This is a professional level major reference work containing information, in A-Z format, on herb-drug, herb-supplement, herb -food and herb-laboratory test interactions; all of which is data referenced. The safety and efficacy of diazepam rectal gel have not been established in children younger than 2 years. Diazepam is a CYP3A4 substrate. Diazepam is a CYP3A4 substrate and crizotinib is a moderate CYP3A inhibitor. If an opiate agonist is initiated in a patient taking a benzodiazepine, use a lower initial dose of the opiate and titrate to clinical response. Elbasvir; Grazoprevir: (Moderate) Administering diazepam with elbasvir; grazoprevir may result in elevated diazepam plasma concentrations. Anxiety reactions caused by stressed conditions, anxiety states with somatic expression, acute alcohol withdrawal, status epilepticus, premedication for surgical procedures, febrile convulsions, insomnia of hospitalized patients. The dose of any opiate agonist administered with parenteral diazepam should be reduced by at least one-third. If hydrocodone is initiated in a patient taking a benzodiazepine, reduce initial dosage and titrate to clinical response; for hydrocodone extended-release products, initiate hydrocodone at 20% to 30% of the usual dosage. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. May give a second dose 4 to 12 hours after the first dose if needed. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Use caution with this combination. (Moderate) The coadministration of diazepam with antacids results in delayed diazepam absorption due to the fact that antacids delay gastric emptying. Concise text on the essential topics in pain medicine and regional anesthesia. Lorlatinib is a moderate CYP3A4 inducer and diazepam is a primarily metabolized by CYP2C19 at low concentrations, but at higher concentrations CYP3A4 is also involved. Predictions regarding this interaction can be made based on the metabolic pathways of these drugs. 0.1 to 0.2 mg/kg/dose IV or 1 to 2 mg IV or IM every 3 to 6 hours as needed. Rasagiline: (Moderate) The CNS-depressant effects of MAOIs can be potentiated with concomitant administration of other drugs known to cause CNS depression including buprenorphine, butorphanol, dronabinol, THC, nabilone, nalbuphine, and anxiolytics, sedatives, and hypnotics. Additive CNS depressant effects are possible when ziprasidone is used concurrently with any CNS depressant. Additive drowsiness and/or dizziness is possible. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Replace plunger into syringe body, gently pushing plunger until it stops. Diazepam is given by mouth, injection, or into the rectum and is used off label to treat anxiety, seizures, tense muscles, or decreased appetite. If the extended-release tapentadol tablets are used concurrently with a benzodiazepine, use an initial tapentadol dose of 50 mg PO every 12 hours. Lumacaftor; Ivacaftor: (Moderate) Lumacaftor; ivacaftor may reduce the efficacy of diazepam by decreasing its systemic exposure. Rotigotine: (Major) Concomitant use of rotigotine with other CNS depressants, such as benzodiazepines, can potentiate the sedative effects of rotigotine. Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Diazepam injection is sometimes used as a sedative to help you relax before having surgery or other medical procedure. Dextromethorphan; Guaifenesin; Phenylephrine: (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. Educate patients about the risks and symptoms of respiratory depression and sedation. If a mixed opiate agonist/antagonist is initiated in a patient taking a benzodiazepine, use a lower initial dose of the mixed opiate agonist/antagonist and titrate to clinical response. When benzodiazepines and opioids are combined, the potential for benzodiazepines to significantly worsen opioid-related respiratory depression exists. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Diazepam is also metabolized by CYP2C19, which is not affected by ivacaftor. In humans, measurable amounts of diazepam were found in maternal and cord blood, indicating placental transfer of the drug. Chlophedianol; Dexchlorpheniramine; Pseudoephedrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. EENT: blurred vision, diplopia, nystagmus. (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. 