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Diazepam is a benzodiazepine tranquilizer. Drugs in this class act directly on the brain and are central nervous system (CNS) depressants. Although the precise mechanism of action is not fully known, specific benzodiazepine receptors have been found in the brain and other tissues including the heart, kidney, liver and lungs. Diazepam is used clinically for sedation, to diminish anxiety or modify behavior, as a muscle relaxant, an anticonvulsant, and in some species as an appetite stimulant. It may be administered intra-venously, intra-muscularly, orally and rectally via suppository or enema. Diazepam is metabolized by the liver to nordiazepam and other active metabolites. They are excreted in the urine.
Diazepam can be used as a sedative either alone or in combination with other drugs. It is considered a relatively safe pre-operative sedative for patients with underlying cardiac or metabolic diseases because it causes minimal cardiopulmonary side effects and provides good muscle relaxation. It may be used in combination with ketamine for induction of anesthesia.
Diazepam is used in both dogs and cats as an anti-anxiety drug and for the treatment of many behavioral problems including some stereotypic behaviors. These behaviors include separation anxiety, fear of loud noises or thunderstorms, territorial or social aggression between animals, urine marking or spraying, and hair loss due to excessive licking or grooming. Diazepam can be used to treat aggressive dogs in order to make them more manageable although occasional individuals can have a contradictory reaction and become more aggressive. If diazepam is used in a potentially aggressive animal, it is important to be aware of this possibility, warn the animal's handler, and take appropriate precautions. Because diazepam causes drowsiness and decreased coordination, it may impair the ability of working dogs. Diazepam alone is less likely to be effective as a sedative when used in an animal that is already excited.
Diazepam is frequently used in the treatment of seizures. It is the treatment of choice for clusters of seizures or status epilepticus in both dogs and cats. It is used in the emergency treatment of seizures due to poisoning or intoxication. It is also used for the long-term management of seizures in cats (either alone or in combination with other drugs). Diazepam is not as commonly used in the long-term management of epilepsy in the dog because it loses effectiveness within a few weeks. Other drugs such as phenobarbital or potassium bromide are more commonly used for this purpose in dogs.
Diazepam is used as a muscle relaxant either alone or
in combination with other drugs. It can be used to treat pain and muscle
spasm associated with many conditions including inter-vertebral disc disease,
urethral obstruction, muscle cramping, tremors and tetanus.
It is used in combination with corticosteroids to treat "Little White
Shakers" Syndrome in Maltese and West Highland white terriers.
Diazepam is a powerful appetite stimulant in the cat.
Diazepam is most frequently used in horses as a part of a pre-operative sedative combination and in the treatment of seizures both in the neonate and in adult horses. It is not commonly used on its own as a sedative in adult horses but can be used to sedate neonates. It is generally considered a safe choice in the young foal because it causes minimal cardiovascular depression, while providing good muscle relaxation and CNS depression. It is important to note that diazepam provides little or no analgesia.
When diazepam is used as a pre-op, it is given in combination with other drugs such as xylazine, ketamine, glycerol guaiacolate, and butorphanol. Many practitioners report that the inclusion of diazepam in the traditional xylazine/ketamine anesthesia provides for longer "down time" and a smoother recovery.
Diazepam is used to control seizures and status epilepticus in both adult horses and foals. It may be used alone or in combination with other drugs including xylazine, detomidine, glycerol guaiacolate, methocarbamol, pentobarbital, phenobarbital and others. The drug choices, combinations, and doses will vary with the underlying cause of the seizures.
Diazepam is also used to diminish sexual inhibition in order to improve breeding behavior in the slow or shy stallion.
• Common: weakness, drowsiness, and loss of coordination.
• Rare: paradoxical excitement, aggression, or unusual behavior. Liver failure is a rare but serious side effect that can occur in cats after receiving oral diazepam for several days. Affected cats do not have a prior history of liver disease or elevated enzymes. The cause of this hepatic toxicity is not known at this time.
• Diazepam should be used with caution in debilitated
or geriatric animals, animals with decreased kidney or liver function,
animals in shock, coma or with significant respiratory depression.
• Diazepam may be addictive and should not be withdrawn abruptly
from those animals that have been on long-term treatment.
• Some animals may show unexpected behavior such as excitement or
aggression after administration of diazepam. Alternative drugs should
be considered in these animals.
• Intravenous injection of diazepam should be performed slowly particularly
when used in small animals or when injecting into smaller veins because
of potential thrombophlebitis and cardiotoxicity due to the propylene
glycol base.
• Diazepam should not be stored in plastic syringes or bottles as it may adsorb to the plastic and become inactivated.
• Diazepam should be avoided in pregnant or lactating animal and only be used when the benefits clearly outweigh the risks. In humans, it has been shown to be teratogenic when used during the first trimester of pregnancy. Diazepam crosses the placenta and is present in milk.
• Diazepam is a CNS depressant. When given with
other CNS depressant drugs (tranquilizers, narcotics, barbiturates, MAOIs,
antihistamines and antidepressants) the effects will be additive.
• Cimetidine, erythromycin, isoniazid, ketoconazole, propanolol,
and valproic acid slow the metabolism of diazepam. The dose of diazepam
may need to be decreased.
• The effects of digoxin may be increased in patients receiving diazepam.
Serum digoxin levels may need to be checked and patients monitored for
signs of toxicity.
• Antacids may delay the absorption of oral diazepam. This can be
managed by separating the medications by 2 hours.
• Rifampin may decrease the effect of diazepam.
Overdose with diazepam alone produces significant CNS depression (disorientation, depression, decreased reflexes, coma). Combinations of diazepam with other CNS depressant drugs may increase the severity and complicate the treatment of an overdose. Cardiovascular and respiratory support measures may be necessary.
Dr.
Barbara Forney is a veterinary practitioner in Chester County, Pennsylvania.
She has a master's degree in animal science from the University of Delaware
and graduated from the University of Pennsylvania School of Veterinary Medicine
in 1982.
She began to develop her interest in client education and medical writing 1997. Recent publications include portions of The Pill Book Guide to Medication for Your Dog and Cat, and most recently Understanding Equine Medications published by the Bloodhorse.
Dr. Forney is an FEI veterinarian and an active member of the AAEP, AVMA, and AMWA.
You can purchase books by Dr. Forney at www.exclusivelyequine.com
The information contained on this site
is general in nature and is intended for use as an informational aid. It does
not cover all possible uses, actions, precautions, side effects, or interactions
of the products shown, nor is the information intended as medical advice or
diagnosis for individual health problems or for making an evaluation as to the
risks and benefits of using a particular product. You should consult your doctor
about diagnosis and treatment of any health problems. Information and statements
have not been evaluated by the Food and Drug Administration ("FDA"),
nor has the FDA approved the products to diagnose, cure or prevent disease.
Wedgewood compounded veterinary medicines are not intended for use in food and food-producing animals.
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