Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. If used together, a reduction in the dose of one or both drugs may be needed. Use caution with this combination. There are reports of sedation, poor feeding, and poor weight gain in infants exposed to benzodiazepines through breast milk. Diazepam is indicated for the management of anxiety disorders or for the short-term relief of the symptoms of anxiety. Do not use more than 2 doses to treat a single episode. There have also been reports that the metabolic elimination of phenytoin is decreased by diazepam. Diazepam is a CYP3A substrate and maribavir is a weak CYP3A inhibitor. The use of benzodiazepines exposes users to risks of abuse, misuse, and addiction, which can lead to overdose or death. Levonorgestrel; Ethinyl Estradiol; Ferrous Bisglycinate: (Minor) Ethinyl estradiol may inhibit the clearance of benzodiazepines that undergo oxidation, thereby increasing serum concentrations of concomitantly administered benzodiazepines. 10 mg administered as an intramuscular injection before surgery. Pharmacokinetic parameters were similar between seizure and non-seizure states in patients with epilepsy. Phentermine; Topiramate: (Moderate) Topiramate has the potential to cause CNS depression as well as other cognitive and/or neuropsychiatric adverse reactions. Diazepam is not recommended for chronic, daily use as an anticonvulsant. (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. Concomitant administration of apomorphine and benzodiazepines could result in additive depressant effects. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. doi: 10.1002/14651858.CD009491.pub2. Presence in Breast Milk, Medline Plus, Advise patients to seek immediate medical attention if they experience symptoms such as trouble breathing. To reduce the risk of withdrawal reactions, use a gradual taper to discontinue diazepam tablets or reduce the dosage (see, Compounds Which Inhibit Certain Hepatic Enzymes, Injury, Poisoning and Procedural Complications. Telotristat Ethyl: (Moderate) Monitor patients for decreased efficacy of diazepam if coadministration with telotristat is necessary. Lower doses (usually 2 mg to 5 mg) and slow increase in dosage should be used for elderly or debilitated patients and when other sedative drugs are administered. If parenteral diazepam is used with an opiate agonist, reduce the opiate agonist dosage by at least 1/3. Uses; Warnings; Before taking; Side effects; Interactions Do not treat more than 1 episode every 5 days and more than 5 episodes/month. Titrate by 0.1 mg/kg/hour if symptoms persist as long as respiratory rate is maintained at an adequate rate based on age. If parental diazepam is used with an opiate agonist, reduce the opiate agonist dosage by at least 1/3. Do not treat more than 1 episode every 5 days and more than 5 episodes/month. 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. If concurrent use is necessary, initiate pregabalin at the lowest recommended dose and monitor patients for symptoms of respiratory depression and sedation. (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. Modafinil: (Moderate) Modafinil has demonstrated an inhibition of the CYP2C19 hepatic microsomal isoenzyme at pharmacologically relevant concentrations. Concurrent use may increase diazepam exposure. Meperidine; Promethazine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. PMC If parental diazepam is used with an opiate agonist, reduce the opiate agonist dosage by at least 1/3. Belzutifan: (Moderate) Monitor patients for decreased efficacy of diazepam if coadministration with belzutifan is necessary. Use caution with this combination. 0.3 mg/kg/dose rectally once; round dose upward to the next available dosage strength. Triprolidine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. In acute conditions the injection may be repeated within one hour although an interval of 3 to 4 hours is usually satisfactory. 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. If concomitant use of ketoconazole and vardenafil oral tablets is required, the maximum single vardenafil oral tablet dose is 5 mg every 24 hours for patients receiving ketoconazole 200 mg daily and 2.5 mg every 24 hours for patients receiving ketoconazole 400 mg daily. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Monitor patients for decreased pressor effect if these agents are administered concomitantly. Acetaminophen; Chlorpheniramine; Dextromethorphan: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Monitor patients for decreased pressor effect if these agents are administered concomitantly. [43932]. 