Diazepam and the BNF: Essential Information for Safe Use

Diazepam, commonly known by its brand name Valium, is a widely prescribed medication used to treat a variety of conditions, including anxiety, muscle spasms, and seizures. It belongs to a class of drugs called benzodiazepines, which work by enhancing the effect of a neurotransmitter called gamma-aminobutyric acid (GABA) in the brain, producing a calming effect. The British National Formulary (BNF) is a crucial resource for healthcare professionals in the UK, providing detailed information about the safe and effective use of medications, including diazepam. This article will delve into essential information about diazepam as outlined in the BNF, focusing on its uses, dosages, side effects, interactions, and guidelines for safe use.

Understanding Diazepam

Diazepam is a benzodiazepine that has been in use since the early 1960s. It is prescribed for various medical conditions, including:

  • Anxiety Disorders: Diazepam is effective in reducing anxiety and agitation. It is often used for short-term relief of severe anxiety symptoms.
  • Muscle Spasms: It helps alleviate muscle spasms caused by conditions such as multiple sclerosis and cerebral palsy.
  • Seizure Disorders: Diazepam is used as an adjunctive therapy for certain types of seizures.
  • Alcohol Withdrawal: It is used to manage symptoms of acute alcohol withdrawal, such as tremors, agitation, and hallucinations.
  • Preoperative Sedation: Diazepam is administered to calm patients before surgical procedures or other medical treatments.

Diazepam and the BNF

The British National Formulary (BNF) is a comprehensive resource that provides healthcare professionals with up-to-date information on the prescribing, dispensing, and administration of medicines in the UK. The BNF includes detailed information about diazepam bnf, covering its indications, contraindications, cautions, drug interactions, side effects, and dosage guidelines.

Indications for Diazepam

According to the BNF, diazepam is indicated for the following conditions:

  • Short-term relief (2-4 weeks only) of severe anxiety
  • Acute alcohol withdrawal
  • Muscle spasm
  • Convulsions
  • Preoperative sedation

Contraindications and Cautions

The BNF outlines several contraindications and cautions for the use of diazepam:


  • Hypersensitivity: Diazepam should not be used in individuals with known hypersensitivity to benzodiazepines.
  • Severe Respiratory Insufficiency: Diazepam can exacerbate respiratory insufficiency and is contraindicated in patients with severe respiratory disorders.
  • Sleep Apnea Syndrome: The sedative effects of diazepam can worsen sleep apnea.
  • Myasthenia Gravis: Diazepam is contraindicated in patients with myasthenia gravis due to the risk of increased muscle weakness.


  • Elderly and Debilitated Patients: Diazepam should be used with caution in elderly or debilitated patients due to the increased risk of sedation, respiratory depression, and falls.
  • History of Substance Abuse: Diazepam should be used with caution in patients with a history of substance abuse, as it carries a risk of dependence.
  • Liver or Kidney Impairment: Dosage adjustments may be necessary for patients with liver or kidney impairment.
  • Pregnancy and Breastfeeding: Diazepam should be used during pregnancy only if the potential benefits outweigh the risks. It is excreted in breast milk and can affect a breastfeeding infant.

Dosage Guidelines

The BNF provides detailed dosage guidelines for diazepam, tailored to the specific condition being treated:


  • Adults: 2 mg to 10 mg taken 2 to 4 times daily, depending on the severity of symptoms.
  • Elderly or Debilitated Patients: 2 mg taken 1 to 2 times daily, with adjustments as needed.

Acute Alcohol Withdrawal

  • Adults: 10 mg taken 3 to 4 times during the first 24 hours, followed by 5 mg taken 3 to 4 times daily as needed.

Muscle Spasm

  • Adults: 2 mg to 15 mg daily in divided doses.
  • Elderly or Debilitated Patients: 2 mg taken 1 to 2 times daily, with adjustments as needed.


