*An off-label use of a medication is a use that is not FDA-approved. Prescribers can decide to use a medication off-label because, in their professional judgment, they believe it may offer a benefit to someone.
Valium is a benzodiazepine medication that is used short-term to treat and prevent anxiety-related symptoms and muscle spasms and treat ongoing seizures. Its main side effects are due to its sedative property and include lethargy, confusion, impaired coordination, and fatigue. Valium is usually meant to be an adjunctive treatment and never a primary treatment of anxiety used by itself.
If you’re considering Valium, you may have some difficulty finding a doctor to provide an assessment and prescription online. Talkiatry is one of the few online psychiatry platforms that can and will prescribe benzodiazepines, like Valium, which are controlled substances. They can provide an assessment and may offer you a Valium prescription if they determine the medication may help your symptoms.
What Is Valium (Diazepam)?
Valium (generic name diazepam) is a benzodiazepine medication that is used for its ability to immediately calm, sedate, and relax individuals. It is used to treat anxiety (and/or related disorders or events), seizures, or symptoms of drug intoxication/withdrawal. Valium is approved and used for certain indications in children older than 6 months of age, adolescents, and adults.
How Does Valium Work?
Benzodiazepines, like Valium, are able to create a calming and sedating effect on individuals by targeting the receptors of gamma-aminobutyric acid (GABA), a neurotransmitter that slows down the central nervous system (CNS).
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What Is Valium Used to Treat?
Valium is FDA-approved for the short-term treatment and management of anxiety-related symptoms. It is used for treatment in adults and children over the age of 6 months. Valium or other benzodiazepines are not required or appropriate for dealing with everyday stressors or anxiety that can be managed with non-pharmacological methods or maintenance medications.
Valium is also FDA-approved to be used acutely to treat certain symptoms of alcohol withdrawal. Other FDA-approved uses of Valium are to stop ongoing seizures and for treating skeletal muscle spasms in certain situations.
Physicians can also use Valium as a non-FDA-approved treatment depending on the situation. This is called off-label use. Valium can be used off-label to treat the agitation and anxiety caused by withdrawals from certain drugs and/or intoxications of other certain drugs.
Valium is commonly used as an FDA-approved medication to treat:1
- Anxiety & anxiety-related disorders (short-term)
- Acute alcohol withdrawal symptoms
- Skeletal muscle spasms
- Seizures
Valium can also be used off-label (non-FDA-approved) for treating:
- Procedural anxiety (CT Scans, Colonoscopies, etc)
- Sudden vertigo episodes
- Cocaine & methamphetamine intoxication
- Opioid withdrawal symptoms
- Neuroleptic malignant syndrome
- Serotonin syndrome
Who Should Not Take Valium?
Valium is not recommended for people who have known allergic reactions to Valium. It is also not considered safe for children under 6 months of age, as the effect of Valium on the population this young has not been sufficiently studied yet.1 Additionally, Valium is not recommended for patients with neuromuscular disorders (such as myasthenia gravis), respiratory difficulties, sleep apnea, and/or poor liver function. Valium should also not be prescribed to people with acute narrow-angle glaucoma.1
Valium should be used with caution in the elderly, those who are at risk to fall, and those taking certain medications. Additionally, Valium is not recommended for pregnant or nursing women.1
People who may need to avoid taking Valium include:
- Those who have allergic reactions to benzodiazepines before
- Children under 6 months of age
- Pregnant and nursing women
- People with neuromuscular disorders (like myasthenia gravis)
- People with respiratory difficulties
- People with sleep apnea
- People with poor liver function
- People with glaucoma
- The elderly
- People who are at high risk to fall
- People experiencing psychosis
Valium Dosages for FDA-Approved Treatment
The US Food and Drug Administration (FDA) approves the use of medications for appropriate treatments based on their research and evaluations of the medications. However, prescribing physicians might use a certain medication to treat conditions or symptoms that are not listed as approved by the FDA. This is called an “off-label” usage.
Valium is prescribed with the intent of using the lowest possible dosage for the best management of symptoms while minimizing any adverse effects. The smallest effective dosage is usually initiated at 2 mg to 2.5 mg once or twice daily, but can be increased if needed and as tolerated by the patient.1 In children, the recommended dosage is 1 mg to 2.5 mg 3-4 times daily initially, and then increased if needed and as tolerated.