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. Oritavancin: (Moderate) Coadministration of oritavancin and diazepam may result in increases or decreases in diazepam exposure and may increase side effects or decrease efficacy of diazepam. To reduce the possibility of venous thrombosis, phlebitis, local irritation, and rarely, vascular impairment, inject slowly and do not use small veins, such as those on the dorsum of the hand or wrist. Diazepam is a CYP3A4 substrate and crizotinib is a moderate CYP3A inhibitor. Dosage adjustments may be necessary when administered together because of potentially additive CNS effects. Risk factors for the development of prolonged QT syndrome may include the use of benzodiazepines. Use lower initial adult doses for the debilitated adult patient. A decrease in the diazepam dose may be needed Pseudoephedrine; Triprolidine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. To minimize potential for interactions, consider administering oral anticonvulsants at least 1 hour before or at least 4 hours after colesevelam. 10 mg, 3 or 4 times during the first 24 hours, reducing to 5 mg, 3 or 4 times daily as needed. Brimonidine: (Moderate) Based on the sedative effects of brimonidine in individual patients, brimonidine administration has potential to enhance the CNS depressants effects of the anxiolytics, sedatives, and hypnotics including benzodiazepines. Diazepam is a CYP2C9, CYP2C19, and CYP3A4 substrate. Brompheniramine; Dextromethorphan; Phenylephrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Diazepam is a CYP3A4 and CYP2C19 substrate and fedratinib is a moderate CYP3A and CYP2C19 inhibitor. Additionally, barbiturates may increase the metabolism of diazepam. The usual dose is: anxiety - 2mg, taken 3 times a day, this can be increased to 5mg to 10mg, taken 3 times a day sleep problems (related to anxiety) - 5mg to 15mg, taken once a day at bedtime muscle spasms in adults - 2mg to 15 mg a day. The clearance of diazepam is 20 to 30 mL/minute in young adults. [See USP Controlled Room Diazepam is metabolized by CYP3A4, CYP2C9, and CYP2C19. Odevixibat: (Moderate) Monitor patients for decreased efficacy of diazepam if coadministration with odevixibat is necessary. Wean more slowly if withdrawal symptoms occur. Patients receiving benzodiazepines that are metabolized by these isoenzymes may experience decreased benzodiazepine serum concentrations if administered concurrently with efavirenz. Aluminum Hydroxide: (Moderate) The coadministration of diazepam with antacids results in delayed diazepam absorption due to the fact that antacids delay gastric emptying. Generally, a dosage of up to 10 mg is adequate, but up to 20 mg I.V. Limit the use of mixed opiate agonists/antagonists with benzodiazepines to only patients for whom alternative treatment options are inadequate. 6 Aluminum Lake. There is also an increase in the average time to achieve peak concentrations to about 2.5 hours in the presence of food as compared with 1.25 hours when fasting. The initial distribution phase is followed by a prolonged terminal elimination phase (half-life up to 48 hours). Methscopolamine: (Moderate) CNS depression can be increased when methscopolamine is combined with other CNS depressants such as any anxiolytics, sedatives, and hypnotics. Additive sedation and somnolence may occur. 0378-0345-05, 0378-0477-01, There are pregnancy exposure registries that monitor outcomes in pregnant patients exposed to diazepam. Titrate intravenous. Garewal D, Powell S, Milan SJ, Nordmeyer J, Waikar P. Cochrane Database Syst Rev. Cetirizine: (Moderate) Concurrent use of cetirizine/levocetirizine with benzodiazepines should generally be avoided. Usual Dosage: See accompanyingprescribing information. 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. Levoketoconazole: (Moderate) Monitor for an increase in diazepam-related adverse reactions, including sedation and respiratory depression, if coadministration with ketoconazole is necessary. Educate patients about the risks and symptoms of respiratory depression and sedation. Diazepam is a CYP3A substrate and taurursodiol is a CYP3A inducer. However, a longer duration of therapy should not preclude the possibility of an association to the drug since most studies included in the analysis did not continue beyond 24 weeks. Conclusions: 10 mg in 1 nostril once, for a total dose of 10 mg. May give a second dose after at least 4 hours after the initial dose, if required. 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. Cimetidine: (Moderate) Monitor for an increase in diazepam-related adverse reactions, including sedation and respiratory depression, if coadministration with cimetidine is necessary. Diazepam is a CYP3A substrate and erythromycin is a CYP3A inhibitor. Cyp3A inducer factors for the development of prolonged QT syndrome may include the use of opiate pain with... 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