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Valium is one of the most popular drugs that came out of the psychopharmacological revolution in the 1950s. It set the standard for pharmacotherapy in terms of potency, onset of action, and safety, treating a wide range of CNS disorders, including anxiety and epilepsy. Diazepam’s synthesis, pharmacology, drug metabolism, adverse events and dependence, clinical use, and regulatory issues.

The most common mental health condition is anxiety. Over 40 million people in the United States suffer from panic disorder, agoraphobia, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), or other forms of anxiety disorders in addition to generalized anxiety disorder (GAD). Anxiety disorders and the lack of treatment for them are prevalent issues in both developed and developing nations, even though estimates of their prevalence vary worldwide.

Valium is approved for the treatment of anxiety, acute alcohol withdrawal, skeletal muscle spasms, and convulsive disorders (such as status epilepticus). Off-label uses include insomnia, restless leg syndrome, and pre-and post-operative sedation It is a schedule IV controlled substance.

Adverse Effects and Dosing 

Valium has very few serious or fatal side effects, most of which happen when it interacts with another drug (like alcohol or opiates). Rather than an acute overdose, respiratory arrest and prolonged seizures brought on by prolonged habitual use are the most common causes of death. Reports of overdoses of up to 2000 milligrams of diazepam have led to an induced coma and rapid recovery. Amnesia, dizziness, ataxia, confusion, sedation, depression, and tachycardia are moderate adverse effects of chronic diazepam use. In addition, some patients receiving treatment for epilepsy or anxiety disorders may experience worsening of their seizures or anxiety.48 Chronic diazepam use is linked to tolerance, dependence, and withdrawal. Diazepam is typically used to treat alcohol and other benzodiazepine withdrawal symptoms because it has a lower risk profile of addiction and dependence than other benzodiazepines. However, for longer-term anxiety symptoms, dosage and duration must be handled with caution. If high-dose chronic treatment is abruptly stopped, benzodiazepine withdrawal symptoms can range from mild headaches and pains during gradual cessation to psychosis, hallucinations, seizures, mania, and death from convulsions.

According to studies, Valium and other benzodiazepines increase tolerance by desensitizing GABA-ergic neurons through receptor internalization and possibly transcriptional regulation. Norepinephrine, serotonin, acetylcholine, and dopamine are known to be reduced by benzodiazepines, which further disrupt normal neuronal network equilibrium. Doses can be gradually decreased before being completely discontinued from a chronic prescription to avoid the effects of dependence and withdrawal.

In normal adults, the first oral doses of anxiolytic and antiepileptic medications range from 2 to 10 mg and are taken 2–4 times per day. Hypnotic use typically requires no more than 30 mg taken orally before sleep, with maximum recommended doses as high as 30 mg every 8 hours. In the treatment of status epilepticus, 5–10 mg is given intravenously or intramuscularly every 10–15 minutes, up to 30 mg with other anti-seizure medications as an option.

Valium and its Dependence

Dependence can result from using Valium improperly or excessively. The following individuals are particularly vulnerable to diazepam misuse, substance use disorder, or dependence:

  • Diazepam increases alcohol cravings in problem alcohol users who have a history of substance use disorder or dependence. The reason is that drinkers tend to take the medication along with alcohol to experience its increased effects.
  • Patients with severe personality disorders, such as borderline personality disorder, should have their treatment closely monitored for signs of abuse and dependence. If any of these symptoms are present, treatment should be stopped immediately. However, if dependence has developed, treatment should still be stopped gradually to avoid severe withdrawal symptoms. In such circumstances, long-term therapy is not recommended.

The withdrawal from benzodiazepines should be gradual for those who are suspected of being dependent. Valium, when taken in higher dosage amounts for quite a long time can cause severe withdrawal symptoms or adverse effects that  can be dangerous and life-threatening. Regardless of whether dependence occurs in a recreational or therapeutic setting, caution should be exercised.

Valium (Diazepam) has a long half-life, making it a good choice for tapering for people taking high doses of other benzodiazepines. Withdrawal symptoms are also tolerable with diazepam. Although it takes a long time (usually 14 to 28 weeks), the procedure is considered safe when carried out correctly.