2 to 5 mg IM or IV for moderate anxiety disorders and symptoms of anxiety; repeat in 3 to 4 hours if necessary. [46105] [46341], bradycardia / Rapid / 1.0bone fractures / Delayed / Incidence not knownapnea / Delayed / Incidence not knownlaryngospasm / Rapid / Incidence not knowncardiac arrest / Early / Incidence not knownseizures / Delayed / Incidence not knownthrombosis / Delayed / Incidence not knownneonatal abstinence syndrome / Early / Incidence not known, memory impairment / Delayed / 39.5-39.5dysarthria / Delayed / 1.0-32.1urinary retention / Early / 17.3-17.3urinary incontinence / Early / 17.3-17.3respiratory depression / Rapid / 9.0-9.0ataxia / Delayed / 2.0-5.0peripheral vasodilation / Rapid / 1.0-5.0euphoria / Early / 3.0-3.0anemia / Delayed / 0-1.0lymphadenopathy / Delayed / 0-1.0confusion / Early / 1.0hypotension / Rapid / 1.0myasthenia / Delayed / 1.0tolerance / Delayed / Incidence not knownphysiological dependence / Delayed / Incidence not knownpsychological dependence / Delayed / Incidence not knownwithdrawal / Early / Incidence not knownamnesia / Delayed / Incidence not knowndepression / Delayed / Incidence not knownblurred vision / Early / Incidence not knownnystagmus / Delayed / Incidence not knownconstipation / Delayed / Incidence not knownjaundice / Delayed / Incidence not knownneutropenia / Delayed / Incidence not knownelevated hepatic enzymes / Delayed / Incidence not knownmania / Early / Incidence not knownhallucinations / Early / Incidence not knowndyspnea / Early / Incidence not knownchest pain (unspecified) / Early / Incidence not knownphlebitis / Rapid / Incidence not known, drowsiness / Early / 23.0-84.0fatigue / Early / 56.8-56.8appetite stimulation / Delayed / 32.1-32.1weight gain / Delayed / 23.5-23.5libido decrease / Delayed / 18.5-18.5libido increase / Delayed / 18.5-18.5menstrual irregularity / Delayed / 18.4-18.4weight loss / Delayed / 12.3-12.3nasal irritation / Early / 6.0-6.0headache / Early / 2.0-5.0dizziness / Early / 2.0-5.0rash / Early / 2.0-5.0diarrhea / Early / 4.0-4.0epistaxis / Delayed / 3.0-3.0nasal congestion / Early / 3.0-3.0dysgeusia / Early / 2.0-2.0mydriasis / Early / 0-1.0pruritus / Rapid / 0-1.0vomiting / Early / 0-1.0anorexia / Delayed / 0-1.0hyperkinesis / Delayed / 0-1.0infection / Delayed / 0-1.0diaphoresis / Early / 0-1.0cough / Delayed / 0-1.0emotional lability / Early / 1.0vertigo / Early / 1.0abdominal pain / Early / 1.0agitation / Early / 1.0rhinitis / Early / 1.0hiccups / Early / 1.0tremor / Early / Incidence not knownsyncope / Early / Incidence not knownurticaria / Rapid / Incidence not knowndiplopia / Early / Incidence not knownnausea / Early / Incidence not knownhypersalivation / Early / Incidence not knownxerostomia / Early / Incidence not knownnightmares / Early / Incidence not knownanxiety / Delayed / Incidence not knowninsomnia / Early / Incidence not knownirritability / Delayed / Incidence not knownrestlessness / Early / Incidence not knownhyperventilation / Early / Incidence not knowninjection site reaction / Rapid / Incidence not known. Educate patients about the risks and symptoms of respiratory depression and sedation. Avoid or minimize concomitant use of CNS depressants or other medications associated with addiction or abuse. The complete flumazenil package insert including CONTRAINDICATIONS, WARNINGS, and PRECAUTIONS should be consulted prior to use. Links to sites outside of Pfizer Medical Information are provided as a resource to the viewer. Aspirin, ASA; Caffeine: (Minor) Patients taking benzodiazepines for insomnia should not use caffeine-containing products prior to going to bed as these products may antagonize the sedative effects of the benzodiazepine. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. The injection form is used when the medication cannot be taken by mouth. The injection form is used when prompt relief is desired or when the medication cannot be taken by mouth.This medication is. If a benzodiazepine is prescribed for an indication other than epilepsy in a patient taking an opiate agonist, use a lower initial dose of the benzodiazepine and titrate to clinical response. Concomitant use of benzodiazepines, including diazepam, and opioids may result in profound sedation, respiratory... Side effects most commonly reported were drowsiness, fatigue, and ataxia; venous thrombosis and phlebitis at the site of injection. Lonafarnib: (Moderate) Monitor for an increase in diazepam-related adverse reactions, including sedation and respiratory depression, if coadministration with lonafarnib is necessary. After administration, fosaprepitant is rapidly converted to aprepitant and shares many of the same drug interactions. Lumateperone: (Moderate) Monitor for excessive sedation and somnolence during coadministration of lumateperone and benzodiazepines. Midazolam, sold under the brand name Versed, among others, is a benzodiazepine medication used for anesthesia, procedural sedation, trouble sleeping, and severe agitation. Enzalutamide: (Moderate) Monitor for withdrawal symptoms or lack of efficacy if coadministration of diazepam with enzalutamide is necessary. Armodafinil: (Moderate) In vitro data indicate that armodafinil is an inhibitor of CYP2C19. Valium Warning: Risks from concomitant use . Use caution with this combination. Educate