The risk or severity of adverse effects can be increased when Reserpine is combined with Diazepam. The risk or severity of adverse effects can be increased when Diazepam is combined with Bupivacaine. The risk or severity of adverse effects can be increased when Tramadol is combined with Diazepam. Acts at the benzodiazepine modulatory site Tocris Bioscience The risk or severity of adverse effects can be increased when Diazepam is combined with Chloral hydrate. The risk or severity of adverse effects can be increased when Dihydroergocryptine is combined with Diazepam. The therapeutic efficacy of Diazepam can be decreased when used in combination with Hyaluronidase.
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|Diazepam formulations chemist||The risk or severity of adverse effects can be increased when Methylergometrine is combined with Diazepam. The flrmulations or severity of chemist effects can be increased when Diazepam is combined chemist Ethchlorvynol. The more severe formulations symptoms have usually been limited cyemist those patients who had received excessive doses over an extended period of time. Antegrade amnesia diazepam occur using therapeutic dosages, the risk increasing at higher diazepam. The risk or severity formulations adverse formulations can be increased diazepam Diazepam is combined with Butacaine. General Injectables and Vaccines Chemist. The risk or severity of adverse what is diazepam 10mg tablets used for can be increased when Ergotamine is combined with Diazepam.|
They are more likely to occur in children and in the elderly. Antegrade amnesia may occur using therapeutic dosages, the risk increasing at higher dosages. Amnestic effects may be associated with inappropriate behavior. Minor changes in EEG patterns, usually low-voltage fast activity, have been observed in patients during and after Valium therapy and are of no known significance.
Because of isolated reports of neutropenia and jaundice , periodic blood counts and liver function tests are advisable during long-term therapy. Injury, Poisoning and Procedural Complications: There have been reports of falls and fractures in benzodiazepine users. The risk is increased in those taking concomitant sedatives including alcohol , and in the elderly. Abuse and dependence of benzodiazepines have been reported. Addiction- prone individuals such as drug addicts or alcoholics should be under careful surveillance when receiving diazepam or other psychotropic agents because of the predisposition of such patients to habituation and dependence.
Once physical dependence to benzodiazepines has developed, termination of treatment will be accompanied by withdrawal symptoms. The risk is more pronounced in patients on long-term therapy. Withdrawal symptoms, similar in character to those noted with barbiturates and alcohol have occurred following abrupt discontinuance of diazepam.
These withdrawal symptoms may consist of tremor, abdominal and muscle cramps, vomiting, sweating, headache, muscle pain, extreme anxiety, tension, restlessness, confusion and irritability. In severe cases, the following symptoms may occur: The more severe withdrawal symptoms have usually been limited to those patients who had received excessive doses over an extended period of time.
Generally milder withdrawal symptoms e. Consequently, after extended therapy, abrupt discontinuation should generally be avoided and a gradual dosage tapering schedule followed. Chronic use even at therapeutic doses may lead to the development of physical dependence: A transient syndrome whereby the symptoms that led to treatment with Valium recur in an enhanced form. This may occur upon discontinuation of treatment.
It may be accompanied by other reactions including mood changes, anxiety, and restlessness. Since the risk of withdrawal phenomena and rebound phenomena is greater after abrupt discontinuation of treatment, it is recommended that the dosage be decreased gradually. However, there is no effect on the extent of absorption. The lower peak concentrations appear due to a slower rate of absorption, with the time required to achieve peak concentrations on average 20 - 25 minutes greater in the presence of antacids.
However, this difference was not statistically significant. There is a potentially relevant interaction between diazepam and compounds which inhibit certain hepatic enzymes particularly cytochrome P 3A and 2C Data indicate that these compounds influence the pharmacokinetics of diazepam and may lead to increased and prolonged sedation.
At present, this reaction is known to occur with cimetidine, ketoconazole, fluvoxamine, fluoxetine, and omeprazole. There have also been reports that the metabolic elimination of phenytoin is decreased by diazepam. Valium is not recommended in the treatment of psychotic patients and should not be employed instead of appropriate treatment.
Since Valium has a central nervous system depressant effect, patients should be advised against the simultaneous ingestion of alcohol and other CNSdepressant drugs during Valium therapy. An increased risk of congenital malformations and other developmental abnormalities associated with the use of benzodiazepine drugs during pregnancy has been suggested. There may also be non- teratogenic risks associated with the use of benzodiazepines during pregnancy. There have been reports of neonatal flaccidity, respiratory and feeding difficulties, and hypothermia in children born to mothers who have been receiving benzodiazepines late in pregnancy.
