Talk:Diazepam/Archive 1

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Indications

Have added "Treatment of overdosage with hallucinogens, such as LSD or CNS stimulants, such as cocaine, methamphetamine." to the indications as specifically cited in citation #13. have tried to fix this two or three times but every time i come back someone has undone. please leave alone, this is a cited indication ... just follow the link it specifically states this medicine is used to treat this condition. please leave in as knowledge of this can reduce harm and possibly save lives. thank you! —Preceding unsigned comment added by 24.218.178.56 (talk) 10:47, 9 March 2010 (UTC)

Contraindications

removed "history of alcohol or drug dependence" from contraindications because this medicine is specifically indicated to aid in the treatment of alcohol and/or opiate withdrawal. to both indicate and contraindicate for the same condition is contradictory and confusing to the reader. i have tried to fix this twice or three times before yet every time i come back someone has undid my changes. please leave alone. thank you. —Preceding unsigned comment added by 24.218.178.56 (talk) 10:40, 9 March 2010 (UTC)

Criminals

From my knowledge this drug is used alot by bank robbers to keep them cool, should I add a section ? Kernel geek (talk) 23:25, 23 January 2009 (UTC)

from my knowledge, this drug is used alot by snipers to steady their aim of their long range weapons? should I add a section? kidding! —Preceding unsigned comment added by 24.218.178.56 (talk) 07:39, 28 February 2010 (UTC)

^^playing to much MGS? :P some may use it but it would be a bit pointless as it takes 30-45 minutes to kick in —Preceding unsigned comment added by 77.100.212.182 (talk) 22:38, 3 July 2010 (UTC)

Relation to Opiates

I really don't see anything in citation 29 (or anywhere else) that states that diazepam increases the effects of opioid analgesics:

"...nts. The euphoriant effects of opioids may be increased, leading to increased risk of psychological dependence.[28][29]"

Additionally I think the following related subject needs edited/removed:

"... as an adulterant in heroin.[37] This may be because diazepam greatly amplifies the effects of opioids."

Yes the heroin citation is fine but I think the proceeding sentence should either have a clear citation or be removed entirely as I believe none of this opiate-diazepam business to be true. Of course if any non-tolerant user take opiates and any benzo they will be rather impaired.

And is euphoriant a word? Shouldn't it just be euphoric? And if it is a word it seems like it should be used to describe an example of a physcological-type drug. Example: "Valium is a strong euphoriant at high doses"

It is common clinical practice to use benzodiazepines (diazepam, midazolam and the like) in conjunction with opiates. They work on different receptors and provide different effects as a premedication or in the conscious sedation setting. The benzos tend to cause memory loss and drowsiness, whereas the opiates tend to provide pain relief. Both suppress breathing to some degree. I must admit to ignorance where the "euphoriant effects" of these drugs are concerned. Orinoco-w (talk) 06:13, 14 April 2008 (UTC)

yep euphoriant is a word, just tyype define: euphoriant into google —Preceding unsigned comment added by 77.100.212.182 (talk) 22:37, 3 July 2010 (UTC)

Comment

This is simple grossly outdated information in need of an update. Yes there is a benzo receptor on the GABA A receptor as well as a barbiturate binding site and ethanol. The benzo receptor consists of 3 subunits alpha, beta and gamma. Newer hypnotics target the alpha subunit to induce sleep (zolpidem etc). Diazepam affects all 3 subunits. Hence the numerous therapeutic useage basically central muscle relaxant, hypnotic (at higher doses), sedation or anxiolytic properties (5mg) usually all that is needed due to a long half life and build up in the lipid tissues in the body. SO there you go. I can't be bothered going in-depth into the signal transduction, increased influx of Calcium ions to make endogenous GABA (gamma aminobutyric acid) bind with increased efficacy and binding affinity. This is at least 10 years old and should be basic knowledge.

Incorrect. Benzodiazepines bind to alpha subunits only. The benzo receptor is actually located on alpha subunits. There are alpha 1,2,3,4,5. Benzodiazepines bind to alpha 1,2,3 and 5 containing subunits. Flumazenil binds to them all but is an antagonist. The Z drugs bind to alpha 1,2 and 3 subunits on the GABAa receptor. They bind with high affinity to the alpha 1 subunit which is responsible for the effects of sedation and anticonvulsant properties. The Z drugs also bind to alpha 2 and 3 subunits which are responsible for anti-anxiety and muscle relaxation but with a lower affinity than the benzodiazepines.

Carpetman2007 21:29, 27 April 2007 (UTC)

COntradiction

It gives dose recommendations for young children 30 days-5years and then right below it says Do not give diazepam to children under 6 months of age. This should be clarified a bit more. --Donnie from the mean streets of Boston, KY 20:28, 5 January 2007 (UTC)

Valium is used as an anxiolytic but Ativan would have to win out in that dept. even with it's short half-life. For a skeletal muscle relaxant vitamin V wins over all benzos hands down, including its little cousin Librium. Did I mention it also helps with insomnia and recurrent periods of agitation? Like the state of mind caused when you're low on Valium....