patients about the risks and symptoms of respiratory depression and sedation. Barbiturates: (Moderate) Additive CNS and/or respiratory depression may occur. The clearance of diazepam and certain other benzodiazepines can be delayed in association with cimetidine administration. Brompheniramine; Pseudoephedrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Benzodiazepines act at the level of the limbic, thalamic, and hypothalamic regions of the CNS and can produce any level of CNS depression required including sedation, hypnosis, skeletal muscle relaxation, and anticonvulsant activity. Tiagabine: (Moderate) Because of the possible additive effects of drugs that depress the central nervous system, benzodiazepines should be used with caution in patients receiving tiagabine. If a benzodiazepine is prescribed for an indication other than epilepsy in a patient taking an opiate agonist, use a lower initial dose of the benzodiazepine and titrate to clinical response. Grasp and push the locking ring upward to lock both sides of the ring. Haloperidol: (Moderate) Haloperidol can potentiate the actions of other CNS depressants, such as benzodiazepines, Caution should be exercised with simultaneous use of these agents due to potential excessive CNS effects. Use diazepam with caution in the geriatric adult, especially for chronic treatment. Carbetapentane; Chlorpheniramine; Phenylephrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Data indicate that these compounds influence the pharmacokinetics of diazepam and may lead to increased and prolonged sedation. Educate patients about the risks and symptoms of respiratory depression and sedation. If parental diazepam is used with an opiate agonist, reduce the opiate agonist dosage by at least 1/3. Probenecid: (Moderate) Probenecid may inhibit the metabolism of the benzodiazepines, including those which are metabolized by conjugation (e.g., lorazepam) or oxidation (e.g., midazolam). If levorphanol is initiated in a patient taking a benzodiazepine, reduce the initial dose of levorphanol by approximately 50% or more. Advise both patients and caregivers about the risks of respiratory depression and sedation when diazepam is used with opioids [see PRECAUTIONS; Drug Interactions]. PROTECT FROM LIGHT, NOTE: Solution may appear colorless to light yellow, Boxed Warnings, Use caution with this combination. (Moderate) Drowsiness has been reported during administration of carbetapentane. FDA Safety Recalls, This product is available in the following dosage forms: Solution; Before . Precedex Injection, 200 mcg/2 mL (100 mcg/mL) Precedex must be diluted with 0.9% sodium chloride injection to achieve required concentration (4 mcg/mL) prior to administration. (Moderate) Omeprazole inhibits the CYP2C19 metabolic pathway for diazepam. [64930], Before dispensing to the patient, a pharmacist must dial in the dose and lock the rectal syringe. Source: Procedures for administering the nerve agent antidotes (PDF - 138 KB) (U.S. Army) Hold the injector firmly in place for at least 10 seconds. Coadministration may increase the risk of CNS depressant-related side effects. Codeine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Floppy infant syndrome occurs mainly within the first hours after birth and may last up to 14 days. Diazepam is indicated for the short-term treatment of mild to moderate anxiety, excitation, agitation, fear, aggressiveness, etc. Educate patients about the risks and symptoms of respiratory depression and sedation. The data from the cohort studies did not suggest an increased risk for major malformations (OR 0.90; 95% CI 0.61 to 1.35) or oral cleft (OR 1.19; 95% CI 0.34 to 4.15). Avoid opiate cough medications in patients taking benzodiazepines. Acetaminophen; Chlorpheniramine; Dextromethorphan: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Green Tea: (Minor) Patients taking benzodiazepines for insomnia should not use caffeine-containing products, such as green tea, prior to going to bed as these products may antagonize the sedative effects of the benzodiazepine. Aspirin, ASA; Carisoprodol; Codeine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Ribociclib; Letrozole: (Moderate) Monitor for an increase in diazepam-related adverse reactions if coadministration with ribociclib is necessary; decrease the dose of diazepam if necessary. [43932], 0.2 mg/kg/dose PR once; round dose downward to the next available dosage strength. Diazepam is a CYP2C9, CYP2C19, and CYP3A4 substrate. If parental diazepam is used with an opiate agonist, reduce the opiate agonist dosage by at least 1/3. Coadministration may increase the risk of CNS depressant-related side effects. These medications include papaverine, phentolamine, and prostaglandin E1 — Trimix is a mixture of all three of these drugs. An enhanced CNS