Valium Forms & Strengths
Valium can be used orally (as a tablet) or (as an injectable liquid solution). The available dosages vary from 2 mg to 20 mg per dose.2 There is also a nasal formulation and a rectal formulation, both of which can be used for seizures.2 The right formulation and strength prescribed to a patient depends on many factors and is specific to the individual and their circumstances requiring Valium.
Valium is available in the following forms and strengths:
- Oral tablets (2 mg, 5 mg, 10 mg)
- Oral solution (5 mg/5 mL)
- Oral concentrated solution (5 mg/mL)
- Rectal gel for adults (10 mg/tube, 20 mg/tube)
- Rectal gel for children (2.5 mg/tube)
- Nasal Liquid (5 mg dose, 10 mg dose, 15 mg dose, 20 mg dose)
- Injectable solution (5 mg/mL)
It is important to take your medication exactly as prescribed if you are prescribed Valium.
How Should I Take Valium?
You should take Valium if it is prescribed to you exactly as how your physician prescribed it to you. Valium can be taken with food or water and there is no need to have a meal in order to take the Valium. You should avoid operating heavy machinery or driving after taking your Valium as well since it can make you very drowsy.
What Happens If I Miss a Dose of Valium?
If you miss a dose of Valium, you should take your missed dosage as soon as possible. However, if it is close to the time of your next dosage, you should only take one dosage of the medication. Sskip the missed dosage and continue to the prescribed dosage/administration schedule prescribed.
If Valium is stopped abruptly, benzodiazepine withdrawal can occur. This withdrawal is similar to alcohol withdrawal and can result in seizures.
If Valium doses are doubled in an attempt to catch up on missed doses, it can lead to oversedation, breathing difficulties, and other adverse effects.
Side Effects of Valium
Benzodiazepines act by targeting the GABA neurotransmitter receptors of the central nervous system and thus slowing activity in the central nervous system. Because of this, some of the common side effects of benzodiazepines such as Valium are increased drowsiness/dizziness, and trouble with coordination/walking.
Common Side Effects of Valium
Some of the common side effects of Valium are drowsiness/dizziness, and trouble with coordination/walking. It is important to discuss the side effects you are experiencing while taking the medication with your prescribing provider. If you are experiencing severe side effects, it is important to access immediate medical attention as soon as possible. Additionally, because of its side effects, it is important not to drive or operate heavy machinery while using benzodiazepines like Valium.
Common side effects of Valium include:
- Drowsiness
- Fatigue
- Trouble with coordination and walking
- Shakiness
- Dizziness
- Headache
- Slurred speech
- Tremor
- Trouble concentration
Severe Side Effects of Valium
When taking benzodiazepine medications such as Valium, it is possible to experience severe side effects. These can include changes in consciousness, loss of consciousness, hallucinations, slow or shallow breathing (to a dangerous point), agitation, and sluggishness. It is important to seek immediate medical attention if you think you or someone you know has overdosed on Valium as it can be a fatal emergency. Almost 14% of the overdose-related deaths in 2021 involved benzodiazepines, including Valium.3
Severe side effects of Valium may include:
- Benzodiazepine withdrawal: Benzodiazepine withdrawal can occur when a benzodiazepine medication, such as Valium, is stopped abruptly. The symptoms are similar to alcohol withdrawal symptoms and can lead to seizures. Mild withdrawal symptoms can include trouble sleeping and mood swings.1
- Persistent tremors: Persistent tremors could be a sign of withdrawal from benzodiazepine, but it can also be a sign of overdose or an inability to tolerate the medication. You should call your physician immediately if you are experiencing persistent tremors when taking Valium.
- Loss of consciousness: Oversedation can lead to the loss of consciousness and requires immediate medical attention.
- Trouble breathing fully (decreased respirations): This is a side effect of the sedative effect of Valium and might require immediate medical attention.
- Trouble walking or standing straight: Although this side effect can be common if mild, if there is a sudden change or worsening of coordination and gait with the medication, you need to contact your prescribing physician or seek immediate medical attention right away.
- Hallucinations: If you are experiencing hallucinations when taking your Valium medication, you need to contact your prescribing physician or seek immediate medical attention right away.
- Increased agitation/irritability: If there is a sudden new onset or worsening of agitation or irritability while on Valium, you need to contact your prescribing physician or seek immediate medical attention right away.
