advise caution risk of increased cerebral sensitivity to benzodiazepines. For continuous intravenous infusion solution Diazepam , Hameln , dilute to a concentration of max. For intravenous injection , give over 3—5 minutes. Dilute to a concentration of not more than 40 mg in mL. May be diluted to a max. Solution for injection should not be diluted, except for intravenous infusion. Only use intramuscular route when oral and intravenous routes not possible. May cause drowsiness, impair judgement and increase reaction time, and so affect ability to drive or perform skilled tasks; effects of alcohol increased. Moreover the hangover effects of a night dose may impair performance on the following day. For information on legislation regarding driving whilst taking certain controlled drugs, including benzodiazepines, see Drugs and driving under Guidance on prescribing. Patients given sedatives and analgesics during minor outpatient procedures should be very carefully warned about the risks of undertaking skilled tasks e. For intravenous benzodiazepines the risk extends to at least 24 hours after administration. Responsible persons should be available to take patients home afterwards. The dangers of taking alcohol should be emphasised. Navigate to section Indications and dose Unlicensed use Important safety information Contra-indications Cautions Interactions Side-effects Pregnancy Breast feeding Hepatic impairment Renal impairment Directions for administration Palliative care Patient and carer advice Profession specific information Medicinal forms Related treatment summaries Other drugs in class. Interactions View interactions for diazepam. Medicinal forms and pricing There can be variation in the licensing of different medicines containing the same drug. View all medicinal forms and pricing information Or jump straight to: Oral tablet Oral suspension Oral solution Solution for injection Enema. Indications and dose For diazepam Muscle spasm of varied aetiology for diazepam By mouth Adult 2—15 mg daily in divided doses, then increased if necessary to 60 mg daily, adjusted according to response, dose only increased in spastic conditions. Adult 10 mg for 1 dose, then 10 mg for 1 dose, to be administered 4 hours after first dose if required. Child 1—4 years Initially 2. Child 5—11 years Initially 5 mg twice daily. Child 12—17 years Initially 10 mg twice daily, dose can be increased if necessary up to maximum 40 mg per day. Adult 2 mg 3 times a day, dose can be increased if necessary to 15—30 mg daily in divided doses. Elderly 1 mg 3 times a day, dose can be increased if necessary to 7. Adult 1 mg 3 times a day, dose can be increased if necessary to 7. Adult 5—15 mg once daily, to be taken at bedtime. Adult 5—10 mg for 1 dose, then 5—10 mg, to be administered at least 10 minutes after previous dose as required. Adult 5—10 mg for 1 dose, to be given 1—2 hours before procedure. Elderly 2. Adult 2. Adult Up to 20 mg for 1 dose, to be given 1—2 hours before procedure. Adult 10—20 mg for 1 dose, to be administered immediately before procedure. Child 12—17 years 10 mg for 1 dose, then 10 mg for 1 dose, to be administered 10 minutes after first dose if required. Adult 10 mg for 1 dose, then 10 mg for 1 dose, to be administered 10 minutes after first dose if required. Neonate 1. Child 1 month—1 year 5 mg for 1 dose, then 5 mg for 1 dose, to be administered 5—10 minutes after first dose if required. Child 2—11 years 5—10 mg for 1 dose, then 5—10 mg for 1 dose, to be administered 5—10 minutes after first dose if required. Child 12—17 years 10—20 mg for 1 dose, then 10—20 mg for 1 dose, to be administered 5—10 minutes after first dose if required. Adult 10—20 mg for 1 dose, then 10—20 mg for 1 dose, to be administered 5—10 minutes after first dose if required. Elderly 10 mg for 1 dose, then 10 mg for 1 dose, to be administered 5—10 minutes after first dose if required. Child 12—17 years 5—10 mg, dose can be repeated if necessary. Adult 5—10 mg daily. Anaesthesia