Ativan (Lorazepam) + anxiety : your statement is true, but Lorazepam might well have a greater addictive potential. The same is true for Alprazolam and Clonazepam. Valium is most effective as muscle-relaxant. Right, Valium is commonly used and effective against insomnia and agitation. But tolerance to sedation might develop, so the effect against insomnia is often limited to weeks.

page needs cleaning up, lots of punctual errors

I learned nothing from reading this wiki entry :(

The article on Diazepam (Valium) reads like a chemistry book or medical journal ... that's fine ... but I just wanted to know what valium is and after reading the article I still have no clue. I wish this article read like, say, articles on RAM or Linux or even the complex math/science entries -- for example, I know nothing of advanced physics or even computer parts but I still can read a wikipedia article on ROM or special relativity and leave having a general idea of what they are. Great work, I know maintaining these pages isn't easy and I guess I'd suggest at least one paragraph summary that an average Joe can read without all of the medical jargon. 67.149.220.91 09:25, 10 February 2007 (UTC)TotalNewbie

Agreed! This article reads like a pharmacy text book. I came to the article hoping to have it shed some light on the consistent references to Valium in popular culture, of which there is basically no mention in this article. I don't think wikipedia should be a pharmacy text-book. --Akeshet 17:47, 12 May 2007 (UTC)

Perhaps you could try reading the benzodiazepine article. Also, most of the medical jargon links to a page explaining it -- don't know what a anxiolytic is? Just follow the link and it tells you exactly what it is in plain English. The reason for the more textbook only approach in this case is because there are many similar drugs, and explaining everything on one page is redundant as you end up with different versions of the same info. 122.57.136.187 (talk) 04:49, 8 June 2008 (UTC)

Akeshet - Good point on the popular culture section. I added one, meager as it may be, but it is there. Hopefully others will add. —Preceding unsigned comment added by 24.218.178.56 (talk) 21:48, 8 June 2010 (UTC)

Trivia

I've removed the text

It was also used in the video game Metal Gear Solid. Elvis was a compulsive user of it.

for the following reasons:

  1. A video game cannot "use" a drug. It may appear in that game but we are talking about one of the most prescribed drugs in history. Would you edit the aspirin article and list every game, song or film where someone takes a painkiller? Therefore IMO this is not notable enough to mention.
  2. Elvis may well have used it. The Obituary of Leo Sternbach in The Guardian newspaper mentions that "Elvis Presley had substantial amounts in his system when he was found dead at Graceland". However, millions of Americans used and abused diazepam.

--Colin 18:27, 12 January 2006 (UTC)

Er... So a videogame character can't use a drug, but characters in SONGS can? I'm not a particularly rabid Metal Gear Solid fan (to tell you the truth I don't even like the game at all), but why is it worth mentioning Lou Reed or the Rolling Stones, and not Metal Gear Solid? I mean, rock stars use and abuse about every possible substance in the known universe after all, whereas very few videogame characters rely on real life drugs to improve their skills. --Nico, 22 March 2006

First of all, most people have heard of the Rolling Stones (particularly the song "Mother's Little Helper" - and most people don't even know what the song is about) and/or Lou Reed; therefore that is pertinent information. Diazepam is mentioned in quite a few videogames - too many to list here - and most people (above the age of 20) have not heard of Metal Gear Solid. It is also pretty near impossible to find a legitimate reference for that piece of information (even though I know it to be true, that's obviously not adequate). The simple solution is to have the Metal Gear Solid include a link to the diazepam article. This way people who care about the game can learn of this detail, whereas those interested in the drug won't have to hear about some random videogame. If you feel very strongly about including it, I suppose we could put it to a vote (though it would take several months to get a sufficient number of votes). Fuzzform 20:21, 23 March 2006 (UTC)
Actually no, I don't "feel strongly" about including it. Like I said, I don't even like that game. It's just that the arguments against seemed a little bit weak/biased to me. They had that "it's in a videogame and videogames are just for stupid kids, so we should negate their existence" tone, you know? "Lots of people have heard these songs, therefore it's pertinent"... Well, as you said, we've all heard Walk on the Wild Side thousands of times, I don't really think we need an encyclopaedia to tell us that Lou Reed pronounces the word "Valium" in it. Shouldn't less well-known facts, on the other hand, be included as (remotely) interesting bits of trivia? I mean, this is the trivia section we're talking about after all. It's not like I'm suggesting to begin the whole article with the sentence "Diazepam is a drug used by videogame character Solid Snake to shoot people with a sniper rifle, and was actually invented for the sole purpose of being used in videogames by fictional characters."
Oh and on a side note, I'd be interested to hear about, say, two random games from that incredibly long list of games that mention diazepam, because I've played hundreds of videogames of all kinds and Metal Gear Solid is really the only one where diazepam was mentioned in my experience at least. Are the super mushrooms in Super Mario Bros. actually mushroom-shaped Valiums? --Nico, 24 March 2006
I can think of one title off the top of my head: Bio Menace, from the early 90's. Horrible game. At one point, the character says "Geez, take some Valium or something." Ironically, the main character's name is also Snake. If you don't believe me, download the game. It's freeware now (probably because it was so awful). Anyway, this clearly isn't worth mentioning. I feel like I wasted my time even giving this explanation. Oh well. Fuzzform 00:25, 13 April 2006 (UTC)
Thanks for your considered comments, Nico. Perhaps you would like to get an account, it makes discussing such things easier and you tend to get taken more seriously. My comments earlier on this page and in the HTML-comment on the talk page reflect the exasperation at having to remove unreferenced fancruft by anonymous editors.
I think the argument against mentioning MGS in this medical article is pretty strong but (as you point out) is weakened by the inclusion of other trivia that also has a fairly weak justification for its existance. Wikipedia does not need to include all the facts of the world, only those you would expect to see in a comprehensive encyclopedia. Of the trivia currently listed:
  • The Lou Reed song should go since it does just mention Valium obliquely.
  • In contrast, Mothers Little Helper is a poem about valium (Do a Google for the lyrics) and it is a notable song by a very notable group. It surely deserves a mention in any substantial article on Valium. The authors of the newspaper obituaries to Sternbach also felt it worth mentioning.
  • The Valley Of the Dolls should go unless someone can provide some additional evidence. I think the reference is wrong - see the Wikipedia article. I suspect "dolls" are just the word for any tranquilizer.
  • Karen Ann Quinlan's entry should be trimmed and the word "allegedly" removed unless any reference also uses that word.
  • As I said above, the famous users list is pointless and should go.
  • The potato entry is interesting trivia.
Colin°Talk 09:42, 24 March 2006 (UTC)
I'm not sure about getting an account... I mean, I'd be the exact same guy that I am right now and I don't know how you would feel about me if I did get an account, but I know I still wouldn't take myself too seriously anyway. Besides, I'm not good enough in English to write good articles, and my area of knowledge is limited to geek stuff and I don't think Wikipedia needs more of that.
But I thought it was interesting to discuss the "Metal Gear" thing, not because it's very interesting in itself, but because as I said, I thought some of the arguments against were weak and biased. But it was just discussion for the sake of discussion actually, I had absolutely no intention to add this information myself to the article anonymously, since I agree that it is not exactly the most interesting information about diazepam (but neither is the part about Lou Reed, yet I do enjoy Lou Reed's song much more than this videogame). Then again, it's just the "trivia" section and that's generally the kind of dispendable information you find in a "trivia" section. Besides, it's not like we're talking about some obscure title that was only released in Lieschtenstein in 1983 and sold 3 copies... Anyway, I realize that this is a serious medical article, and that people who will read it probably don't care much about fictional characters, so I guess you're right. --Nico, 24 March 2006