Valium Withdrawal
When someone has been taking Valium for some time or has been taking a moderate-to-high dosage of Valium, and it is stopped suddenly, they can start to experience severe benzodiazepine withdrawal symptoms. To prevent this, the dosage of Valium is decreased gradually by prescribers before it is stopped completely.
Mild withdrawal symptoms can start with trouble sleeping and mood swings.1 Withdrawal symptoms may include shaking, tremors, or seizures. Due to the dangerous progression of symptoms with Valium withdrawal, it is important to seek immediate medical attention when the symptoms are noticed.
Allergic Reactions to Valium
Although not common, there have been reported cases of severe allergic reactions to benzodiazepines such as Valium. Someone allergic to another benzodiazepine is more likely to be allergic to Valium. It is important to discuss your allergies with your physician and your pharmacists, including your allergies to any medications, supplements, and food items.
Allergic reactions to Valium may include:
- Trouble breathing
- Trouble speaking
- Wheezing
- Swelling of the mouth, face, lips, tongue, throat, hands, or feet
- Rash/Hives
- Increased anxiety and confusion
Allergic reactions require immediate medical attention. If you feel as if you are having increased trouble breathing, increased coughing, lightheadedness, or other signs of anaphylaxis and have an EpiPen, you should use your Epipen and call 911 as soon as possible.
Valium Warnings & Precautions
Take Valium only as your doctor has prescribed it for you. Valium can be addictive and can cause physical dependence. When Valium is stopped suddenly, people can start to experience severe withdrawal symptoms. To prevent this, the dosages of Valium must be decreased gradually by prescribers before it is stopped completely.
Additionally, due to its sedative properties, Valium can decrease an individual’s breathing function to a critical point. There is a higher risk when Valium is taken in the same time period as another benzodiazepine medication, opioid medication, or alcohol.
Precautions for taking Valium include:
- Potential for misuse and addiction: Like all benzodiazepines, Valium has addictive properties and has the likelihood to be misused and abused even when it is prescribed. This increases the risk of overdosing on Valium, which can be fatal. If you notice signs of addiction or misuse with yourself or a loved one, it is important to contact the prescribing physician immediately.
- Risk of suicidal Ideation: Valium can cause sudden mood changes and might worsen depression. This can increase the risk of suicidal ideation, suicidal behavior, or other thoughts of harming oneself. It is important to keep note of such changes in moods, behaviors, and feelings and contact your physician right away.
- Taking Valium while pregnant: It is important to discuss taking any anti-anxiety medications while pregnant with your prescribing physician, your primary care physician, and your obstetrician – especially if you are pregnant, going to be pregnant, or are nursing.
- Patients with respiratory problems: As Valium can trigger slower breathing, those with respiratory problems swould need to be monitored while taking Valium. People with conditions such as COPD, sleep apnea, or ones caused by neuromuscular dysfunctions (such as myasthenia gravis).
- Patients with alcohol use disorder: When Valium is combined with alcohol, the sedative properties of both alcohol and Valium are enhanced. This can lead to worsened side effects caused by both substances – including decreased respiratory functions.
- The elderly: Precautions should be used when Valium is prescribed to the elderly as they are likely to metabolize (break down in the body) Valium more slowly.
- Those with impaired kidney function: Valium is excreted by the kidneys and more Valium might be in their system than expected for a prescribed dosage.
- Those at increased risk of falls: As benzodiazepines such as Valium increase your risk of falls, they must be used with extra caution when given to those who are already at increased risk of falling
- Those with liver problems: In patients with cirrhosis or other liver problems, the metabolism of Valium is decreased, meaning that the medication leaves the body more slowly. Thus, more Valium might be in their system than expected for a prescribed dosage.
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Talkiatry can match you with a real psychiatrist who takes your insurance and is seeing new patients. They’re in-network with major insurers and offer medication management. Get started with a short online assessment
Interactions With Valium
Valium can interact with various other substances and alter their effects in an individual’s body to something other than how it was meant to be when prescribed originally. For example, when taken with other sedating medications (like opioids or gabapentin), Valium enhances the sedating effect as it is also a sedative.
When used with certain other medications or other substances that are processed by the liver, Valium’s toxicity and its effectiveness can be either increased or decreased depending on the other substance – while also affecting the metabolism of the other substance. This can include prescribed medications, over-the-counter medications, supplements, vitamins, and herbal supplements/remedies. Thus, it is important to discuss with your physician and your pharmacist all the other medications and substances you are taking/using as well when being prescribed Valium.
