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WARNINGMIXING OR WITHDRAWAL CAN BE DANGEROUS
Ordinary doses in combination with other depressants can fatally stop breathing. After prolonged dependency, stopping suddenly can also cause seizures or delirium; seek medical help.
Diazepam
Diazepam
Diastat, Apaurin, Mother's Little Helper
Diazepam is a long-acting benzodiazepine1 first patented in 1959 by Hoffmann-La Roche and launched in 1963.citation needed It is widely regarded as the prototypical benzodiazepine against which others in its class are measured. Prescribed for anxiety disorders, seizures, alcohol withdrawal, muscle spasms, and insomnia,2 it became one of the most frequently prescribed medications in the world, ranking as the best-selling medication in the United States from 1968 to 1982.citation needed
Dosage & Duration
Dosage
Doses are population estimates that vary widely between individuals.
Threshold~2.5 mg
Light2.5-5 mg
Moderate5-15 mg
Strong15-25 mg
Heavy25+ mg
Doses of 5 mg or more can cause significant deterioration in alertness alongside increased sleepiness. In elderly patients the smallest effective amount is recommended, starting at 2-2.5 mg once or twice daily and increasing gradually only as needed and tolerated.
Duration
Onset20-60 minutes
After Effects1-120 hours
Total10-24 hours
Subjective Effects
Legacy content. A statistically backed ontology from Mindstate Design Labs is coming soon.
Effects vary widely by individual, dose, and context.
Physical
The physical effects of diazepam can be broken down into several components which progressively intensify proportional to dosage.
Cognitive
The cognitive effects of diazepam can be broken down into several components which progressively intensify proportional to dosage. The general head space of diazepam is described by many as one of intense sedation and decreased inhibition. It contains a large number of typical depressant cognitive effects. Paradoxical reactions to benzodiazepines such as increased seizures (in epileptics), aggression, increased anxiety, violent behavior, loss of impulse control, irritability and suicidal behavior sometimes occur (although they are rare in the general population, with an incidence rate below 1%). These paradoxical effects occur with greater frequency in recreational abusers, individuals with mental disorders, children, and patients on high-dosage regimes.
Pharmacology
Pharmacodynamics
Diazepam acts primarily as a positive allosteric modulator of GABA-A receptors at the benzodiazepine binding site, enhancing GABA-mediated chloride ion conductance to hyperpolarize neurons1 and reduce cortical and limbic system excitability. Its effects vary with receptor subunit composition: α1-containing GABA-A receptors mediate sedative and amnestic effects, α2-containing receptors primarily underlie anxiolytic and myorelaxant activity (with contributions from α3 and α5 subunits), and α5-containing receptors additionally modulate spatial and temporal memory. Diazepam also acts as an agonist at the translocator protein and produces muscle relaxation through inhibition of polysynaptic pathways in the spinal cord. Its anticonvulsant properties may also involve voltage-gated sodium channel blockade and inhibition of depolarization-sensitive calcium uptake at micromolar concentrations.
Pharmacokinetics
Diazepam is rapidly and nearly completely absorbed after oral administration, with greater than 90% absorbed from the gastrointestinal tract.citation needed It is highly lipid-soluble, widely distributed throughout the body, readily crosses the blood-brain barrier, and is extensively bound to plasma proteins (96-99%, primarily albumin). Hepatic metabolism occurs through demethylation (primarily CYP2C19 and CYP3A4, with contributions from CYP2C9, CYP2B6, and CYP3A5) and hydroxylation (CYP3A4, CYP2C19), yielding the active metabolites desmethyldiazepam, temazepam, and oxazepam. These metabolites undergo glucuronide conjugation and are excreted mainly in the urine,3 with very little parent drug eliminated unchanged. CYP2C19 is polymorphic, and poor metabolizers show significantly reduced clearance (12 vs 26 mL/min) and roughly double the elimination half-life compared to extensive metabolizers.citation needed The elimination half-life of diazepam is 30 to 56 hours, while the principal metabolite desmethyldiazepam has a longer half-life of 2 to 7 days, contributing to accumulation with repeated dosing.
Dangerous
Highest riskThese combinations are considered extremely harmful and should always be avoided. Reactions to these drugs taken in combination are highly unpredictable and have a potential to cause death.
Unsafe
AvoidThere is considerable risk of physical harm when taking these combinations, they should be avoided where possible.
Caution
Use cautionThese combinations are not usually physically harmful, but may produce undesirable effects, such as physical discomfort or overstimulation. Extreme use may cause physical health issues. Synergistic effects may be unpredictable. Care should be taken when choosing to use this combination.