Any drug test info. to share.

    The amount of time substances can be detected and sure cures for cleaning out toxins for us folks who don't use but like to stay clean. lol

P.S. 

    Feel free to elaborate in any fasion that this page alows.

Well, it takes up to 6 weeks for benzodiazepines to be undetectable in urine tests, according to erowid.org. It likely takes a longer time for the drugs with longer half-lives to be completely "cleaned out" of one's body.

—Rmenee 13:03, 31 October 2006 (UTC)--Rmenee 13:03, 31 October 2006 (UTC)== Plagiarization ==

Much of the content of this page is copied word for word from www.rxlist.com. I'm starting work (finally) to rehabilitate all the benzodiazepine pages, and this seemed like the best place to start. Fuzzform 20:16, 10 February 2006 (UTC)

OK! I just completely reworked the page. This should be the standard setup for all the other benzodiazepine pages. Fuzzform 21:47, 10 February 2006 (UTC)

I think there is a need to differentiate between approved and off-label usage. Seems like pertinent information. Fuzzform 19:35, 11 February 2006 (UTC) Valium is needed to live in this harsh world as a recouvouring herion addict im sure society would rather me steal for a vally script than heaps of $$$ for the H, yeah?Rmenee 13:03, 31 October 2006 (UTC)Australia renee look for me at rmenee

More accurate information

I just did a little more research, and I've concluded that the new information I just added is far more correct than what was there before. As far as I know, there are no "benzodiazepine receptors", rather, the benzos target the a-subtype of GABA receptors. I would like to set it up to show "GABA" with a subtext "A" (this is the way it is done in textbooks and medical literature), but I'm not yet sure how to do this.

Do you mean like this: GABAA --Colin 19:52, 12 February 2006 (UTC)
Yep, just like that. I've already changed it. Fuzzform 20:53, 12 February 2006 (UTC)

I added a reference to another book by Barondes. I think the reference section needs cleanup, quite badly. None of the references are written in the standard way; they're all different (and pretty sloppy if you ask me). I'll clean them up eventually, if noone else does. Fuzzform 19:46, 12 February 2006 (UTC)

If there are no, "benzodiazepine receptors," then what on Earth are these?
Synthesis, labeling, and biological evaluation of halogenated 2-quinolinecarboxamides as potential radioligands for the visualization of peripheral benzodiazepine receptors. (Bioorganic & Medicinal Chemistry, 2006)
Quantitative Analyses of 18F-FEDAA1106 Binding to Peripheral Benzodiazepine Receptors in Living Human Brain (Journal of Nuclear Medicine, 2006)
The BZD receptor is a recognition site on the GABAA receptor:
On the Benzodiazepine Binding Pocket in GABAA Receptors (Journal of Biological Chemistry, 2004)
Also, benzos are not GABAA agonists, they are positive allosteric modulators of GABA (PMID 12171574).
Am going to correct that now because I finally have time.--Rmky87 00:27, 5 March 2006 (UTC)
ETA: This not the same binding site as GABA uses.--Rmky87 01:21, 5 March 2006 (UTC)

Yeah, I came across that same information in "Molecules and Mental Illness". I'd forgotten that I came to this conclusion before. I've made the appropriate changes and referenced them. Fuzzform 21:58, 11 March 2006 (UTC)

Questionable info

I've been unable to confirm the information from the infobox "half-life" section: "Biphasic 1-2d/2-5d, active metabolites with long half lives"

All Google searches lead to pages mirroring the content here on Wikipedia. Searches for "1-2d/2-5d" also list Wikipedia mirrors. Also, it seems that the concept of a metabolic half-life would (by it's very nature) imply a biphasic system. I think the suspect information should be confirmed or deleted. Fuzzform 21:21, 12 February 2006 (UTC)

Be ruthless with "info" that you can't find in the references (or your own knowlege, which you should of course try to get references for...). If it is more than a word or two, then remove it and put it in the talk page with a comment like you've done above. Someone else may come along (perhaps the original author) and put it back when they are able to. Better to say nothing than to mislead. --Colin 21:54, 12 February 2006 (UTC)

Something that should perhaps be added is the fact that natural (endogenous?) benzodiazepines have been found in plants, including wheat and potatoes. This may account for the fact that food has sometimes been reported to increase the effects of that class of compounds (although this is my own theory, so far as I know, so I can't include that). In any case, see this link.

