[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Benzodiazepines](https://durgical.com/en/pharmacology/classes/benzodiazepines/) › Diazepam

[Pharmacology](https://durgical.com/en/pharmacology/) · [Benzodiazepines](https://durgical.com/en/pharmacology/classes/benzodiazepines/)

# Diazepam

A long-acting benzodiazepine for anxiety, alcohol withdrawal, muscle spasm and seizures. It and its active metabolites stay in the body for days.

Updated 2026-11-01

- Class: [Benzodiazepines](https://durgical.com/en/pharmacology/classes/benzodiazepines/)
- Receptor: GABA-A receptor, benzodiazepine site
- ATC code: N05BA01
- WHO Model List of Essential Medicines

## ⚠ High-alert medication

An error with this medicine can cause serious harm: double checks and protocols are used.

◎**GABA-A receptor, benzodiazepine site**Diazepam

ⓘ The figure shows diazepam itself bound to the human GABA-A receptor (α1β2γ2) together with GABA.

**Target in 3D:** GABA-A receptor, benzodiazepine site. PDB structure 6X3X (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/6X3X) · Drag to rotate · pinch to zoom

## Mechanism of action

Diazepam binds the benzodiazepine site of the GABA-A receptor and makes GABA open the chloride channel more often. The extra inhibition gives anxiolytic, sedative, muscle-relaxant, anticonvulsant and amnestic effects. The liver turns it into active metabolites (desmethyldiazepam, temazepam and oxazepam), so its effect lasts long.

- Binds the benzodiazepine site of the GABA-A receptor
- GABA opens the chloride channel more often
- Chloride enters and the neuron is inhibited
- Anxiety, muscle spasm and seizures are calmed

## Pharmacokinetics

**Absorption**
More than 90% absorbed by mouth; peak in about 1 to 1.5 hours; food slows absorption

**Metabolism**
In the liver by CYP3A4 and CYP2C19 to active desmethyldiazepam and temazepam, then oxazepam

**Half-life**
Up to 48 hours for diazepam and up to 100 hours for desmethyldiazepam

**Onset and duration**
Fast after intravenous injection

## Indications

- Anxiety disorders and short-term relief of anxiety [Generalized anxiety disorder →](https://durgical.com/en/conditions/generalized-anxiety-disorder/)
- Acute alcohol withdrawal (agitation, tremor, delirium tremens) [Alcohol withdrawal and delirium tremens →](https://durgical.com/en/conditions/alcohol-withdrawal-and-delirium-tremens/)
- Status epilepticus, as add-on treatment (injection) [Status epilepticus →](https://durgical.com/en/conditions/status-epilepticus/)
- Muscle spasm, spasticity and tetanus, as add-on treatment [Tetanus →](https://durgical.com/en/conditions/tetanus/)
- Sedation before endoscopy, cardioversion or surgery (injection)

## Adverse effects

### Common

- Drowsiness and tiredness
- Unsteadiness (ataxia) and muscle weakness
- Confusion and memory problems, especially in older adults
- Pain and phlebitis at the injection site

### Serious (rare, important)

- Profound sedation, respiratory depression, coma and death when combined with opioids
- Abuse, misuse and addiction
- Physical dependence; stopping suddenly can cause life-threatening withdrawal, including seizures
- Apnoea and cardiac arrest with intravenous use in older, very ill or lung-compromised patients
- Propylene glycol toxicity (acidosis, kidney injury) with very large injected amounts

## Contraindications

- Hypersensitivity to diazepam
- Acute narrow-angle glaucoma
- Myasthenia gravis, severe respiratory insufficiency, sleep apnoea (oral form)
- Severe liver failure (oral form)
- Infants under 6 months (oral form)

## Key interactions

**Opioids**
Profound sedation, respiratory depression, coma and death

**Alcohol and other central nervous system depressants**
Additive sedation and breathing depression

**CYP3A4 and CYP2C19 inhibitors (cimetidine, ketoconazole, fluvoxamine, fluoxetine, omeprazole)**
Longer and stronger sedation

**Phenytoin**
Phenytoin clearance may fall

## What is monitored

- Breathing, oxygen saturation and level of consciousness, above all after IV doses
- Blood pressure during IV use
- Accumulation and falls in older adults
- Signs of misuse or dependence with long use

## Administration and safety

- IV: injected slowly into a large vein, never into the small veins of the hand or wrist
- Not mixed or diluted with other solutions or drugs in the syringe or bag
- Intra-arterial injection and extravasation are avoided
- Airway and ventilation equipment ready before IV use
- Contains benzyl alcohol: risk of gasping syndrome in premature infants

## Nursing care

- Before each dose, check level of alertness, breathing rate and oxygen saturation
- Ask about opioids, alcohol and other sedatives
- Prevent falls, especially in older adults (unsteadiness, confusion)
- Teach not to drive or drink alcohol and not to stop the medicine suddenly
- Check the IV site for redness, pain or swelling

## Pregnancy and breastfeeding

Use late in pregnancy can cause sedation and withdrawal symptoms in the newborn, who is watched after birth.

## Memory aid

Diazepam: «D for Days» – long half-life plus active metabolites; good for alcohol withdrawal, risky in older adults.

## Test yourself

Think of the answer, then tap the question to see it.

## Why does diazepam act for so long with regular use?

Its active metabolite desmethyldiazepam has a half-life of up to about 100 hours.

## Into which veins is IV diazepam not injected, and why?

Small veins of the hand or wrist, because of thrombosis, phlebitis and irritation.

## What are three emergency uses of diazepam?

Status epilepticus, alcohol withdrawal and tetanus spasms.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/diazepam/)

## Related drugs

- [Lorazepam](https://durgical.com/en/pharmacology/lorazepam/)
- [Chlordiazepoxide](https://durgical.com/en/pharmacology/chlordiazepoxide/)
- [Midazolam](https://durgical.com/en/pharmacology/midazolam/)
- [Flumazenil](https://durgical.com/en/pharmacology/flumazenil/)

## Related conditions

- [Generalized anxiety disorder](https://durgical.com/en/conditions/generalized-anxiety-disorder/)
- [Alcohol withdrawal and delirium tremens](https://durgical.com/en/conditions/alcohol-withdrawal-and-delirium-tremens/)
- [Status epilepticus](https://durgical.com/en/conditions/status-epilepticus/)
- [Tetanus](https://durgical.com/en/conditions/tetanus/)

[← Back to the class: Benzodiazepines](https://durgical.com/en/pharmacology/classes/benzodiazepines/)

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [DailyMed - DIAZEPAM tablet](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=c397a9da-862f-4f3f-8109-7d21691de53a) (DailyMed (U.S. National Library of Medicine), 2026); [DailyMed - DIAZEPAM injection, solution](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ae52866a-0b9a-4baf-af1b-f9d5e00c0e56) (DailyMed (U.S. National Library of Medicine), 2026); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=N05BA01) (WHO Collaborating Centre for Drug Statistics Methodology, 2026); [6X3X: Human GABAA receptor alpha1-beta2-gamma2 subtype in complex with GABA plus diazepam](https://www.rcsb.org/structure/6X3X) (RCSB Protein Data Bank, 2020).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

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