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Psychotropic Use during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Maternal use of diazepam or related compounds during the first trimester of pregnancy and an increased risk for cardiovascular anomalies was observed in two case-control studies involving 773 infants (Bracken and Holford, 1981; Rothman et al., 1979). However, in a reanalysis, no significant association was found (Bracken, 1986). In a follow-up study of 298 infants with congenital heart defects, no association with first-trimester diazepam was found (Zierler and Rothman, 1985). The risk for congenital heart disease among the infants of women who have first-trimester exposure to diazepam, is probably not increased, but if it is increased the magnitude is small (<1–2 percent).
Drug Withdrawal: Recognition and Treatment
Published in Frank Lynn Iber, Alcohol and Drug Abuse as Encountered in Office Practice, 2020
A variety of agents are advocated for the treatment of alcohol withdrawal, but several are superior in my experience. Use of a single agent in a unit leads to far superior withdrawal treatment than use of multiple agents. For 95% of sedative and opiate withdrawals, the very-long-acting agents diazepam and chlordiazepoxide are heavily preferred. The long action makes everyone’s efforts easier, for when adequate sedation is attained (see treatment curve in Figure 12) so that withdrawal signs are decreasing, no further dosing is required. In a consecutive series of 100 patients adequately treated for withdrawal using chlordiazepoxide, the average patient required a total of 5.7 doses for the entire withdrawal. The mean dose in the first 24 h was 312 mg, and the mean in the second 24 h was 97 mg. In a subsequent study of 100 similar patients treated with diazepam, 6.3 doses were required (not significantly greater), with 43 mg used in the first 24 h and 28 mg used in the subsequent 24-h period. The very prolonged duration of action is desirable in uncomplicated withdrawal but may be less desirable when there is a question of serious head injury or impending surgery. The inability to give these two agents i.m. is their major disadvantage. Chlordiazepoxide has almost no anticonvulsant effect. An evaluation of withdrawal treated with a single 20-mg dose of diazepam has appeared.9
Drugs Affecting the Central Nervous System
Published in Radhwan Nidal Al-Zidan, Drugs in Pregnancy, 2020
Risk Summary: The use of Diazepam during the in 1st and 3rd Trimesters should be avoided because the pregnancy experience in humans, and the reproduction studies in animals have shown an increased risk of congenital abnormalities, neonatal flaccidity and withdrawal symptoms.
Acute organophosphate and carbamate pesticide poisonings – a five-year survey from the National Poison Control Center Of Serbia
Published in Drug and Chemical Toxicology, 2023
Žana M. Maksimović, Jasmina Jović-Stošić, Slavica Vučinić, Nataša Perković-Vukčević, Gordana Vuković-Ercegović, Ranko Škrbić, Miloš P. Stojiljković
With energetic supportive measures (securing a breathing line), poison removal and detoxification (gastric lavage until obtaining clear lavage liquid, application of activated charcoal) and symptomatic therapy, specific treatment of OPP poisoning include administration of antidotes (atropine, oximes, diazepam) (Vanova et al.2018, Eddleston 2019, Jokanović et al.2020). Atropine, which has a 100 times stronger affinity for cholinergic receptors than ACh, alleviates the muscarinic effects but has no impact on the nicotinic ones. It is given for as long as there are signs of acute cholinergic crisis, that is until the signs of atropinization occur (Henretig et al.2019). Oximes, AChE reactivators, bind to OPP already bound to AChE, which leads to the reactivation of AChE. The affinity of oximes for different organophosphorus compounds (OPCs) varies significantly. Globally, pralidoxime (PAM-2) is the oxime most frequently used for the treatment of OPP poisoning. Apart from that, in practice, obidoxime (LüH-6) is also used and it is considered the most effective oxime against OPP poisonings (Worek et al.2020, Maksimović et al.2021). Diazepam inhibits the excitability of the neurons in the CNS; by increasing the effect of GABA, it increases cAMP, decreases the level of cGMP, leading to the cessation of convulsions (Lundy and Magor 1978).
Current medicines hold promise in the treatment of orphan infections due to brain-eating amoebae
Published in Expert Opinion on Orphan Drugs, 2021
Ruqaiyyah Siddiqui, Mohamed Yehia Abouleish, Mustafa Khamis, Taleb Ibrahim, Naveed Ahmed Khan
For example, compounds used clinically as anti-seizure drugs, would be a logical choice to determine their anti-amoebic properties, given their established blood–brain barrier permeability and known pharmacokinetics and pharmacodynamics profiles, as well as FDA approval. Of promise, three compounds, phenytoin, diazepam, and phenobarbitone demonstrated effects against trophozoite and cyst of N. fowleri and Acanthamoeba. The clinical use of diazepam is for anxiety disorder and/or anti-seizures in combination with other compounds[3]. The clinical use of phenobarbitone and phynytoin is for epilepsy to control seizures [4,5] (Table 1). Importantly, these drugs have been approved by the FDA as well as by the WHO as vital medicines for clinical use. Notably, when conjugated with silver-nanoparticles, the efficacy of these medicines against brain-eating amoebae were enhanced[6], suggesting the potential translational value of this approach, however intensive future research is needed in the coming years to realize these expectations.
A review of a diazepam nasal spray for the treatment of acute seizure clusters and prolonged seizures
Published in Expert Review of Neurotherapeutics, 2021
Lindsay M. Higdon, Michael R. Sperling
No severe adverse effects or deaths have been reported with IN diazepam and most (91.3%) adverse effects were mild [17]. In healthy volunteers, the rate of adverse effects was lower with nasal spray (60.9%) than rectal gel (93.5%) or the oral tablet (84.8%). The most common adverse effect was somnolence, more frequently seen with rectal and oral administration than nasal dosing. Many study participants have reported nasal irritation after receiving diazepam nasal spray, but this is typically modest and would rarely prevent use of the agent [17]. In another study, low rates of adverse effects were found related to nasal administration, with the most notable adverse effects consisting of dysgeusia (5.3%), nasal discomfort (3.5%), and burning sensation (1.8%) [19]. In a large study where diazepam nasal spray was administered 4390 times for 3853 seizure clusters, transient nasal irritation was noted in only 6.1% of subjects [21].