6 types of substances you should avoid while taking Valium include:
- Other benzodiazepines: Taking Valium with other benzodiazepines can enhance the effect of the medications and lead to oversedation, overdose, and potentially even death.
- Central nervous system (CNS) depressants: Taking Valium with other central nervous system depressants enhances the effect of slowing the nervous system. This may lead to possible oversedation, overdose, trouble properly breathing, and potentially even death.
- Opioids: Opioids are CNS depressants. The combination of both medications can cause significant sedation, respiratory depression, coma, and death.
- Alcohol: Alcohol and benzodiazepines (like Valium) can enhance each other’s effects, including the adverse effects – which can lead to oversedation, overdose, and potentially even death.
- Substances affecting the liver and its enzymes: When used with certain other medications or other substances that are processed by the liver, benzodiazepines’ toxicity and effectiveness can be either increased or decreased depending on the other substance. This includes anti-acid medications, allergy medications, antifungal medications, anti-seizure medications, St. John’s Wort, grapefruit (and its juice), and kava.
Can You Overdose on Valium?
An overdose occurs when you take too much of a medication or a substance which can have dangerous consequences. Like with all other benzodiazepines, Valium can be misused and abused leading to overdose. Some symptoms of overdose can include changes in consciousness, loss of consciousness, hallucinations, slow or shallow breathing (to a dangerous point), agitation, sluggishness/lethargy, and trouble with coordination. Overdose of Valium can lead to coma and death.
What Should You Do If You Take Too Much Valium?
It is important to seek immediate medical attention if you think you or someone you know has overdosed on Valium as it can be a fatal emergency. Almost 14% of the overdose-related deaths in 2021 involved benzodiazepines, including Valium.3 When seeking medical attention, it is important to note all the medications or substances used by the individual who overdosed in general and at the time of overdose.
Questions to Ask Your Healthcare Provider About Valium
Valium is a short-term medication that is used for managing anxiety and anxiety-related symptoms. It is important to take medications that work for you in the best manner with minimal adverse side effects. For this to happen, open communication must happen between you and your healthcare team.
Ask your primary care physician, your psychiatrist, and your therapist any questions or concerns you might have about starting a medication like Valium, its side effects, its addictive potential, and any other alternative treatment. In the treatment of anxiety and anxiety-related symptoms, engaging in cognitive behavioral therapy (CBT) with the right therapist can be extra beneficial and potentiate the effect of pharmacological anti-anxiety treatment.
Questions to ask your care team about Valium include:
- Can I use Valium along with therapy to treat anxiety?
- How soon might I notice side effects from taking Valium?
- Am I at risk for more severe symptoms if I am already taking other anxiety /depression medications?
- What is the best dosage to ensure fewer side effects?
- Are there drugs I am taking that could have negative interactions?
- Is it safe to take Valium with my other medications?
- When should I reach out to you if I am experiencing side effects?
- Is there anything I should tell you or my therapist about this new medication?
- Will Valium be covered by my insurance?
- Does my medical history increase my risk of experiencing the side effects of Valium?
- How long can I expect side effects to last?
- How often should I see you for checkups and follow-up visits while taking Valium?
- How often should I be taking Valium? How long will I be taking it?
- Which long-term anti-anxiety medication works best when Valium is taken only as needed for breakthrough anxiety?
- How can I identify markers that might indicate that I am being dependent or addicted to Valium?
- What should I do if I reach that point?
How to Get a Valium Prescription
Valium is prescribed by a prescribing provider with a Drug Enforcement Administration (DEA) licensing number. For the treatment of anxiety and anxiety-related symptoms, Valium should never be used alone.
Due to the severity of the anxiety and anxiety-related symptoms, your primary care physician might refer you to a psychiatrist and/or mental health therapist for evaluation and management. If you are unable to see a physician in person for the management of your anxiety, you might consider working with an online psychiatry service.
In My Experience
In my experience, Valium is used only as a short-term medication. It is important to discuss with your physician why you might need Valium, the right dose that you might need, the side effects of Valium, and a plan on how to discontinue Valium once it is no longer required.
It is important to avoid stopping the medication abruptly. This is because doing so can cause benzodiazepine withdrawal and even seizures. After consulting with your physician, s/he will prescribe the medication in an optimal manner for you. Therefore it is important to follow their guidance when taking Valium.
Additional Resources
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