Benzodiazepines should only be administered for anaesthesia by, or under the direct supervision of, personnel experienced in their use, with adequate training in anaesthesia and airway management. Avoid prolonged use and abrupt withdrawal thereafter ; debilitated patients reduce dose in adults ; elderly reduce dose in adults ; history of alcohol dependence or abuse; history of drug dependence or abuse; myasthenia gravis; personality disorder within the fearful group—dependent, avoidant, obsessive-compulsive may increase risk of dependence; respiratory disease Cautions, further information Paradoxical effects A paradoxical increase in hostility and aggression may be reported by patients taking benzodiazepines. Potentially inappropriate: for a duration of 4 weeks or longer no indication for longer treatment; risk of adverse events; all benzodiazepines should be withdrawn gradually if taken for more than 2 weeks as there is a risk of causing a benzodiazepine withdrawal syndrome if stopped abruptly with acute or chronic respiratory failure i. General cautions: Muscle weakness; organic brain changes; parenteral administration close observation required until full recovery from sedation Specific cautions: With intravenous use High risk of venous thrombophlebitis with intravenous use reduced by using an emulsion formulation Cautions, further information Special precautions for intravenous injection With intravenous use: When given intravenously facilities for reversing respiratory depression with mechanical ventilation must be immediately available. Common or very common Alertness decreased; anxiety; ataxia more common in elderly ; confusion more common in elderly ; depression; dizziness; drowsiness; dysarthria; fatigue; headache; hypotension; mood altered; muscle weakness; nausea; respiratory depression particularly with high dose and intravenous use—facilities for its treatment are essential ; sleep disorders; tremor; vision disorders; withdrawal syndrome Uncommon Agitation more common in children and elderly ; anterograde amnesia; behaviour abnormal; hallucination; libido disorder; rash Rare or very rare Aggression more common in children and elderly ; blood disorder; delusions; jaundice; paradoxical drug reaction; restlessness with sedative and peri-operative use ; urinary retention Frequency not known Drug dependence Overdose Benzodiazepines taken alone cause drowsiness, ataxia, dysarthria, nystagmus, and occasionally respiratory depression, and coma. Epilepsy and Pregnancy Register All pregnant women with epilepsy, whether taking medication or not, should be encouraged to notify the UK Epilepsy and Pregnancy Register Tel: Benzodiazepines with a shorter half-life are considered safer. Dose adjustments In general, manufacturers advise dose reduction in mild to moderate impairment, adjust dose according to response. Dose adjustments In general, manufacturers advise to consider dose reduction. With intravenous use: Diazepam is adsorbed by plastics of infusion bags and giving sets. Expert sources advise emulsion formulation preferred for intravenous use. M For continuous intravenous infusion solution Diazepam , Hameln , dilute to a concentration of max. M With intravenous use for Status epilepticus or Febrile convulsions or Convulsions due to poisoning or Life-threatening acute drug-induced dystonic reactions in children: For intravenous injection , give over 3—5 minutes. M With intramuscular use or intravenous use in adults: Solution for injection should not be diluted, except for intravenous infusion. M With intramuscular use in adults: Only use intramuscular route when oral and intravenous routes not possible. Driving and skilled tasks May cause drowsiness, impair judgement and increase reaction time, and so affect ability to drive or perform skilled tasks; effects of alcohol increased. Patients or carers should be given advice on how and when to administer rectal diazepam. Dental practitioners' formulary Diazepam Tablets may be prescribed. Back to top.

