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Valium no prescription overnight
Valium
International name:
Diazepam (Diazepam)
Group Affiliation:
Anxiolytic means
Description of the active substance (INN):
Diazepam
Dosage form: valium no prescription overnight
coated tablets, solution for intravenous and intramuscular injection, injection, tablets, coated tablets, coated tablets [for children]
Pharmacological Effects:
Anxiolytic drug (tranquilizer) benzodiazepinovogo series. Sedative-hypnotic, anticonvulsant and central miorelaksiruyuschee action. The mechanism of action of diazepam is due to stimulation of benzodiazepine receptor supramolecular GABA-benzodiazepine-hlorionofor receptor complex, valium no prescription overnight leading to increased inhibitory action of GABA (a neurotransmitter pre-and postsynaptic inhibition in all regions of CNS) on the transfer of nerve impulses. Stimulates benzodiazepine receptors located in the allosteric center of postsynaptic GABA receptors of the ascending activating reticular formation and lateral horn neurons of the spinal cord, reduces the excitability of the subcortical brain structures (the limbic system, thalamus, hypothalamus), inhibits polysynaptic spinal reflexes. Anxiolytic effects due to the influence on the amygdaloid complex of the limbic system and appears to reduce the emotional stress, reducing anxiety, fear, anxiety. Sedation due to the influence of the reticular formation of the brain and nonspecific thalamic nuclei and shown a decrease in symptoms of neurotic origin (anxiety, fear). The main mechanism of somnolent valium no prescription overnight action is inhibition of cells of the reticular formation of the brain. Anticonvulsant effect is realized by increasing presynaptic inhibition. Reduces spread of epileptogenic activity, but not removed the excited state of the hearth. Central miorelaksiruyuschee effect is due to inhibition of spinal polysynaptic afferent inhibitory ways (to a lesser extent and monosynaptic). Possible, and direct inhibition of motor nerve and muscle function. With moderate sympatholytic activity, may cause decrease in blood pressure and dilation of coronary vessels. Increases the threshold of pain sensitivity. Suppresses sympathoadrenal and parasympathetic (including vestibular) paroxysms. Reduces the nocturnal secretion of gastric juice. The action of the drug is observed to 2.7 day of treatment. At productive psychotic symptoms genesis (acute delusional, hallucinatory, affective disorders) has practically no effect, is rarely observed decrease in valium no prescription overnight affective intensity, delusional disorders. When opioid syndrome in chronic alcoholism causes a weakening of agitation, tremor, negativism, as well as alcoholic delirium and hallucinations. The therapeutic effect in patients with false angina, arrhythmias, and paresthesia observed by the end of 1 week.
Indications:
Anxiety disorders. Dysphoria (in combined therapy as an additional LAN). Insomnia (difficulty sleeping). Spasm of skeletal muscle under local trauma; spastic condition associated with damage to the brain or spinal cord (cerebral palsy, athetosis, tetanus), myositis, bursitis, arthritis, rheumatic pelvispondiloartrit, progressive chronic polyarthritis, arthrosis, accompanied by tension in skeletal muscle; vertebral syndrome, angina pectoris , tension headache. Alcohol withdrawal valium no prescription overnight syndrome: anxiety, tension, agitation, tremor, transient reactive states. In the complex therapy: hypertension, peptic ulcer and 12 duodenal ulcers, psychosomatic disorders in obstetrics and gynecology: Menopausal and menstrual disorder, gestosis, status epilepticus, eczema and other diseases accompanied by itching, irritability. Meniere’s disease. Poisoning LS. Premedication before surgical intervention and endoscopic manipulation, general anesthesia. For parenteral administration: premedication before general anesthesia, as a component of combined general anesthesia, myocardial infarction (in the complex therapy); motor stimulation of different etiology in neurology and psychiatry paranoid-hallucinatory state, epileptic seizures (docking); relief of labor activity; premature genera (only in the late III trimester of pregnancy), premature detachment of the placenta.
Contraindications:
Hypersensitivity, coma, shock, acute alcohol intoxication with the weakening of the vital functions, acute intoxication BOS, providing a depressing effect on the central nervous system (including narcotic analgesics and hypnotics HP), myasthenia gravis, angle-closure glaucoma (acute onset or predisposition), severe COPD (risk of progression of the degree of respiratory failure), acute respiratory valium no prescription overnight failure, absans or Lennox-Gastaut syndrome (with a / in the introduction contributes to the emergence of tonic status epilepticus), pregnancy (especially the I trimester), lactation, children under the age of 6 months (at intake ), up to 30 days inclusive (in V / m and / in the introduction). C care. Epilepsy or seizures in the history of (initiation of treatment with diazepam or abrupt withdrawal may accelerate the development of seizures or status epilepticus), liver and / or renal failure, cerebral and spinal ataxia, hyperkinesis, drug dependency history, the propensity to abuse LS, organic disease brain, hypoproteinemia, sleep apnea (fixed or estimated), advanced age.