Tolerance
Tolerance timelines are rules of thumb, not exact schedules, and vary widely between individuals and use patterns.
Full Tolerance
Tolerance to the effects of diazepam develops with regular use. Extensive accumulation of diazepam and its primary active metabolite desmethyldiazepam occurs with chronic administration, contributing to altered drug response over time. Individuals with established benzodiazepine tolerance may require substantially higher doses than benzodiazepine-naive users, with experienced users sometimes consuming amounts that would be dangerous or fatal for those without tolerance.
Cross Tolerance
Benzodiazepines, Other GABAergic depressants
Baseline Reset
A considerable period of abstinence is recommended between uses to allow tolerance to reset, though specific timeframes are not well-established in available sources.
Harm Potential
Addiction & Dependence
Psychological
HighDiazepam has a high risk of misuse and psychological dependence. The FDA requires boxed warnings describing risks of abuse, misuse, and addiction.4 Recreational users, particularly those using stimulants, may escalate dosage from 2 to 25 times the therapeutic dose. Between 50 and 64% of rats will self-administer diazepam in experimental settings.
Physical
Extremely HighPhysical dependence develops readily with regular use, with approximately one-third of individuals who take benzodiazepines for longer than four weeks becoming dependent. Withdrawal can be life-threatening, particularly after extended use at high doses, and may include seizures, psychosis, tremors, sweating, nausea, and hallucinations.citation needed Gradual dose reduction under medical supervision is essential; abrupt discontinuation is dangerous.
Toxicity
Central Nervous System
Chronic use may cause cognitive impairment including memory deficits that can persist for six months or longer after discontinuation; it remains unclear whether these effects are permanent in some individuals.citation needed
Respiratory
Respiratory depression can occur at high doses or in overdose, and is more serious in patients with sleep apnea or chronic obstructive airway disease; severe cases may progress to respiratory arrest.citation needed
Psychosis Risk
Psychosis is a rare but documented withdrawal symptom following cessation of chronic use.citation needed Hallucinations and severe psychiatric symptoms may occur during withdrawal. Paradoxical reactions including excitement, agitation, rage, and in extreme cases suicidal tendencies have been reported during use, more commonly in children, the elderly, and those with substance use history.
Seizure Risk
Seizures are a serious risk during withdrawal from chronic use and can be life-threatening if discontinuation is too rapid.4 Paradoxically, frequent use in those with epilepsy may increase seizure risk.citation needed Withdrawal-related seizures necessitate medically supervised gradual dose tapering.
History & Culture
Discovery and Development
Diazepam was the second benzodiazepine developed by chemist Leo Sternbach at Hoffmann-La Roche's facility in Nutley, New Jersey, following his earlier creation of chlordiazepoxide (marketed as Librium), which had received approval for medical use in 1960. Sternbach patented diazepam in 1959, and it…
Legality
International
1961 Single Convention: diazepam is not scheduled.
1971 Convention on Psychotropic Substances: Schedule IV.
1988 Convention: diazepam is not listed in precursor Tables I or II.
By Country
Prescription20
United StatesPrescription onlyCurrent federal regulation lists diazepam as a Schedule IV depressant with DEA controlled-substances code 2765. Under 21 USC § 829(b), a Schedule IV controlled substance that is a prescription drug may not be dispensed without a written or oral prescription conforming to federal prescription requirements.
ArgentinaPrescription onlyLaw No. 19.303 regulates psychotropics in Lists I–IV and provides in Article 14 that List III and IV psychotropics may be dispensed only on a retained prescription. Official Argentine legal material identifies diazepam in Lista IV, and ANMAT product material labels diazepam for sale under retained prescription. Diazepam is available only by prescription, with retained-prescription controls.
AustraliaPrescription onlyThe Federal Register records the Therapeutic Goods (Poisons Standard, June 2026) Instrument 2026 as in force, made 28 May 2026 and commencing 1 June 2026. Its Schedule 4 is expressly titled ‘Prescription only medicines and prescription animal remedies’; the current federal instrument lists Diazepam in Schedule 4. The TGA independently defines Schedule 4 as Prescription Only Medicine. Supplementary state or territory controlled-medicines rules may also apply.
AustriaPrescription onlyThe current RIS consolidated Psychotropenverordnung lists Diazepam exactly in Anlage 1 section 2, covering substances and preparations of Annex IV to the UN Convention on Psychotropic Substances. Section 10 restricts prescription and dispensing of medicines containing psychotropic substances to medical, dental, or veterinary science, and prohibits ordering repeat dispensing for benzodiazepine medicines. BASG explains that prescription medicines may be dispensed only on a physician’s prescription and specifically identifies diazepam among substances for which repeats are excluded.
