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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.

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Vinood Patel does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment. When anyone under the age of 40 is admitted to a hospital emergency department complaining of chest pain, the doctor is likely to ask if the patient has taken cocaine. Cocaine use is a risk factor for heart attacks, but that risk is magnified when combined with alcohol. According to EU data, around 2. And cocaine use in the UK has been increasing rapidly , with Bristol and London leading the way. Londoners consume twice the amount of any other European city — roughly 23kg of the class A drug every day. Cocaine has many effects on the body but has several target organs: the brain, heart and liver. Cocaine affects the brain by increasing the amount of a chemical called dopamine in the brain, which causes a person to feel euphoric, have more energy and feel more confident. Cocaine stimulates the reward centre of the brain within seconds to minutes. But the effects are short-lived, lasting between five and 30 minutes, which partly depends on how it is taken. Injecting or smoking cocaine results in a shorter-lasting high five to ten minutes than snorting 15 to 30 minutes. Read more: Explainer: what is dopamine — and is it to blame for our addictions? The short-lasting effects cause a user to repeat taking cocaine for the rewarding stimulus, which can result in a person eventually becoming addicted. The consequences of long-term use include an increased risk of stroke, heart attack and depression. Many people who take cocaine drink alcohol at the same time. This is in part because of the opposing physiological effects of each drug. Cocaine can increase anxiety, whereas alcohol acts as a depressant, which relieves anxiety. Despite this, an unknown consequence to many regular or even recreational users is that combining alcohol with cocaine is cardiotoxic. The liver is the major organ where cocaine is metabolised broken down. But when cocaine is taken with alcohol, the liver produces a new byproduct called cocaethylene. Cocaethylene also remains in the blood circulation three to five times longer than cocaine. Read more: Middle class cocaine users are a scapegoat for ineffective drugs policy. Cocaethylene has considerably greater potency than cocaine, increasing the heart rate and blood pressure, which can lead to increased risk of stroke, arrhythmia and heart attack. Some studies suggest a fold increased risk of a heart attack when cocaine and alcohol are used together. Our group has shown that binge drinking can increase the risk of a heart attack. As cocaethylene blocks the reabsorption of dopamine in the brain, it produces higher euphoric effects for both cocaine and alcohol, which can create a vicious cycle of taking more of each drug. A person is also more likely to engage in risky and violent behaviour. Both alcohol and cocaine alone can cause inflammation hepatitis to the liver, however, when taken together where cocaethylene is produced, studies have reported greater liver injury. As cocaine is more readily available in many cities across the world, it is important for users to be fully aware of the short- and long-term health risks of using cocaine and alcohol because the consequences can be fatal. Edition: Available editions Europe. Become an author Sign up as a reader Sign in. Vinood Patel , University of Westminster. Alcohol Depression Stroke Heart attack Cocaine. Events More events.

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