Side effects:
From the nervous system: at the beginning of treatment (especially in elderly patients) – drowsiness, dizziness, fatigue, decreased ability to concentrate, ataxia, disorientation, instability of gait and poor motor coordination, lethargy, blunted emotions, slowing of mental and motor responses, anterograde amnesia (in more frequently than when receiving benzodiazepines, etc.), rarely – headache, euphoria, depression, tremor, depressed mood, catalepsy, confusion, extrapyramidal dystonic reactions (involuntary movements of the body, valium no prescription overnight including eyes), weakness in myasthenia gravis During the day, hyporeflexia, dysarthria, very rarely – paradoxical reactions (aggressive outbursts, psychomotor agitation, fear, suicidal tendencies, muscle spasms, confusion, hallucinations, severe agitation, irritability, anxiety, insomnia). On the part of hematopoiesis: leukopenia, neutropenia, agranulocytosis (chills, pyrexia, sore throat, extreme fatigue or weakness), anemia, thrombocytopenia. From the digestive system: dry mouth or hygrostomia, heartburn, hiccups, stomachodynia, nausea, vomiting, decreased appetite, constipation, liver damage, increased activity of “liver” transaminases and alkaline phosphatase, jaundice. From the CCC: palpitations, tachycardia, decreased blood pressure (with parenteral administration). The part of the urogenital system: incontinence, urinary retention, renal impairment, increased or decreased libido, dysmenorrhea. Allergic reactions: skin rash, itching. Effect on the fetus: teratogenicity (especially the I term), CNS depression, respiratory failure and the suppression of sucking reflex in infants whose mothers used the drug. Local reactions: at the injection site – phlebitis or venous thrombosis (redness, swelling or pain at the injection site). Other: addiction, drug dependency, rarely – inhibition valium no prescription overnight of the respiratory center, the violation of lung function, impaired vision (diplopia), bulimia, weight loss. With a sharp dose reduction or termination of the reception – a syndrome “cancellation” (irritability, headache, anxiety, agitation, excitement, fear, nervousness, sleep disturbances, dysphoria, a spasm of smooth muscles of internal organs and skeletal muscles, depersonalization, increased sweating, depression, nausea, vomiting, tremors, disorders of perception, including giperakuziya, paresthesia, photophobia, tachycardia, seizures, hallucinations, rare – acute psychosis). When used in obstetrics – in term and preterm children – muscular hypotension, hypothermia, dispnoe.Peredozirovka. Symptoms: drowsiness, confusion, paradoxical excitement, decreased reflexes, arefleksiya, stupor, reduced reaction to pain stimuli, deep sleep, dysarthria, ataxia, visual disturbances (nystagmus), tremor, bradycardia, dyspnea or labored breathing, apnea, marked weakness, decrease blood pressure, collapse, depression of cardiac and respiratory activity, coma. Treatment: gastric lavage, forced diuresis, intake of activated carbon. Symptomatic therapy (maintenance of respiration and blood pressure), mechanical ventilation. As a specific antagonist flumazenil use (in hospital). Hemodialysis is ineffective. Antagonist of benzodiazepines flyumazenil not shown in patients with epilepsy, who received treatment with benzodiazepines. In these patients, the antagonistic action in relation to benzodiazepines can provoke the development of epileptic seizures.