BrazilPrescription onlyANVISA's controlled-substances list expressly places DIAZEPAM in Lista B1, the psychotropic-substances list under Portaria SVS/MS n.º 344/1998. ANVISA identifies Lista B1 substances as subject to Notificação de Receita B, the controlled prescription notification. Diazepam is available only by controlled prescription.
CanadaPrescription onlyControlled Drugs and Substances Act, Schedule IV; Benzodiazepines and Other Targeted Substances Regulations (SOR/2000-217), Schedule 11920212223
The current Controlled Drugs and Substances Act expressly lists diazepam in Schedule IV. The current Benzodiazepines and Other Targeted Substances Regulations separately list Diazepam in Schedule 1 as a targeted substance, and Health Canada’s Drug Product Database identifies authorised diazepam products as TARGETED SUBSTANCES (CDSA IV). Diazepam is available only by prescription.
FrancePrescription onlyArrêté du 22 février 1990 fixant la liste des substances psychotropes; public medicines database2425262728
The current French psychotropics order expressly lists Diazépam as a psychotropic substance. Official French public medicine records for diazepam products identify their dispensing classification as Liste I and, for the cited 10 mg product, state that prescription is limited to 12 weeks. Diazepam is available only by prescription.
GermanyPrescription onlyDiazepam is listed in BtMG Anlage III, with an exception for preparations containing no other Annex I–III substance and up to 10 mg diazepam per divided form. The exception removes the special BtM classification for those preparations; AMVV § 1 requires prescription dispensing for medicines containing Annex 1 substances.
Available as a prescription medication. Marketed both as a standalone product and in combination formulations with other active ingredients such as metamizole sodium.
IrelandPrescription onlyMisuse of Drugs Regulations 2017 (S.I. No. 173/2017), Schedule 4 Part 1; Medicinal Products (Prescription and Control of Supply) Regulations 2003 (S.I. No. 540/2003)333435
The official Irish Statute Book text for the Misuse of Drugs Regulations 2017 identifies Diazepam in Schedule 4 Part 1. That Schedule is expressly subject to regulations 14–18 and related control requirements; regulation 10(2) permits possession of a Part 1 Schedule 4 drug for medical purposes in accordance with a practitioner's directions, while regulations 8–9 limit authorised supply to persons who may lawfully possess it. The official HPRA authorised-medicine record for Diazepam confirms an approved product's legal supply status as a prescription product that may not be renewed (A).
MexicoPrescription onlyThe current official Cámara de Diputados consolidated Ley General de Salud lists Diazepam in Article 245, fraction III among psychotropic substances. Article 226 places medicines containing fraction III psychotropics in the prescription-controlled dispensing regime; this establishes prescription-only supply for therapeutic Diazepam products. State-level pharmacy controls may add implementation requirements.
New ZealandPrescription onlyDiazepam appears in Part 5 of Schedule 3 to the Misuse of Drugs Act 1975. The current Medsafe-hosted Arrow-Diazepam Consumer Medicine Information is explicitly marked ‘Prescription Medicine,’ and Medsafe explains that prescription medicines may be supplied only on a prescription. Diazepam is therefore available for medical use by prescription only.
NorwayPrescription onlyThe current Norwegian narcotics regulation lists diazepam as P IV. The official Norwegian Medicines Agency Legemiddelsøk record for diazepam products identifies them as prescription-only (Reseptpliktig: Ja) and in prescription group B. Diazepam is available medically by prescription under the narcotics-control regime.
PolandPrescription onlyRozporządzenie Ministra Zdrowia, consolidated text Dz.U. 2024 poz. 1139; official Register of Medicinal Products, Relanium product 577645464748
The current consolidated controlled-substance schedule lists DIAZEPAM in psychotropic group IV-P. The official Register of Medicinal Products’ Relanium 5 mg/ml package (product 5776) identifies the active substance as Diazepamum and gives availability category ‘Rp - Lek wydawany na receptę’ (medicine supplied on prescription).
SingaporePrescription onlySingapore Statutes Online lists diazepam in the Schedule to the Poisons Act 1938 as part of the benzodiazepine entry. The Poisons Rules require poisons in the Third Schedule to be sold only in accordance with a prescription by a medical practitioner. Diazepam is therefore supplied only by prescription under the poisons-control regime; it is not characterized as a Misuse of Drugs Act scheduled drug.
SpainPrescription onlyAEMPS CIMA authorised-medicinal-product record; Orden de 30 de mayo de 1984 (Lista IV de sustancias psicotrópicas)5354
The Spanish Medicines Agency CIMA database records active marketed diazepam products as ‘Medicamento Sujeto A Prescripción Médica. Psicótropos’ and flags receta true. The official BOE psychotropic-list material identifies diazepam in Lista IV.