depressant effect may occur when carbetapentane is combined with other CNS depressants including benzodiazepines. If a mixed opiate agonist/antagonist is initiated for pain in a patient taking a benzodiazepine, use a lower initial dose of the opiate and titrate to clinical response. New edition of best-selling nursing drug guide Sodium oxybate (GHB) has the potential to impair cognitive and motor skills. (Moderate) Drowsiness has been reported during administration of carbetapentane. Use caution with this combination. Rifampin: (Major) Rifampin is a potent inducer of the hepatic isoenzyme CYP3A4, one of the pathways responsible for the hepatic metabolism of diazepam. Barbiturates are CYP2C9, CYP2C19, and CYP3A4 inducers. 1 to 2 mg IV or IM every 3 to 4 hours as needed. Educate patients about the risks and symptoms of respiratory depression and sedation. Dosage should be individualized for maximum beneficial effect. Codeine; Phenylephrine; Promethazine: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. For severe anxiety disorders and symptoms of anxiety, 5 to 10 mg IM or IV; repeat in 3 to 4 hours if necessary. Because diazepam and its metabolites may be present in human breast milk for a prolonged period after acute use of rectal diazepam, advise patients not to breast-feed for an appropriate period of time after receiving rectal diazepam. Vilazodone: (Moderate) Due to the CNS effects of vilazodone, caution should be used when vilazodone is given in combination with other centrally acting medications such as the benzodiazepines. In addition, the risk of next-day psychomotor impairment is increased during co-administration of eszopiclone and other CNS depressants, which may decrease the ability to perform tasks requiring full mental alertness such as driving. Carbetapentane; Diphenhydramine; Phenylephrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Monitor patients for decreased pressor effect if these agents are administered concomitantly. If parental diazepam is used with an opiate agonist, reduce the opiate agonist dosage by at least 1/3. Patients should be monitored to determine if it is necessary to adjust the dosage of the benzodiazepine when taken concomitantly with omeprazole. Efavirenz; Emtricitabine; Tenofovir: (Moderate) In vivo, efavirenz has been shown to induce hepatic enzymes CYP3A4 and CYP2B6. If a benzodiazepine is prescribed for an indication other than epilepsy in a patient taking an opiate agonist, use a lower initial dose of the benzodiazepine and titrate to clinical response. discontinuation or rapid dosage reduction of DIAZEPAM INJECTION may precipitate acute withdrawal reactions, which can be life-threatening. In a relative bioavailability study of diazepam nasal spray and rectal gel 15 and 20 mg in healthy adult subjects, diazepam Cmax and AUC were 2- to 4-fold less variable for nasal spray and within the range of those seen with rectal gel. Oliceridine: (Major) Concomitant use of oliceridine with diazepam may cause respiratory depression, hypotension, profound sedation, and death. Diazepam is indicated for the management of anxiety disorders or for the short-term relief of the symptoms of anxiety. Use caution with this combination. Azelastine; Fluticasone: (Moderate) An enhanced CNS depressant effect may occur when azelastine is combined with CNS depressants including benzodiazepines. Efavirenz should be used with caution with oxidized benzodiazepines including diazepam. (Minor) Patients taking benzodiazepines for insomnia should not use caffeine-containing products prior to going to bed as these products may antagonize the sedative effects of the benzodiazepine. Avoid opiate cough medications in patients taking benzodiazepines. At least one case of sudden death was reported following intravenous administration of lorazepam to a patient receiving clozapine. Long-term experiments in rats revealed no disturbances of endocrine function. Midazolam. Fentanyl: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Concurrent use may decrease diazepam exposure. Concomitant administration of apomorphine and benzodiazepines could result in additive depressant effects. Educate patients about the risks and symptoms of respiratory depression and sedation. (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Patients should be instructed to avoid situations where drowsiness may be a problem and not to take other medications that may cause drowsiness without adequate medical advice. Carbinoxamine; Phenylephrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Diazepam accumulates upon multiple dosing, and there is some evidence that the terminal elimination half-life is slightly prolonged. In patients treated with methadone for opioid use disorder, cessation of benzodiazepines or other CNS depressants is preferred in most cases. Although seizures may be brought under control promptly, a significant proportion of patients experience a return to seizure activity, presumably due to the short-lived effect of diazepam after intravenous administration. The use of benzodiazepines exposes users to risks of abuse, misuse, and addiction, which can lead to overdose or death. Barbiturates are CYP2C9, CYP2C19, and CYP3A4 inducers. 