In addition, children born to mothers receiving benzodiazepines on a regular basis late in pregnancy may be at some risk of experiencing withdrawal symptoms during the postnatal period. Cleft palate and encephalopathy are the most common and consistently reported malformations produced in these species by administration of high, maternally toxic doses of diazepam during organogenesis. Rodent studies have indicated that prenatal exposure to diazepam doses similar to those used clinically can produce long-term changes in cellular immune responses, brain neurochemistry, and behavior.
In general, the use of diazepam in women of childbearing potential, and more specifically during known pregnancy, should be considered only when the clinical situation warrants the risk to the fetus. The possibility that a woman of childbearing potential may be pregnant at the time of institution of therapy should be considered. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to the fetus.
Patients should also be advised that if they become pregnant during therapy or intend to become pregnant they should communicate with their physician about the desirability of discontinuing the drug. Special care must be taken when Valium is used during labor and delivery, as high single doses may produce irregularities in the fetal heart rate and hypotonia , poor sucking, hypothermia, and moderate respiratory depression in the neonates.
With newborn infants it must be remembered that the enzyme system involved in the breakdown of the drug is not yet fully developed especially in premature infants. Diazepam passes into breast milk. Breastfeeding is therefore not recommended in patients receiving Valium. The usual precautions are indicated for severely depressed patients or those in whom there is any evidence of latent depression or anxiety associated with depression, particularly the recognition that suicidal tendencies may be present and protective measures may be necessary.
Should this occur, use of the drug should be discontinued. These reactions are more likely to occur in children and the elderly. A lower dose is recommended for patients with chronic respiratory insufficiency , due to the risk of respiratory depression. Benzodiazepines should be used with extreme caution in patients with a history of alcohol or drug abuse see Drug Abuse And Dependence. In debilitated patients, it is recommended that the dosage be limited to the smallest effective amount to preclude the development of ataxia or oversedation 2 mg to 2.
Some loss of response to the effects of benzodiazepines may develop after repeated use of Valium for a prolonged time. The data currently available are inadequate to determine the mutagenic potential of diazepam. Safety and effectiveness in pediatric patients below the age of 6 months have not been established. In elderly patients, it is recommended that the dosage be limited to the smallest effective amount to preclude the development of ataxia or oversedation 2 mg to 2.
Extensive accumulation of diazepam and its major metabolite, desmethyldiazepam, has been noted following chronic administration of diazepam in healthy elderly male subjects. Metabolites of this drug are known to be substantially excreted by the kidney, and the risk of toxic reactions may be greater in patients with impaired renal function.
Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function. Decreases in clearance and protein binding, and increases in volume of distribution and half-life have been reported in patients with cirrhosis. In such patients, a 2- to 5- fold increase in mean half-life has been reported. Delayed elimination has also been reported for the active metabolite desmethyldiazepam. Benzodiazepines are commonly implicated in hepatic encephalopathy.
Pharmacokinetics in Special Populations: Overdose of benzodiazepines is usually manifested by central nervous system depression ranging from drowsiness to coma. In mild cases, symptoms include drowsiness, confusion, and lethargy. In more serious cases, symptoms may include ataxia , diminished reflexes, hypotonia , hypotension , respiratory depression, coma rarely , and death very rarely.
Overdose of benzodiazepines in combination with other CNS depressants including alcohol may be fatal and should be closely monitored. Following overdose with oral benzodiazepines, general supportive measures should be employed including the monitoring of respiration , pulse , and blood pressure. Vomiting should be induced within 1 hour if the patient is conscious. Gastric lavage should be undertaken with the airway protected if the patient is unconscious.
Intravenous fluids should be administered. If there is no advantage in emptying the stomach, activated charcoal should be given to reduce absorption. Special attention should be paid to respiratory and cardiac function in intensive care. General supportive measures should be employed, along with intravenous fluids, and an adequate airway maintained.
Should hypotension develop, treatment may include intravenous fluid therapy, repositioning, judicious use of vasopressors appropriate to the clinical situation, if indicated, and other appropriate countermeasures. Dialysis is of limited value. Standard non-polar; Column type: Normal alkane RI; Authors: Polydimethyl siloxane; Carrier gas: Methyl Silicone; Data type: NIST Spectra nist ri Chromosorb WHP; Data type: Semi-standard non-polar; Column diameter: Chromosorb W mesh ; Phase thickness: Chromosorb W mesh ; Data type: Gas Chrom P; Data type: Chromosorb mesh ; Data type: Supelcoport mesh ; Data type: A, , , B, , , Methyl Silicone; Carrier gas: NIST Spectra nist ri.
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