Question to Ryan about Valium

Hi Ryan,

I find your posts interesting and really appreciate you sharing your knowledge with us.  I have a question about Valium.

My doctor prescribed Valium 10 mg. once a day, but lately I've been feeling a lot more anxiety and a lot more muscular tension.  I even feel "tingly" and all physical causes have been ruled out (tests, X-rays, etc.)  It has been attributed to the fact that I'm carrying so much muscular tension in my pelvic area (lower buttocks and thighs).  The dose of Valium has been increased (hopefully temporarily) to 10 mg. every eight hours, at 8:00, 4:00, and 12:00.  The doctor said hopefully this will give me some emotional stability (no highs and lows from taking Valium only once a day) and get my anxiety under control and my muscle tension will relax.

You seem to have so much knowledge of Valium I wondered what you thought of this and when this new dosage of Valium will reach steady state.  Thirty milligrams of Valium seems like a lot of Valium to me, but I don't plan on being on that dose forever, just until I get things under control, then I can try reducing the dosage.

I can't take tricyclics (cardiac effects) and the SSRIs make me nervous.  I've never found anything better than Valium for my symptoms.

Thank you in advance for any advice you can give me.

[OneScaredBuckeye]

Just do not want this to get lost until Ryan comes back.  He knows more about Valium than my doctor. :)

[OneScaredBuckeye]

Bumped up for Ryan.  He'll never find it back on page six! ;)

[level]

Ryan,
I'm not sure how much effect the metabolites Oxazepam and Temazepam have from taking Diazepam from what I've read. It makes it appear from what your saying that the Oxazepam and Temazepam effects occur from dosing Diazepam and I'm not sure if that is completely accurate. From what you write it makes it appear you are essentially taking three drugs but I believe oxazpeam and temazepam are minor metabolites that are rapidly excreted in the urine where diazepam and nordiazepam are what provides the beneficial effect. I don't think taking diazepam is the same as taking essentially 3 drugs-nordiazpeam, serax, and restoril.  I am far from knowledgeable on Pharmacokinetics so maybe you can clear up if I am incorrect here.  

Some info:

Although diazepam is 99% protein-bound, interactions based on protein binding are not clinically significant. Metabolism of diazepam is primarily hepatic and involves demethylation (involving primarily CYP2C19 and CYP3A4) and 3-hydroxylation (involving primarily CYP3A4)��. Diazepam is extensively metabolized to one major active metabolite desmethyldiazepam and two minor active metabolites temazepam (3-hydroxydiazepam) and oxazepam (3-hydroxy-N-diazepam), with half-lives of 30-100 hours, 9.5-12 hours, and 5-15 hours, respectively.

At therapeutic doses, desmethyldiazepam is found in plasma at concentrations equivalent to those of diazepam. Oxazepam and temazepam plasma concentrations are usually undetectable. The half-life of diazepam is 30-60 hours. These metabolites are subsequently glucuronidated and excreted in the urine.


Some more info:

Pharmacokinetics:  Diazepam is rapidly absorbed. Oral bioavailability is approximately 100%, and close to 99% is bound in plasma. The half-life of diazepam is 43±13 hours, but ranges from 40-100 hours if the contribution from active metabolites is included. Diazepam is metabolized to nordiazepam which is an active metabolite with a half-life of 40-99 hours. Temazepam and oxazepam are minor active metabolites of diazepam. Diazepam is excreted in urine mainly as oxazepam conjugate (~33 %), and temazepam conjugate, with only traces of diazepam and nordiazepam.

[OneScaredBuckeye]

Thank you very much!  I very much appreciate the information.

Ryan, I will talk to my doctor about the 5 mg., 5 mg. 10 mg. dosage.  I don't feel that anxious, but I carry a lot of tension in my body.

Thank you again so very much.