Dosage and administration:
Inside, in / m / w, rectally. The dose is calculated individually depending on the condition of the patient, the clinical picture of disease, sensitivity to the drug. As an anxiolytic BOS appointed interior, the 2.5-10 mg 2-4 times a day. Psychiatry: with neurosis, hysterical or hypochondriacal reactions, states of dysphoria different genesis, phobias – 5-10 mg 2-3 times a day. If necessary, the dose may be increased to 60 mg / day. When alcohol withdrawal syndrome – 10 mg 3-4 times a day in the first 24 h, with a subsequent decrease to 5 mg 3-4 times a day. Elderly, debilitated patients and patients with atherosclerosis in the beginning of treatment – oral, 2 mg 2 times a day, if necessary be increased to optimum effect. A working patients are encouraged to take on 2.5 mg 1-2 times per day or 5 mg (base dose) in the evening. Neurology: spasms of central origin in degenerative neurological diseases – oral, 5-10 mg 2-3 times a day. Cardiology and Rheumatology: angina pectoris – at 2-5 mg 2-3 times a day, hypertension – at 2-5 mg 2-3 times a day, vertebral syndrome with bedrest – 10 mg 4 times a day as an additional LAN in Physiotherapy in Rheumatoid pelvispondiloartrite, progressive chronic polyarthritis, arthrosis – 5 mg 1-4 times per day. In the complex therapy of acute myocardial infarction: initial dose – 10 mg / m, then by mouth, 5-10 mg 1-3 times a day, and premedication in the case of defibrillation – 10-30 mg IV slowly (single dose), spastic of rheumatic origin, vertebral syndrome – an initial dose of 10 mg / m, then inside, 5 mg 1-4 times per day. Obstetrics and Gynecology: psychosomatic disorders, climacteric and menstrual disorder, gestosis – at 2-5 mg 2-3 times a day. Pre-eclampsia – initial dose – 10-20 mg IV, then 5-10 mg by mouth 3 times daily; eclampsia – during the crisis – in / at 10-20 mg, followed if necessary w / jet or drip, does not more than 100 mg / day. In order valium no prescription overnight to facilitate labor and delivery during the opening of the cervix for 2-3 finger – i / m 20 mg, premature birth and premature detachment of the placenta – a / m at the initial dose of 20 mg after 1 h, the introduction of the same dose is repeated; maintenance doses — 10 mg 4 times up to 20 mg 3 times a day. When premature placental abruption treatment is carried out without interruption – to the ripening fruit. Anesthesiology, Surgery: premedication – on the eve of the operation, in the evening – 10-20 mg orally, preparation for surgery – for 1 h prior to anesthesia / m adults – 10-20 mg, children – 2.5-10 mg; introduction to anesthesia – in / at 0.2-0.5 mg / kg for short-term narcotic sleep with sophisticated diagnostic and therapeutic interventions in therapy and surgery – in / in adults – 10-30 mg, children – 0.1-0.2 mg / kg. Pediatrics: psychosomatic and reactive disorders, spasms of central origin – appoint a gradual increase in dose (starting with low doses and slowly increase them until the optimal dose, well tolerated sick), daily intake (can be divided into 2-3 doses, with the main, largest dose, taken in the evening): inside, up to 6 months is not recommended, from 6 months and older – 1-2.5 mg, or 40-200 mg / kg, or 1.17-6 mg / m 3 — 4 times a day. Inside, from 1 to 3 years – 1 mg, from 3 to 7 years – 2 mg, from 7 years and older – 3-5 mg. Daily doses – 2, 6 and 8-10 mg, respectively. Parenteral, status epilepticus and severe recurrent seizures: children from 30 days to 5 years – in / in (slowly) to 0.2-0.5 mg every 2-5 minutes up to a maximum dose of 5 mg of 5 years and over – 1 mg every 2 — 5 min to a maximum dose of 10 mg, if necessary, treatment can be repeated after 2-4 h. Muscle relaxation, tetanus: children from 30 days to 5 years – i / m or / 1.2 mg, 5 years and older — 5-10 mg, if necessary, the dose may be repeated every 3-4 h. Patients aged and old, treatment should begin with half the usual dose for adults, gradually increasing it, depending on valium no prescription overnight the achieved effect and tolerability. Parenteral with anxiety given intravenously in the initial dose of 0.1-0.2 mg / kg, repeat injections every 8 h until symptoms disappear, then move on to oral. When the motor excitation is introduced in the / m or / 10-20 mg 3 times a day. In traumatic lesions of the spinal cord, accompanied by paraplegia or hemiplegia, chorea – a / m in adults the initial dose of 10-20 mg, for children – 2-10 mg. When status epilepticus – w / in the initial dose of 10-20 mg, in the subsequent, if necessary – 20 mg / m or i / v drip. If necessary, w / drip (no more than 4 ml) diluted in 5-10% solution of dextrose or 0.9% solution of NaCl. To avoid loss of drug in the sediment should be used no less than 250 ml infusion solution, quickly and thoroughly mix the resulting solution. To relieve muscle spasm expressed – in / at once, or twice 10 mg. Tetanus: initial dose – 0.1-0.3 mg / kg / in intervals 1-4 hours or as i / v infusion of 4.10 mg / kg / day. Rectal as antiepileptic LS (status epilepticus and severe recurrent seizures) – 0.15-0.5 mg / kg to a maximum dose – 20 mg. Children – 0.2-0.5 mg / kg, elderly patients – 0.2-0.3 mg / kg.