Fuzzform 04:59, 17 February 2006 (UTC)

References

Please do not remove the "citation needed" tags without inserting a reference!

As for the citations of German sources, I'm fairly sure that the only sources which can be used are ones in the same language as the document using the sources. A translation of those sources could be cited, but a source in a different language is essentially useless (as most people cannot cross check it for accuracy). Fuzzform 23:58, 11 March 2006 (UTC)

If the article no longer relies on the German sources, then they can be dropped. I suspect that since you have rewritten it, and don't speak German, that this is the case.

You may be interested in another RxList page: Diastat for the rectal gel.

I don't think there is any need to give multiple citations for every fact (e.g. the indications) - doing so is just overloading the article with superscript numbers. There are just too many online pharmeceutical info sites for you to reference them all. Decide on the main source that you trust and feel is up-to-date (e.g. RxList) and then use that as the sole reference for each fact that it supports. Then only add the others (InChem, Drugs.com, etc) if they are necessary to cover holes in RxList's info.

Colin°Talk 19:08, 13 March 2006 (UTC)

Good idea, I'll begin slimming it down. I've removed the following section, because all search results lead to pages mirrored from Wikipedia. Funny how if you leave something on Wikipedia long enough, it seems to become fact on the rest of the internet, regardless of where the "facts" came from. Nonetheless, it may actually be legit, but until I can actually find a reference for it, it will remain here.

Fuzzform 19:45, 14 March 2006 (UTC)

Certain paragraphs (e.g. in "Overdose" section) make use of several combined sources, and it seems easier to read when the superscript numbers come at the end. I'm just going to leave it this way for now, even though one can't tell which statement is attributed to which source.

Also, as for the piece of trivia that so-and-so uses diazepam in Metal Gear Solid: this is true, but I have no idea how to cite it. All the sites with information about it are cheat code sites, and are not appropriate sources. Maybe a game review or something would work. Fuzzform 20:02, 14 March 2006 (UTC)

You are obvious still editing so I'll stay off for now. Here are some comments:
  • The Indications should list indications currently recommended by the major US/UK/Australian/Canadian/etc heath bodies. This section is no place for experimental treatments or for indications that are no longer used (e.g. because better drugs are available or because it has been found to be ineffective, etc). Therefore, drop the German stuff about "Experimental treatment of children". I wound't even bother to try to find another place in the article for it.
  • The Metal Gear Solid reference is fancruft and should be removed. See my comments at the top of this talk page. This and any references to "famous" users should be removed. Everyone who was famous in the 70s used it - we can't list them all! Wikipedia does not need to contain all that is true - only what is interesting.
  • If you use Firefox, you can filter out a lot of Wikipedia Mirrors from your searches. See Mirror Filter.
  • Be ruthless removing unreferenced stuff. Only move it to the talk page if you think it is interesting and potentially salvagable. Otherwise, it can always be retrieved from the history. Use the Edit summary.

Colin°Talk 20:30, 14 March 2006 (UTC)

Info in need of references

  • "It is the most effective benzodiazepine for treating muscle spasms." - This may well be true, but it needs a reference to be considered a fact. Removed until verified.
  • "Doses for in-patients are usually higher than for out-patients." - This is most definitely true, although it will pretty difficult to reference. Removed until verified.
  • "In the video game Metal Gear Solid you can use Diazepam to steady your aim while using a sniper rifle. It is also used by the enemy sniper (Sniper Wolf)." - This is true, but of questionable importance. Removed.
  • "Experimental treatment of children with anxiety due to separation from their parents (long-term hospitilizations, treatment in rehabiliative institutions far away from home etc.) and their normal social connections (also known under German term 'Trennungsangst')" - Removed.
  • "In the autumn of 1973, a report aired on the television show 60 Minutes, attesting to the drug's addictiveness. This can occur in as little as four weeks. Following a controversial and often polemic discussion, benzodiazepine prescriptions declined by nearly half in the 1980's and 1990's." - Removed, pending verification.

Fuzzform 02:03, 15 March 2006 (UTC)


For some reason, "RXL.Indications" is appearing under note number 13 as entries duplicated from number 7. Fuzzform 02:36, 15 March 2006 (UTC)

It was "RXL.Indications" vs "RXL.indications". Colin°Talk 09:29, 15 March 2006 (UTC)

I've searched the web quite extensively for information/references that can be used in this article, and I've compiled a list of the best sites. I've also created several lists of information which I plan to use (at some point) to finish referencing the sections that have been overlooked. All of this can be found on this page. Hopefully there is enough material to completely reference the article (it will likely need some expansion too). Fuzzform 20:58, 23 March 2006 (UTC)

Someone added a reference to diazepam's use in hyperbaric procedures. The reference appears to be valid, but the page number is not given and I'm unsure how to properly list both authors (editors, actually) of the book. I've cleaned it up, anyway (it was done incorrectly before). Fuzzform 22:03, 24 March 2006 (UTC)

Veteranary Use

This can also be used as an anti-depressant for dogs/cats, for example, some dogs may need it to relax them in situiations of discomfort. One dog I'm aware of takes it to relax it during thunderstorms. This should be written about, although I do not know enough about it to do the writing.