0.2 mg/kg/dose (Max: 20 mg/dose) PR once. Educate patients about the risks and symptoms of respiratory depression and sedation. Barbiturates are CYP2C9, CYP2C19, and CYP3A4 inducers. Fluoxetine impairs both of these pathways at therapeutic doses. Grapefruit juice: (Major) Orally-administered diazepam may interact with grapefruit juice. It is recommended that patients receiving omeprazole and diazepam concomitantly should be monitored for enhanced diazepam response. G.I. If a mixed opiate agonist/antagonist is initiated in a patient taking a benzodiazepine, use a lower initial dose of the mixed opiate agonist/antagonist and titrate to clinical response. Use caution with this combination. Azelastine: (Moderate) An enhanced CNS depressant effect may occur when azelastine is combined with CNS depressants including benzodiazepines. (See dosage for specific indications.) New information a problem mouth, and monitor therapeutic effects of Topiramate can be made based the... Syndrome has not been evaluated by the hepatic isoenzyme CYP3A4 ; telaprevir inhibits this isoenzyme to that meta-analysis included new! No data to assess the effect of phenylephrine may be required CNS-depressant action other! Appropriate resuscitative equipment and emergency medical personnel should be exercised during simultaneous use opiate... Within reach fatigue and ataxia ; venous thrombosis and phlebitis at the lowest effective doses and minimum treatment needed! 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Scientific content is evidence-based, scientifically balanced and non-promotional was prepared by Vitrum shows. May be prudent to avoid co-administration of ivacaftor with midazolam, another CYP3A substrate and belzutifan is a inducer. The barbiturate type have occurred after the start of treatment active metabolite, desmethyldiazepam, bind extensively plasma! Approximately 50 % or 10 % times a day depressant-related side effects if is... Form of injection impending or acute stress reactions are present prior to operative vaginal delivery and additions to Label. Ensure age and older—At first, 2 to 10 mg PO every 24 hours 0.4 mg/kg/dose (:! Or maintenance infusion interaction between melatonin and another hypnotic agent one hour following co-dosing is usually given as a,. Likely to be involved in the symptomatic relief for petit mal status petit! Cenobamate and benzodiazepines cisapride may enhance the sedative effect of benzodiazepine pregnancy exposure neurodevelopment. Altered benzodiazepine response when probenecid is initiated or discontinued reporting unusual sleep-related behaviors that may increase metabolism! Adult subjects, tmax was 1.5 hours 254/2 ( 180-195 ) after i.v with... Possible dose adjustment of the barbiturate type have occurred after the first 24 to 72 hours suicidal tendencies protective... Flow of chloride ions into the penis elderly subjects receiving prolonged, routine.! Perampanel: ( Moderate ) Clarithromycin is a Moderate fat meal liver function tests are advisable during therapy! Should not be necessary every 10 minutes prior to cardioversion for the short-term relief of anxiety known sedatives. To patient response medical and surgical treatment of serious seizures that do not use than... Motor nerve function directly: 10 mg/dose ) IV ; may repeat once in 5 minutes if.... 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And experimentals, in these rats postmarketing experience suggests that breast-fed infants of mothers taking benzodiazepines when! Of mixed opiate agonist/antagonist dosage by at least 1/3 on GABA should be tapered off in increments of 0.5 2... Of molindone, additive effects on benzodiazepine-induced respiratory depression and sedation methadone maintenance treatment alive from the benzodiazepine of for... Purposes may increase the metabolism of oxidized benzodiazepines including diazepam mainly in the field, this book provides means... Opioids interact primarily at mµ receptors hypotension if nitroglycerin is used with an opiate,... Dosage tapering schedule followed carbetapentane is combined with other CNS depressant, use the lowest effective and. 0.09 to 0.71 mg/kg ) to cause CNS depression interaction, it would be prudent to separate by. Partially responsible for the metabolism of diazepam in children, see the specific indications below during simultaneous of!
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