Diazepam (Valium): dosage, uses, side effects, and risks

Valium (diazepam) was once one of the most popular prescription drugs available. Some think its calming effects are featured in song lyrics by The Rolling Stones in 1966: “Mother needs something today to calm her down / And though she's not really ill / There's a little yellow pill / She goes running for the shelter of a mother's little helper." 

Diazepam is a benzodiazepine drug (“benzo”) with anti-anxiety effects, but it’s no longer as widely used as it once was. The drug carries several risks, including dangerous drug interactions and addiction. 

In this article, we’ll dig into some details about diazepam. Read on to learn about diazepam’s dosage, uses, side effects, and risks.

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Diazepam, commonly called Valium, is an anti-anxiety drug and belongs to a class of drugs called benzodiazepines (Roche, 2021).

Benzodiazepines work by boosting the activity of a brain chemical called gamma-aminobutyric acid (GABA). Increased GABA results in a calming effect on your brain and nervous system. Besides its anxiolytic (anti-anxiety) effect, diazepam also has sedation (sleep-inducing), muscle-relaxant, and anticonvulsant effects (Bounds, 2020).

Diazepam and all benzodiazepines are categorized as schedule IV (four) controlled substances by the Drug Enforcement Administration (DEA). Schedule IV substances like Valium carry risks of drug abuse and dependence. Still, the risk is relatively lower than controlled substances in schedules III (such as Tylenol with codeine), II (such as oxycodone), and I (such as heroin). The government has set forth strict laws that healthcare professionals must follow to prescribe and dispense them (DEA, n.d.). 

Diazepam comes in several forms: oral tablet, oral solution, intravenous or intramuscular injection, rectal gel (Diastat), and nasal spray (Valtoco). The rest of this article will focus on diazepam tablets, the most common form of the drug, which come in three strengths: 2 mg, 5 mg, and 10 mg (Roche, 2021).

Diazepam is a long-acting benzodiazepine. It starts working within 15 to 60 minutes after taking your dose and usually reaches its peak effects in your body within 1 to 1.5 hours. It stays in your body longer than some other benzodiazepines, with the diazepam’s effects lasting for 12 hours or longer (Dhaliwal, 2021; Roche, 2021).

The Food and Drug Administration (FDA) initially approved the brand-name version of diazepam, Valium, in 1963. Diazepam tablets are FDA-approved to treat (Dhaliwal, 2021; Roche, 2021):

• Short-term relief of anxiety symptoms

• Acute alcohol withdrawal symptoms such as agitation, tremor, delirium tremens, and hallucinations

• Muscle spasms

• Seizure disorders, with other anti-epileptic medications

• Management of anxiety disorders

Despite diazepam’s FDA approval for these uses, it’s important to note that many healthcare providers prefer other medications over diazepam for the long-term management of these conditions. For example, antidepressants such as SSRIs are safer for the long-term treatment of generalized anxiety disorder. Diazepam, and all benzodiazepines, carry risks of drug addiction and can cause harmful effects when used with opioid painkillers (Roche, 2021; Bystritsky, 2020). 

Diazepam can also be used “off-label” to treat tension headaches. “Off-label” means drugs are prescribed to treat conditions that are not FDA-approved uses. Off-label prescribing is a common practice when a healthcare professional deems a drug medically appropriate for their patient (Paiva,1982; FDA, 2018). 

The most common side effects of diazepam (Valium) are (Roche, 2021):

• Drowsiness

• Muscle weakness

• Fatigue (feeling drained of energy)

• Ataxia, which is a loss of muscle coordination that makes it difficult to move or talk normally

Because of these side effects, you should not drive or engage in potentially dangerous tasks after taking diazepam. Also, alcohol can enhance the sedation side effect of diazepam and should be avoided.

Long-term, daily use of diazepam is not recommended in most cases because its many risks usually outweigh the benefits (Bystritsky, 2020). 

Diazepam tablets are available in three strengths: 2 mg, 5 mg, and 10 mg. The dosage of diazepam depends on the person’s condition. For example, the typical starting dosage of diazepam for relieving anxiety symptoms is 2 mg, taken 2 to 4 times per day. Your healthcare provider may instruct you to take the drug only as needed and not necessarily on a scheduled basis (Roche, 2021).

Your healthcare provider may also adjust your dosing based on your age, symptoms, any side effects you develop, and any other medications you’re taking. Be sure to follow the medical advice from your healthcare provider, and do not take the drug in a higher dose or more often than prescribed.

The FDA has alerted healthcare providers and patients regarding several boxed warnings for all benzodiazepines, including diazepam. Boxed warnings are the strongest type of warning from the FDA. These boxed warnings include (Roche, 2021; FDA, 2020):

Risk of harmful side effects when used with opioid painkillers 

Taking diazepam with opioid painkillers can cause dangerous side effects. These include severe drowsiness, troubled breathing, coma, and, in some cases, death. Examples of opioids include hydrocodone, oxycodone, fentanyl, tramadol, and street drugs such as heroin. You should not take diazepam with an opioid unless you and your healthcare provider have discussed these dangers and have established a plan to monitor and manage these risks.

Risk of drug abuse and addiction

Using diazepam can lead to addiction, even when it’s taken as prescribed. It’s possible to develop the feeling that you need to take the drug in higher doses to get the same effect. This can lead to abuse and taking the drug more than prescribed, raising your risk of a drug overdose. 

Risk of physical dependence and withdrawal

Taking diazepam, even as prescribed, can cause your body to become physically dependent, and withdrawal can occur if you suddenly stop taking it. Withdrawal can cause harmful effects, especially if you took benzodiazepines long-term or in high doses. If you and your healthcare provider decide that you’ll stop taking diazepam, they’ll guide you on how to gradually reduce your dose before stopping it completely.

Other precautions

People with certain medical conditions should talk to their healthcare provider about their health history before taking diazepam. You should not take diazepam if you have the following (Roche, 2021):

• Past allergic reaction to it or any other benzodiazepine drug

• Any condition that causes muscle weakness such as myasthenia gravis

• Eye problems including acute narrow-angle glaucoma or untreated open-angle glaucoma

Older adults (ages 65 and older) have an increased risk of side effects with benzodiazepines, and healthcare providers tend to consider alternatives before prescribing diazepam.

Before taking diazepam, be sure to tell your healthcare provider if you’ve ever had kidney problems, liver disease, or breathing problems such as sleep apnea. Taking this drug could worsen your condition or increase your risk for serious side effects. It’s also important to tell your healthcare provider if you’re pregnant or if you become pregnant while taking diazepam. Breastfeeding is not recommended while taking diazepam. The drug passes into breast milk and can cause adverse effects in an infant.

If you have questions or concerns about taking diazepam, it’s best to reach out to your healthcare provider or pharmacist.

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Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

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Current version

July 29, 2021

Written by

Patricia Weiser, PharmD

Fact checked by

Felix Gussone, MD

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About the medical reviewer

Felix Gussone, MD, Ro

Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.