This article is inscrutable

I am a layman when it comes to medicine, and I am really finding it hard to understand anything about this article. All I wanted to know is what Valium was used for, and why, but the article clouds this information in complex scientific and medical terms that I don't understand. An encyclopedia should be accessible to laymen. Would you all object to dumbing it down...? --Hyphen5 18:53, 28 March 2006 (UTC)

Not at all. In fact, I'm glad you made this comment. I'll try to clarify the overall description of the drug in the introduction (at some point when I've more time...) Fuzzform 22:42, 29 March 2006 (UTC)
Could you also please check whether the use of the word "amnestic" is intended. Surely "amnesic" would be more accurate? Revera 13:55, 13 May 2006 (UTC)
I just checked, and was surprised to see that "amnestic drug" is a more common phrase than "amnesic drug" in Google and PubMed searches. Also, "amnesic" seems to commonly describe a person or a problem, while "amnestic" seems to only describe a drug. However, both terms appear acceptable and are commonly used.Fluoborate 07:16, 18 May 2007 (UTC)

Veterinary use

I removed the indication for long-term (maintenance) treatment of epilepsy in dogs because the short elimination half-life and development of tolerance makes diazepam poorly suited for daily therapy. This is mentioned in the cited website.

I changed the doses to reflect the difference between intravenous and rectal administration. The parenteral solution is most commonly used for rectal administration, as this has been studied in laboratory dogs and in dogs with epilepsy. There have been no scientific publications regarding the use of suppositories in dogs or for the rectal administration of wetted tablets mentioned in the cited website.

A good reference would be: Podell M: The use of diazepam per rectum at home for the acute management of cluster seizures in dogs. Journal of Veterinary Internal Medicine 9:68, 1995

..but I’m still not sure how to add/change references.

Finally, I removed the mention of preanestheic sedation because it seemed redundant as sedation was already mentioned as an indication.

Loupe 21:41, 11 October 2006 (UTC)

Rolling Stones

First, is it even worth mentioning the Rolling Stones? Consider elaborating/ removing the Rolling Stones section. Are they really singing about diazepam (This essential question is not answered in the article). Could the Stones simply be singing about a yellow pill (not diazepam) that helps a mother get through her day?

I have always thought, that Mother's little helper was amphetamine used in diet pills in 60s. —The preceding unsigned comment was added by 84.230.71.64 (talk) 08:57, 11 December 2006 (UTC).

Nicotine withdrawal

i read once about the relation ship btw diazepam and reducing the affinity for Nicotine is this true? —The preceding unsigned comment was added by 63.243.163.199 (talk) 08:30, 28 January 2007 (UTC).

Some experiments have shown that nicotine dependence and withdrawal causes increased levels of endogenous diazepam binding inhibitor (DBI), a benzodiazepine inverse agonist that causes anxiety. (PMID 15542765) Benzodiazepine tranquilizers like diazepam inhibit the effect of DBI, so they could help alleviate nicotine withdrawal. Perhaps this is what you are referring to. Although diazepam could specifically antagonize the anxiety produced by nicotine withdrawal, it would not be a good smoking cessation medicine because benzodiazepines cause dependence and do not address most other nicotine withdrawal symptoms.
It should also be noted that benzodiazepines occassionally cause relapse in former addicts (because anxiolytics reinstate punishment-suppressed behaviors - this is what enables phobic patients to fly in airplanes again, but it also makes reformed junkies shoot heroin again). Some sedative abusers actually smoke more after taking a benzodiazepine, probably because the stimulant and sedative effects mix nicely. Any smoker without a serious underlying anxiety disorder probably should not consider benzodiazepines.Fluoborate 07:06, 18 May 2007 (UTC)

Nicotine withdrawal results in far more chemical disturbances than a simple change in DBI levels. Diazepam may help with one of the many changes Nicotine withdrawal may cause, but does not fix them all. It's also been noted that many users who are smokers also find they smoke more when they use diazepam, so thats worthy of a note. The brain is like a clock work, full of gears all working together, one change, will have a reaction on many things. There are still reactions science hasn't touched yet. A simple withdrawal will disturb many synapses in many areas of the brain, which there are no fix it all solutions for. Even with opioid withdrawal they have recently discovered their theory of tolerance may not be true after all with the presence of an endorphin that actually causes the withdrawal. One thing that is certain, is that thoughts themselves can induce chemical changes in the brain. Thinking about happy things, looking forward to a holiday the next day or thinking about your love will also trigger different chemicals to set the right emotion. External situations may also trigger chemical changes such as shopping or the possession of something new is known to cause more endorphins than normal. In other words, to quit smoking, the best way is to practice will power and think positive things. --78.86.159.199 (talk) 03:43, 21 August 2008 (UTC)

Trivia continued

Could the trivia section use an introduction? It looks a bit strange as a just a list to me. cyclosarin 13:51, 31 January 2007 (UTC)

No. It should be ditched. If anyone wishes to restore the text (below) please read the policy Wikipedia:Attribution, the guideline: Wikipedia:Avoid trivia sections in articles and the essay Wikipedia:Trivia. A list of songs and TV programs that briefly mention one of the world's most widely used drugs is not relevant to a pharmaceutical article and none of it is sourced. Colin°Talk 18:49, 19 March 2007 (UTC)

