Anxiol Special Precautions

Diazepam should be used with care in those with chronic pulmonary insufficiency, in the elderly or debilitated patients who may be more prone to adverse effects. Caution is required in patients with muscle weakness, or impaired liver or kidney function; its use should be avoided in severe hepatic impairment. The sedative effects of diazepam are most marked during the first few days of administration; affected patients should not drive or operate machinery. Monitoring of cardiorespiratory function is generally recommended when benzodiazepines are used for deep sedation.
Diazepam is not appropriate for the treatment of chronic psychosis or for phobic or obsessional states. Diazepam-induced disinhibition may precipitate suicide or aggressive behavior and it should not be used alone to treat depression or anxiety as associated with depression; it should also be used with care in patients with personality disorders Caution is required in patients with organic brain changes particularly arteriosclerosis. In cases of bereavement, psychological adjustment may be inhibited by diazepam.
Dependence characterized by a withdrawal syndrome may develop after regular use of diazepam, even in therapeutic doses for short periods; because of its dependence liability, diazepam should be used with caution in patients with a history of alcohol or drug addiction.
Since hypotension and apnoea may occur when diazepam is given intravenously it has been recommended that this route should only be used when facilities for reversing respiratory depression with mechanical ventilation are available. Patients should remain supine and under medical supervision for at least one hour after intravenous injection. Intravenous infusion is best undertaken in specialist centers with intensive care facilities where close and constant supervision can be undertaken.
Dependence: The development of dependence is common after regular use of diazepam and other benzodiazepines, even in therapeutic doses for short periods. Dependence is particularly likely in patients with a history of alcohol or drug abuse and in patients with marked personality disorders. Benzodiazepines should not therefore be discontinued abruptly after regular use for even a few weeks, but should be withdrawn by gradual reduction of the dose; the time needed for withdrawal can vary from about 4 weeks to a year or more. High doses of diazepam and other benzodiazepines, injected intravenously, have been abused for their euphoriant effects.