SwedenPrescription onlyThe Swedish Medical Products Agency identifies diazepam products as narcotics in förteckning IV under the controlled-substances lists. The Agency's authorised medicine records for Stesolid and diazepam products identify their prescription status as Receptbelagt.
SwitzerlandPrescription onlyBetäubungsmittelverzeichnisverordnung des EDI (BetmVV-EDI), Verzeichnis b; Swissmedic authorised-medicine dispensing classification606162
Diazepam is listed in BetmVV-EDI Verzeichnis b. SwissmedicInfo’s current Psychopax diazepam medicine record identifies Abgabekategorie B, the prescription dispensing category.
UkrainePrescription onlyCabinet of Ministers Resolution No. 770 of 6 May 2000; Law of Ukraine No. 60/95-VR on Narcotic Drugs, Psychotropic Substances and Precursors6364
The current national controlled-substances list under Resolution No. 770 places Діазепам in Table III, List No. 2 as a psychotropic substance. The Law on Narcotic Drugs, Psychotropic Substances and Precursors permits citizens to acquire Table II and III psychotropics only on a doctor’s prescription.
United KingdomPrescription onlyMisuse of Drugs Act 1971, Schedule 2 Part III; Misuse of Drugs Regulations 2001, Schedule 4 Part I; MHRA authorised product record656667686970
Current legislation lists Diazepam as a Class C drug in Part III of Schedule 2 to the Misuse of Drugs Act 1971 and in Part I of Schedule 4 to the Misuse of Drugs Regulations 2001. The Schedule 3 prescription-form requirements do not apply to this Schedule 4 Part I classification. Current MHRA product records identify authorised diazepam products as POM (Prescription Only Medicine).
References
Source Pages
Citations
- Jaberpreet Dhaliwal, Alan Rosani, & Abdolreza Saadabadi. (n.d.). Diazepam. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK537022/123
- Nicole E. Calcaterra, & Jason C. Barrow. (2014). Classics in chemical neuroscience: diazepam (valium). ACS Chemical Neuroscience, 5(4), 253-260. https://doi.org/10.1021/cn50000561
- Diazepam tablet. DailyMed (n.d.). https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=4b0c9c0a-4274-4d56-a7a4-bc497916469c123
- Valtoco – diazepam spray. DailyMed (13 January 2020). https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1a8bcc90-68fa-474d-832c-0df01e825f39123
- Law No. 19.303; ANMAT-approved diazepam product material. argentina.gob.ar (n.d.). https://www.argentina.gob.ar/normativa/nacional/ley-19303-20966/actualizacion1
- Law No. 19.303; ANMAT-approved diazepam product material. argentina.gob.ar (n.d.). https://www.argentina.gob.ar/normativa/nacional/resoluci%C3%B3n-705-1975-145339/texto1
- Law No. 19.303; ANMAT-approved diazepam product material. boletin.anmat.gob.ar (n.d.). https://boletin.anmat.gob.ar/Octubre_2014/Dispo_7472-14.pdf1
- Therapeutic Goods (Poisons Standard—June 2026) Instrument 2026 (F2026L00633). legislation.gov.au (n.d.). https://www.legislation.gov.au/F2026L006331
- Therapeutic Goods (Poisons Standard—June 2026) Instrument 2026 (F2026L00633). legislation.gov.au (n.d.). https://www.legislation.gov.au/F2026L00633/asmade/2026-05-28/text/original/epub/OEBPS/document_1/document_1.html1
- Therapeutic Goods (Poisons Standard—June 2026) Instrument 2026 (F2026L00633). tga.gov.au (n.d.). https://www.tga.gov.au/products/regulations-all-products/ingredients-and-scheduling-medicines-and-chemicals/scheduling-national-classification-system/scheduling-basics-medicines-and-chemicals-australia1
Further Reading
Article Status
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Recent changes8 human edits · latest
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19 August 2026
Lyrea · Edited in History & Culture › Sections 2 › Content
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18 August 2026
Lyrea · Changed a word in Dosage & Duration › Routes 1 › Dose ranges › Heavy
Lyrea · Changed a word in Dosage & Duration › Routes 1 › Dose ranges › Strong
Lyrea · Changed a word in Dosage & Duration › Routes 1 › Dose ranges › Strong
24 January 2026
Josie Kins · Updated the article · also 1,4-Butanediol, 1B-LSD, 1cP-AL-LAD and 573 more
Josie Kins · Updated the article · also 1,4-Butanediol, 1B-LSD, 1cP-AL-LAD and 573 more
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