== Popular culture references ==

Physical Dependence and Withdrawal

Physical dependence and withdrawal is one of the most studied and clinically important problem with diazepam and benzodiazepines as a class but yet the problem is barely mentioned in this article. A section on diazepam dependence and withdrawal symptoms which can be experienced is needed for this article. Also a mention of the risk of a more severe withdrawal syndrome if the physically dependenct individual is withdrawn abruptly or over rapidly from diazepam. Even the patient leaflets contain this information but yet a lengthy wiki entry on diazepam is devoid of this mention to any great length which would educate the reader on this clinically important and relevant data. Are the editors involved planning on adding this section? Also in the very small section of this article there is very dangerous advice added. There is advice stating that if signs of dependence develop "drug therapy should be discontinued". No medical authority recommends now that when benzodiazepine dependency has been established that therapy should be discontinued abruptly. It reads like therapy should be discontinued abruptly. Abrupt withdrawal from diazepam when dependence has formed typically brings on a severe withdrawal syndrome including the following symptoms, severe anxiety, insomnia, muscular cramps and or spasms, psychosis and sometimes seizures which can be life threatening. I have personally seen in my line of work known people commit suicide due to abrupt withdrawal from benzodiazepines. This wiki article needs serious and urgent work done to it in this area. Carpetman2007 16:11, 06 June 2007 (UTC)

I agree, diazepam withdrawal has also been proved more difficult than opioid withdrawal. Its for the interest of Wikipedia readers to understand the actions of Diazepam and any other benzodiazepines fully, which should include withdrawals and the possibility of addiciton, both mentally and physically. --78.86.159.199 (talk) 03:14, 21 August 2008 (UTC)

Long-Acting?

One reference calls this a short acting benzodiazepine (15-60 minutes of primary effects), another calls it long acting. Reb42 17:49, 5 November 2007 (UTC)

Diazepam is very long acting and its active metabolite is even more long acting. However it is dispersed fairly quickly into fatty tissues so it's peak blood levels do not last very long. It is still in the blood stream exerting pharmacological effects but with lesser potency. I have reworded the sentence to say instead of "main pharmacological effects" to say "peak pharmacological effects". Hopefully this will read a bit more clearly to the average reader.--Literaturegeek 22:17, 2 December 2007 (UTC)

Extremely Poor English

Can someone fix the 'howevers' in the coming sentence located in the "Dependence" section. Can you also make it more clear the duration one needs to take diazepam to develop dependence, whether recreational or therapeutically: "Withdrawal symptoms tended to develop within 24 hours on the cessation of a short acting benzodiazepine and within 3 - 10 days after the cessation of a more short acting benzodiazepine. Withdrawal effects could occur however after treatment lasting only 2 weeks at therapeutic dose levels; however withdrawal effects tended to occur with habitual use beyond 2 weeks and were more likely the higher the dose. The withdrawal symptoms may appear to be similar to the original condition."

Thank You --78.86.117.164 (talk) 20:14, 23 November 2007 (UTC)

The dependence section has been edited by another editor and then by myself. I think the problem with the grammar in the dependence section has been corrected now.--Literaturegeek 22:09, 2 December 2007 (UTC)

Amnesia

The article claims that diazepam is used "in some surgical procedures to induce amnesia." I can testify to the amnestic properties of benzodiazepines, but I found the idea of its use for that purpose very curious. I mean, what the hell are they doing during this surgery that they don't want the patient to remember?

Anyway, point is I looked at the references and saw nothing about this. I'm about ready to give this a "citation needed" if no one can prove me wrong or add one. --MQDuck (talk) 04:09, 8 January 2008 (UTC)

This should be more than sufficient: [1] Cheers. Wisdom89 (talk) 06:40, 8 January 2008 (UTC)
They are usually not worried about the patient remembering the procedure. They are much more worried about the patient remembering the pain associated with the procedure.Orinoco-w (talk) 06:17, 14 April 2008 (UTC)

Clutter, Vandalism

Please stop cluttering the benzodiazepines with a collection of refs to arbitrary pubmed articles. Those are largely reports of some experiments, which have been carried out sometime, somewhere and for some reason on rats, mice and brain slices. For almost every such article you will find a match which comes to contrary conclusions. Please limit the contribution to agreed conclusions, as found in pharmacology books and the FDA profiles, avoid anecdotal reports, speculative results, could have, may be involved, has one time been observed, is suspected, is being investigated, could have a theoretical connection etc. Not everything which has sometimes been suspected, investigated, speculated or observed is relevant to pharmacology and should be included. Avoid bot-like inclusion of search results. pubmed is not a source but an Augias-Stable of unfinished research and a playground for students. Example: You conclude that diazepam "is related" to quinazolines, by being investigated together with quinazolines in one citation. You conclude that it is a hapten, by being mentioned in an article about immuno assay tests. These are not relevant articles for pharmacology. Of course it is a hapten in an immuno assay test! That is how antibody based immuno assays work! But this has nothing to do with its pharmacology. Please limit yourself to agreed facts, like the FDA profiles and text book content. The intention is to arrive at something which looks more like the FDA fact sheet. Example: You claim as a peer reviewed fact the HIGH abuse liability, because it is mentioned in a drug abuse related article. FDA/DEA says low-to-medium abuse liability, placement in Schedule IV. The article is useless for somebody seeking info about diazepam. The unchecked inclusion of anecdotal, unrelated, loosely associated and spurious references in a bot-like fashion is subtle VANDALISM. —Preceding unsigned comment added by 70.137.178.160 (talk) 04:36, 3 April 2008 (UTC)

No it isn't vandalism. I suggest reading WP:VANDAL. Wisdom89 (T / C) 04:40, 3 April 2008 (UTC)
What makes you think FDA or pharmacology reports are concrete. If you checked out their history, you would realize they have changed their minds about many things in the past numerous of times and still are. It's good that people cite new studies etc. but yes, try to cite studies that have been replicated with similar results. FDA is also relative to the U.S., and is not always in agreement with other bodies such as that of the Europeans and is also known to favor studies that may benefit domestic policies. --78.86.159.199 (talk) 03:32, 21 August 2008 (UTC)

