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Diazepam

 

 

Common brand names: Valium Tablets, Valium Injection

 

Description: Diazepam is classified as an antianxiety, sedative and hypnotic drug; it relaxes the patient, makes him or her drowsy and induces sleep.

 

Dental uses: Diazepam is used in dentistry to help anxious patients relax before and during dental procedures and also to improve sleep in anxious patients the night before a dental procedure. Diazepam is also used (in conjunction with nonsteroidal anti-inflammatory drugs) to treat muscle pain and spasm in the temporomandibular joint region.

 

Dosages for dental purposes: When given by mouth (orally), the typical adult dose can range from 2 milligrams to 10 milligrams. The dose can be administered right before bedtime to improve sleep the night before the dental procedure and then repeated one hour prior to the dental procedure to relax and sedate the patient.

 

For muscle relaxation in the temporomandibular region, the dose is repeated three to four times per day for up to a week. Diazepam also can be administered intravenously (through a vein in the arm) for conscious sedation (which produces a very relaxed, drowsy state), usually by an oral surgeon or dental anesthesiologist. The intravenous dose varies from patient to patient but usually is in the range of 2 milligrams to 20 milligrams given immediately before the procedure.

 

Concerns and possible side effects: When given by mouth, diazepam and related benzodiazepines (that is, triazolam) are considered very safe. However, drowsiness, forgetfulness, impaired thinking and lack of coordination frequently occur. Therefore patients should not operate machinery or drive automobiles for up to 24 hours after taking diazepam.

 

Occasionally, diazepam may temporarily cause a dry mouth (xerostomia) or turn the tongue a black color, a condition known as black hairy tongue.

 

Patients with narrow-angle glaucoma (increased pressure in the eye) should not take diazepam or related benzodiazepines (such as triazolam or midazolam) because these drugs can precipitate a glaucoma attack. Pregnant women should not receive diazepam or related benzodiazepines because these drugs, especially when taken in the first trimester, increase the risk of birth defects.

 

Intravenous diazepam can produce all of the same side effects as oral diazepam. It should be administered only by practitioners with advanced training in anesthesiology (typically oral surgeons and dental anesthesiologists). Patients must be properly monitored with a device known as a pulse oximeter, which measures heart rate and how well the patient is breathing. This is because, occasionally, intravenous diazepam can impair breathing. Patients who are to undergo any form of intravenous sedation are encouraged to ask their doctor about their level of training and experience with these techniques.

 

Intravenous diazepam also can cause a burning feeling on injection, and irritation (pain) around the vein that can last for more than a week. Patients should not drink alcohol during diazepam therapy because the combination can increase the severity of drowsiness, forgetfulness, impaired thinking and lack of coordination, and possibly lead to unconsciousness.

 

Certain other drugs may cause diazepam to accumulate in the body and increase the risks of side effects. These include:

 

The antibiotics erythromycin (Eryc) and clarithromycin (Biaxin)

Azole antifungal drugs such as ketoconazole (Nizoral) and fluconazole (Diflucan)

The ulcer medications cimetidine (Tagamet) and omeprazole (Prilosec)

This list is not complete and it continues to grow. These interactions can be serious, so it is imperative to inform your dentist of all medications you are taking.

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