Simultaneous use of alcohol / depressants of the central nervous system (CNS)
Alcohol and / or CNS depressants should not be consumed during treatment with diazepam. This combination enhances the clinical effects of benzodiazepines, including severe sedation, clinically associated with the treatment of respiratory and / or cardiovascular depression.
Diazepam is with caution prescribed to patients with the history of abuse of alcohol or narcotic drugs. It is not recommended for patients who are dependent on the use of antidepressants of the central nervous system or alcohol, except for the period of exacerbation of withdrawal symptoms.
The use of diazepam for several weeks may lead to a weakening of its hypnotic effects due to the development of tolerance.
When taking benzodiazepines (even in therapeutic doses) addiction, the formation of mental and physical dependence may appear. The risk of addiction increases with the use of large doses and with an increase in the duration of treatment, as well as in patients with alcohol or drug addiction in history, personality disorders. Regular monitoring is necessary for such patients. Repeated administration of the drug should be avoided, treatment should be stopped gradually.
Sudden cessation of benzodiazepine use is accompanied by withdrawal syndrome. Symptoms of withdrawal syndrome: headache, muscle pain, increased anxiety, tension, agitation, confusion, irritability. In severe cases, there can be derealization (perception of the surrounding world), depersonalization, numbness and tingling in the extremities, increased sensitivity to light, noise and physical contact, hallucinations or epileptic seizures.
Recovery of insomnia and anxiety symptoms
Abrupt cessation of Diazepam treatment can trigger the rebound phenomenon, which is manifested by an exacerbation of the condition with subsequent rapid reduction of symptoms (mood changes, anxiety or sleep disturbance, anxiety). To prevent the rebound / withdrawal syndrome phenomenon, it is recommended to gradually lower the dose of the preparation.
duration of treatment
The duration of treatment should be as short as possible depending on the indication, but should not exceed 4 weeks for insomnia, anxiety states 8 to 12 weeks, including a period of gradual reduction of the drug dose. The duration of treatment is increased only after a thorough assessment of the patient’s condition.
Patients should be informed of the beginning and duration of treatment and explained about the gradual reduction of the dose. In addition, the patient should be warned about the possible occurrence of withdrawal symptoms to reduce anxiety, especially when discontinuing therapy with the drug.
In the case of benzodiazepines with a short duration of action, withdrawal symptoms may occur between taking the drug, especially when the dose is high. Due to the risk of developing withdrawal symptoms, it is not recommended to change benzodiazepines with a long-term effect on benzodiazepines with a short duration of action.
It should be borne in mind that benzodiazepines can cause anterograde amnesia. Anterograde amnesia can occur when therapeutic doses are applied, the risk increases with higher doses. Amnestic effects may be associated with inappropriate behavior. The condition manifests itself most often within a few hours after taking benzodiazepines internally, and therefore, in order to reduce the risk, patients should be given the option of continuous sleep 7 – 8:00.
Mental and paradoxical reactions
While taking benzodiazepines, reactions such as anxiety, agitation, irritability, aggressiveness, delirium, anger, nightmares, hallucinations, psychosis, inappropriate behavior and other behavioral disorders are possible. If these reactions occur, discontinue treatment with the medication. Such reactions are more often observed in children and the elderly.
Special groups of patients
Elderly patients and weakened patients need a dose reduction. In connection with the muscle relaxant effect, there is a risk of falls and fractures in this group of patients. Low doses are also recommended for patients with chronic pulmonary insufficiency due to the risk of respiratory depression.
Benzodiazepines are not prescribed to treat patients with severe liver failure, as they can provoke encephalopathy. For patients with chronic liver disease doses should be reduced. Drugs are not recommended for the primary treatment of psychosis. Benzodiazepines should not be used as monotherapy for the treatment of depression or anxiety related to depression, because of the possibility of suicidal behavior in these patients. Benzodiazepines should not be used only to treat depression or anxiety associated with depression, because of the possibility of suicidal behavior in these patients. Preparation can delay the psychological recovery of patients from the symptom complex caused by the severe loss of a loved one. During treatment with Diazepam drinking alcohol is unacceptable. Medication contains lactose, so it should not be prescribed to patients with rare hereditary forms of galactose intolerance, lactase deficiency or glucose-galactose malabsorption syndrome.