Merge of CANA

CANA seems to be a bit of an orphan, with only a few links into that page. How about merging into this article, specifically under "availability"? --Rifleman 82 (talk) 06:28, 23 May 2008 (UTC)

I support your merge proposal.--Literaturegeek | T@1k? 08:12, 23 May 2008 (UTC)

Merged. --Rifleman 82 (talk) 06:32, 8 June 2008 (UTC)

Unfortunate wording in "Pharmacology" section

The paragraph on the "Pharmacology" of diazepam is not well presented. It states that the action of diazepam is via µM binding sites (inhibition of Ca2+ channels). Then, only in the paragraph that follows, is the primary action at the GABA channel mentioned. This may cause confusion or a quick-look-up reader may miss the paragraph that follows. I was perplexed when I read the text and looked up the PNAS paper from 1984 that is cited before I realized it came in the paragraph below.

Suggestion Rewrite: "In addition to the main effect of high affinity binding at GABA receptors (see below)diazepam also bind with µM affinity ..." —Preceding unsigned comment added by 90.149.57.207 (talk) 11:14, 18 August 2008 (UTC)

Misleading : GABA levels

Diazepam does affect GABA levels, but indirectly. This sentence: "Benzodiazepines including diazepam however, do not have any effect on the levels of GABA in the brain.[22]" is misleading, perhaps the word "directly" should be added to the end of the sentence. Also, the point that diazepam does not affect GABA levels directly, has been written numerous of times, once is enough. --78.86.159.199 (talk) 03:16, 21 August 2008 (UTC)

Addiction

There needs to be a topic on addiction.—Preceding unsigned comment added by Ericg33 (talk • contribs)

Hello, there is a section on tolerance, physical dependence and withdrawal in the diazepam article, if that is what you are talking about. There is also a section on misuse and addiction if that is what you mean. I renamed the section title of recreational use to drug misuse and addiction. If there is an aspect of diazepam/benzodiazepine addiction lacking, feel free to point it out here on the talk page.--Literaturegeek | T@1k? 21:06, 30 December 2008 (UTC)

I'll add this: There appears to be some contradiction in the misuse and addiction section. It says: "The most commonly-abused benzodiazepine is, however, alprazolam." However, if we go to the wiki for alprazolam (http://en.wikipedia.org/wiki/Alprazolam), we see the following: "Alprazolam has a fast onset of symptom relief (within the first week); it is unlikely to produce dependency or abuse."

so which is it? Is Alprazolam highly addictive and abused, or not?

thanks —Preceding unsigned comment added by 118.92.182.91 (talk) 03:42, 23 February 2010 (UTC)

I am not sure if there is a contradiction per se, just that the source does not put it into context. I replied in more detail here Talk:Alprazolam#Contradiction if you want to read it and reply on the alprazolam talk page.--Literaturegeek | T@1k? 19:14, 23 February 2010 (UTC)

Mania

I searched pubmed trying to find a study on the use of diazepam in mania but was unsuccessful which was surprising. The best I found was this paper,[2] mentioning a slight antimanic effect. From what I know of the treatment of mental health disorders, when a benzodiazepine is indicated it is usually lorazepam or in some hospitals clonazepam that is used for treating acute mania. I deleted it from the indications list due to unverifiability.--Literaturegeek | T@1k? 21:00, 30 December 2008 (UTC)

Anti-Depressant

Somebody has added the following: In the form of Valium, it has also been successfully used as an anti-depressant in Europe since 1996 and approved for that use in 1998.

AFAIK this is nonsense. Diazepam isn't an antidepressant and is usually contraindicated where depression is present, though it can be used for the short term treatment of depression related anxiety. I have added a citation request. If no citation is forthcoming the section should be deleted. --80.176.142.11 (talk) 11:32, 3 January 2009 (UTC)

I've removed it as it was unsourced and added yesterday by anon and with no edit summary. Diazepam is not listed as an antidepressant in the BNF. Colin°Talk 18:08, 3 January 2009 (UTC)
Indeed, the BNF indicates it shouldn't be used in depression: "should not be used alone in depression or in anxiety with depression". ῤerspeκὖlὖm in ænigmate ( talk ) 19:43, 23 February 2010 (UTC)

Organization of Article

It seems to me that the article could use a little re-ordering, especially given the concerns which have been expressed regarding difficulty following the article. I propose that we re-arrange the sections as follows: Intro, History, Indications, Mechanism of Action, then everything regarding side effects, overdose, etc., then finish off with pharmacology, dosage, availability, and pharmacokinetics. It seems silly to me to have a dozen or so sections before getting to the mechanism of action section. This would also bring the article more in line with other similar pharmaceutical articles. Thoughts? justin.kirkham (talk) 00:01, 16 May 2010 (UTC)

I have added to the lede of the article a summary of the mechanism of action of diazepam. Section layout should be based on WP:MEDMOS.--Literaturegeek | T@1k? 22:22, 19 May 2010 (UTC)
I have rearranged the article section layout in accordance with WP:MEDMOS. I hope that these changes address your concerns. :)--Literaturegeek | T@1k? 22:30, 19 May 2010 (UTC)

Really an Adverse Effect?