  • Adults: 10 mg to 20 mg as a single dose, repeated if necessary.

Preoperative Sedation

  • Adults: 5 mg to 20 mg taken 1 to 2 hours before the procedure.

Side Effects

The BNF lists several potential side effects associated with diazepam use:

Common Side Effects

  • Drowsiness: Diazepam’s sedative effects can cause drowsiness and impair coordination.
  • Dizziness: Users may experience dizziness or lightheadedness.
  • Muscle Weakness: Some individuals may experience muscle weakness or fatigue.
  • Confusion: Especially in elderly patients, diazepam can cause confusion and cognitive impairment.

Serious Side Effects

  • Respiratory Depression: High doses or concomitant use with other central nervous system depressants can lead to respiratory depression.
  • Dependence: Long-term use of diazepam can lead to physical and psychological dependence.
  • Withdrawal Symptoms: Abrupt discontinuation of diazepam can result in withdrawal symptoms, including anxiety, insomnia, and seizures.
  • Psychiatric Effects: Rarely, diazepam can cause paradoxical reactions such as agitation, aggression, hallucinations, and psychosis.

Drug Interactions

The BNF highlights several important drug interactions with diazepam:

  • Alcohol and Other CNS Depressants: Concomitant use with alcohol or other CNS depressants can enhance the sedative effects of diazepam and increase the risk of respiratory depression.
  • Antidepressants: Certain antidepressants, particularly SSRIs and tricyclics, can increase the sedative effects of diazepam.
  • Antiepileptics: Drugs like phenytoin and carbamazepine can alter the metabolism of diazepam, affecting its efficacy.
  • Opioids: Combining diazepam with opioids can result in severe respiratory depression and sedation.
  • Cimetidine and Omeprazole: These medications can inhibit the metabolism of diazepam, leading to increased blood levels and prolonged effects.

Guidelines for Safe Use

To ensure the safe use of diazepam, it is essential to follow the guidelines provided in the BNF and by your healthcare provider:

Follow Prescribing Guidelines

Only take diazepam as prescribed by your healthcare provider. Do not exceed the recommended dose or duration of treatment. Diazepam is generally prescribed for short-term use due to the risk of dependence.

Monitor for Side Effects

Be aware of the potential side effects of diazepam and monitor your response to the medication. Report any concerning side effects to your doctor immediately.

Avoid Alcohol and Other CNS Depressants

Do not consume alcohol or use other CNS depressants while taking diazepam. This combination can enhance the sedative effects and increase the risk of serious side effects.

Gradual Discontinuation

If you need to stop taking diazepam, your doctor will likely recommend tapering off the medication gradually to minimize withdrawal symptoms.

Secure Storage

Keep diazepam in a secure place, out of reach of children and others who might misuse it. Do not share your medication with others.

Alternatives to Diazepam

For individuals who cannot take diazepam or prefer not to use benzodiazepines, there are alternative treatments available:


  • Selective Serotonin Reuptake Inhibitors (SSRIs): These antidepressants are effective for long-term management of anxiety disorders.
  • Cognitive Behavioral Therapy (CBT): This form of psychotherapy addresses the underlying causes of anxiety without the use of medication.

Muscle Spasms

  • Physical Therapy: Exercises and stretches can help manage muscle spasms.
  • Alternative Muscle Relaxants: Medications like baclofen or tizanidine can be used.


  • Antiepileptic Drugs: There are various medications specifically designed to control seizures.


Diazepam is a valuable medication for the treatment of anxiety, muscle spasms, seizures, and other conditions. However, it is crucial to use it safely and effectively to avoid potential risks. The BNF provides essential information for healthcare professionals and patients, ensuring that diazepam is prescribed and used appropriately. By following the guidelines outlined in the BNF and consulting with your healthcare provider, you can use diazepam safely and effectively to manage your medical condition. Always stay informed about your medications and adhere to professional medical advice to maintain your health and well-being.

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