Alteration of Macrophage Functions by Cocaine

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Studies elucidating the effects of cocaine on immune cells and immune function are relatively recent. Although immunomodulation by cocaine has been reported by a number of investigators, it is not consistently associated with immunosuppression. Another study 2 describes a number of immune abnormalities in mice exposed to cocaine including an enhancement of neutrophil phagocytosis, a reduction of T-cell responses to the mitogen phytohemagglutinin, and cytotoxic activity of immune spleen cells. Other reports have described alteration of spleen cell subsets following injection with cocaine 3,4. A number of reports have described a reduction or alteration in the production of certain cytokines 5—7. In a series of publications, Peterson et al. An increase in p24, one of the internal viral proteins, was used to quantify viral replication. This is a preview of subscription content, log in via an institution to check access. Institutional subscriptions. Unable to display preview. Download preview PDF. Watzl B, and Watson RR. Immunomodulation by cocaine-A neuroendocrine mediated response. Life Sci —, Immunological effect of cocaine and host resistance in mice. Google Scholar. Stimulation of natural killer cell activity by murine retroviral infection and cocaine. Tox Let — Modification of spleen cell subsets by chronic cocaine administration and murine retrovirus infection in normal and protein-malnourished mice. Int J Immunopharm —, Cocaine modulation in vitro of tumor necrosis factor production by macrophages from retrovirally-infected mice. Inhibition of cytokine release by cocaine. J Immunol 81—84, Edelman CK, Erice A. Balfour HH. Cocaine amplifies HIV-1 replication in cytomegalovirus-stimulated peripheral blood mononuclear cell cultures. J Immunol —, Human cytomegalovirusstimulated peripheral blood mononuclear cells induce HIV-1 replication via a tumor necrosis factor-amediated mechanism. J Clin Invest —, ;. Cocaine interacts with macrophages to modulate mesangial cell proliferation. Pharm Exptl Therap —, CAS Google Scholar. Cocaine alters the respiratory burst and phagocytic activity of murine macrophages. Clin Immunol Immunopath —, Article Google Scholar. Effects of cocaine on the respiratory burst of murine macrophages. Cocaine reduces macrophage killing by inhibiting reactive nitrogen intermediates. The effects of cocaine and its metabolites on the production of reactive oxygen and reactive nitrogen intermediates. Life Sci. Smith DL, Rommel F. A rapid micro method for the simultaneous determination of phagocytic-microbiocidal activity of human peripheral blood leukocytes in vitro. Plasmid-mediated resistance to phagocytosis in Yersinia enterolitica. Infect Immun —83 ;. Molecular mechanisms associated with cocaine-induced modulation of human T lymphocyte proliferation. The suppression of macrophage secretion by calcium blockers and adenosine. Immunopharm and Immunotox —, Suppression of macrophage reactive intermediates by cocaine. Verapamil inhibits influenza A virus replication. Archives of Virol —, Schlesinger MJ and Cahill D. Verapamil and chlorpromazine inhibit the budding of sindbis and vesicular stomatitis viruses from infected chicken embryo fibroblasts. Virology —, Download references. Lincoln, T. Cain, D. You can also search for this author in PubMed Google Scholar. Reprints and permissions. Lefkowitz, S. Alteration of Macrophage Functions by Cocaine. In: Friedman, H. Advances in Experimental Medicine and Biology, vol Springer, Boston, MA. Print ISBN : Online ISBN : Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Policies and ethics. Skip to main content. Abstract Studies elucidating the effects of cocaine on immune cells and immune function are relatively recent. Access this chapter Log in via an institution. Chapter EUR Softcover Book EUR Tax calculation will be finalised at checkout Purchases are for personal use only. Preview Unable to display preview. Granulocyte colony-stimulating factor G-CSF enhances cocaine effects in the nucleus accumbens via a dopamine release—based mechanism Article 06 September Angiotensin-converting enzyme in innate and adaptive immunity Article 26 March Granulocyte-colony stimulating factor controls neural and behavioral plasticity in response to cocaine Article Open access 16 January Lefkowitz Authors S. Lefkowitz View author publications. View author publications. Rights and permissions Reprints and permissions. About this chapter Cite this chapter Lefkowitz, S. Copy to clipboard. Publish with us Policies and ethics. Search Search by keyword or author Search. Navigation Find a journal Publish with us Track your research.

Pai where can I buy cocaine