This article twice mentions "sedation" as a "side effect" and/or an "adverse effect" of diazepam. I am not sure this is accurate as stated, because the sedative effect may indeed be a desirable positive effect of the medicine if it is being taken for certain conditions commonly treated with diazepam (e.g. anxiety, panic attack, insomnia, agitation, etc.) I propose listing "sedation" as an "effect" of the medicine rather than as a "side-effect." Discuss? —Preceding unsigned comment added by 24.218.178.56 (talk) 21:05, 8 June 2010 (UTC)

I just found out this medicine is also used in sedation dentistry, as well as before endoscopy. I believe this is even mentioned in the wiki article somewhere. In this case, sedation is not only a desirable effect, but the intended one. —Preceding unsigned comment added by 24.218.178.56 (talk) 21:20, 8 June 2010 (UTC)

Sedation actually means tranquillisation rather than drowsiness, hypnotic refers to drowsiness but the medical literature and lay people often use sedation to describe drowsiness/hypnotic effects. I would not have any problems with explaining that drowsiness is desirable for certain medical indications. It may also be worth replacing instances of sedation with drowsiness when hypnotic effects was what was meant.--Literaturegeek | T@1k? 23:01, 8 June 2010 (UTC)

Another Anti-Benzodiazepine Article with Questionable References "Benzodiazepines such as diazepam impair learning and memory via their action on benzodiazepine receptors, which causes a dysfunction in the cholinergic neuronal system" (60). Who in the world would would make such a bold statement based on a 20-year old mouse study? There are oodles of human studies to the contrary, just look them up. What is with the constant anti-benzodiazepine bias in Wikipedia; yes, the drugs have to be used with caution and under a doctor's direction-just like hundreds of other drugs-but there are no safer drugs for anxiety disorders except maybe some of the SSRI's. Maybe. The references to the dangers of the use of this class of compounds seem consistently outdated, out-numbered, and unconvincing. Dehughes (talk) 21:40, 11 October 2010 (UTC)

There is actually little to no controversy regarding benzodiazepines, including diazepam having cognitive impairing effects. Infact the memory side effects are actually a prescribing indication, eg to induce amnesia before investigative proceedures in hospitals. Thus it is not to do with an anti benzo statement. The peer reviewed literature doesn't say what you say it says. It is actually you who is making a bold statement if you state that benzodiazepines do not have any effect on cognition as it disagrees with almost the entire medical literature on the subject. I do agree that the sourcing for the statement is not good, being a primacy sourced animal study. I will try and replace it with a better quality source. Thank you for pointing out the poor quality source.--Literaturegeek | T@1k? 22:00, 11 October 2010 (UTC)
Ok, Dehughes, I replaced the 1990 animal study with a recent secondary academic book source that was published by the American Psychiatric Association.--Literaturegeek | T@1k? 22:32, 11 October 2010 (UTC)

Sorry to have taken my frustrations out on your particular statement-my statement was a bit heavy-handed. Your new references says, "...this class of medications can(my bold) produce consistent adverse effects on memory...benzodiazepines do not appear to impair retrograde memory. Indeed, lists of words learned before benzodiazepine administration may be better recalled in the postingestion period...". That reference still doesn't sound like "Benzodiazepines such as diazepam impair learning and memory..." as quoted in the article. Even your reference says "can", not "does". I just find your statement very definitive in the absence of documented, clinical studies-the word "can" is perhaps more appropriate. The whole subject is obscured by the fact that the condition people often take diazepam for-anxiety-in itself causes memory problems, and upon taking benzos, memory is better. It's a complex issue. Actually, the FDA (http://www.drugs.com/pro/valium.html) and the package insert for Valium list memory problems as "Adverse Reactions"-not a typical response to the medication. BTW, I don't have a horse in this race, I think diazepam is useless as an anti-anxiety med. Dehughes (talk) 18:10, 14 October 2010 (UTC)

Yes benzos do not impair previously learned memory. The article already said that they can cause anterograde amnesia, but worth pointing out not retrograde amnesia. I just kept it simple as the various effects of benzos on memory or lack of effects on memory could take up a couple of paragraphs or more depending on how much detail we go into. I did not use the word "does" in the sentence, I used the word "has", you can change the word "has" to "can" if you like, it is no big deal. I have added in that benzos do not cause impairments of previously learned information. An adverse reaction is an unwanted effect, an unwanted effect which is typical/very common doesn't stop being an adverse reaction just because it is a typical effect. Chemotherapy typically causes nausea but it is still an adverse effect.--Literaturegeek | T@1k? 01:46, 15 October 2010 (UTC)

Good point. The Mayo Clinic (http://www.mayoclinic.com/health/drug-information/DR602809/DSECTION=side-effects) lists memory problems as a "side effect', which is more what I was aiming at...something that might happen with use, but won't necessarily happen. I used "does" because the definitive structure of the statement implies "does" implicitly, I didn't mean you used the word "does"-I just didn't know an alternate way to express the point. Thank you for your consideration of my concerns on this point. Dehughes (talk) 14:29, 15 October 2010 (UTC)

You are welcome Dehughes and thank you for pointing out the poor quality reference.--Literaturegeek | T@1k? 20:56, 17 October 2010 (UTC)

Diazepam citation request

A quantative citation is needed for the onset of action, rather than qualitative ("rapid"), similar to the Alprazolam article.

LordGavin (talk) 11:21, 24 August 2012 (UTC)

Valerian connection?

I have heard that the valium name is derived from the herb name valerian
but I do not know whether this is true
or whether diazepam is chemically related to any active constituent of valerian
Laurel Bush (talk) 14:47, 12 August 2013 (UTC)

There seems to be no connection between the herb and the pharmaceutical brand. Valium is an invented name, sounding vaguely yet eerily similar to Librium (the the first benzodiazepine to be synthesised in the mid-1950s), the leading tranquiliser at the time of Valium's release. MinorProphet (talk) 05:07, 26 August 2013 (UTC)
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