Cautions:
I / v solution of diazepam to enter slowly into a large vein for at least 1 minute for every 5 mg (1 ml) of the drug. Not recommended to carry out continuous i / v infusion – perhaps precipitation and adsorption of the drug polyvinylchloride materials infusion bottles and tubes. In the treatment of patients is strictly prohibited the use of ethanol. In renal / hepatic failure and long-term treatment requires monitoring of peripheral blood picture and “liver” enzymes. Risk of formation of drug dependence of increases in the use of large doses, a significant duration of treatment, patients who previously abused ethanol or LAN. Without specific instructions, should not be used for a long time. It is unacceptable abrupt discontinuation of treatment because of the risk of the syndrome of “lifting” (headache, myalgia, anxiety, tension, confusion, irritability, and in severe cases – derealization, depersonalization, giperakuziya, photophobia, tactile hypersensitivity, paresthesias in the extremities, hallucinations and epileptic seizures), but due to a slow T1 / 2 of diazepam expressed its manifestation is much weaker than that of other benzodiazepines. If you have any patients with such unusual reactions, as increased aggressiveness, acute state of excitement, anxiety, fear, suicidal thoughts, hallucinations, increased muscle cramps, difficult falling asleep, shallow sleep, treatment should be discontinued. Starting treatment with diazepam or its abrupt withdrawal in patients with epilepsy or a history of seizures may accelerate the development of seizures or status epilepticus. During pregnancy, used only in exceptional cases and only on the “life” testimony. Toxic effects on the fetus and increase the risk of congenital malformations when used in I trimester of pregnancy. Therapeutic dose in the later stages of pregnancy may cause neonatal CNS depression. The constant use during pregnancy can lead to physical dependence – can syndrome “cancellation” in the newborn. Children, especially at younger ages, are very sensitive to central depressant drug action of benzodiazepines. Babies not recommended in LS containing benzyl alcohol – may develop a fatal toxic syndrome manifested metabolic acidosis, CNS depression, difficulty breathing, kidney failure, lower blood pressure, and possibly seizures and intracranial hemorrhages. Using (especially in the / m or /) at doses above 30 mg over 15 h before birth or during labor may cause newborn respiratory depression (up to apnea), decreased muscle tone, lower blood pressure, hypothermia, a weak act of sucking ( syndrome “sluggish child”) and violation of metabolism in response to cold stress. In the period of treatment must be careful when valium no prescription overnight driving vehicles and occupation of other potentially hazardous activities that require high concentration of attention and quickness of psychomotor reactions.
Interaction:
Strengthens the central nervous system depressant effect of ethanol, sedative and antipsychotic LS (neuroleptics), antidepressants, narcotic analgesics, drugs, for general anesthesia, muscle relaxants. Inhibitors of microsomal oxidation (including cimetidine, oral contraceptives, erythromycin, disulfiram, fluoxetine, isoniazid, ketoconazole, metoprolol, propranolol, propoxyphene, valproic acid) lengthened T1 / 2 and increase the effect. Inductors microsomal liver enzymes decrease the efficiency. Narcotic analgesics increase the euphoria, leading to an increase in psychological dependence. Antacids LS diazepam reduces the rate of absorption from the gastrointestinal tract, but not its fullness. Antihypertensive BOS can increase the severity of blood pressure lowering. Against the background of the simultaneous appointment of clozapine may increase respiratory depression. In an application with nizkopolyarnymi cardiac glycosides may increase the concentration of the latter in the blood serum and the development digitalisnoy intoxication (as a result of competition for the relationship to plasma proteins). Reduces the effectiveness of levodopa in patients with Parkinson’s disease. Omeprazole prolongs the elimination of diazepam. MAOIs, analeptics, stimulants – reduce activity. Premedication with diazepam reduces the dose of fentanyl required for the induction of general anesthesia, and reduce the time needed to “switch off” of consciousness with induction doses. May increase the toxicity of zidovudine. Rifampin may enhance elimination of diazepam and reduce its concentration in plasma. Theophylline (used in low doses) may reduce or even distort the sedative effect. Pharmaceutically compatible in the same syringe with other LS.