1. Name Of The Medicinal Product
Diazepam Forte Syrup 5mg/5ml
2. Qualitative And Quantitative Composition
Each 5ml contains 5mg of Diazepam B.P.
3. Pharmaceutical Form
Oral Solution
4. Clinical Particulars
4.1 Therapeutic Indications
Diazepam has anticonvulsant, anxiolytic, sedative, muscle relaxant and amnesic properties.
Diazepam Forte Syrup 5mg/5ml is indicated for
Adults
i) For the short-term relief (2-4 weeks only) of anxiety that is severe, disabling or subjecting the individual to unacceptable distress, occurring alone or in association with insomnia or short-term psychosomatic, organic or psychotic illness;
ii) As a sedative and premedicant;
iii) As an anticonvulsant in the management of status epilepticus, febrile convulsions and poisoning;
iv) In the control of muscle spasms as in tetanus;
v) In the management of alcohol withdrawal symptoms;
vi) In selected cases it may be useful in the management of cerebral spasticity;
Children
i) Night terrors and somnambulism;
ii) Premedication;
iii) In the control of muscle spasms as in tetanus;
iv) In selected cases, it may be useful in controlling tension and irritability in cerebral spasticity;
The use of diazepam to treat short term anxiety is inappropriate and unsuitable. Diazepam should be used to treat insomnia only when it is severe, disabling or subjecting the individual to extreme stress.
4.2 Posology And Method Of Administration
Adults:
Anxiety States: 2mg three times daily up to 30mg daily in divided doses.
Insomnia associated with Anxiety: 5mg to 15mg before retiring.
Muscle Spasms: 2mg to 15mg daily in divided doses up to 60mg in severe spastic disorders such as cerebral spasticity, epilepsy and muscle spasms associated with upper-motor neurone disease.
In the control of muscle spasms as in tetanus: 3mg to 10mg/kg bodyweight daily.
Alcohol Withdrawal Symptoms: 5mg to 20mg repeated within 2 to 4 hours if necessary.
Premedication in Dental Patients: 5mg the night before, 5mg on waking and another 5mg 2 hours before the appointment.
Elderly or Debilitated patients: The dosage should be half that recommended in adults.
Children:
Night Terrors and Somnambulism: 1mg to 5mg daily before retiring.
Premedication: 2mg to 10mg.
Management of Cerebral Spasticity: 2mg to 40mg daily in divided doses.
In the control of Muscle spasms as in Tetanus: 3mg to 10mg/kg bodyweight daily.
Doses should be repeated only on medical advice. Long-term chronic use is not recommended and treatment should always be tapered off gradually. When a benzodiazepine is used as a hypnotic, treatment should, if possible, be intermittent.
Route of administration
Oral.
4.3 Contraindications
Patients with a known sensitivity to benzodiazepines, acute pulmonary insufficiency; respiratory depression.
4.4 Special Warnings And Precautions For Use
The lowest dose that can control the symptoms should be used and treatment should not be continued beyond 4 weeks. The risk of dependence increases when high dosages are attained, especially when given over long periods. This is particularly so in patients with a history of alcoholism, drug abuse or in patients with marked personality disorders.
Treatment should always be tapered off gradually. Sudden cessation of treatment can result in symptoms such as depression, nervousness, rebound insomnia, irritability, sweating and diarrhoea even in patients receiving normal therapeutic doses for short periods of time. Abrupt withdrawal following high dosage may produce confusion, toxic psychosis, convulsions or a condition resembling delirium tremens.
Diazepam should not be used to treat chronic psychoses or phobic or obsessional states. Because diazepam-induced disinhibition may precipitate suicidal or aggressive behaviour, it should not be used alone to treat depression or anxiety related depression. Caution must be exercised when treating patients with personality disorders.
Elderly or debilitated patients may be more prone to adverse effects and care must be taken in patients with impaired liver or kidney function. Care is also required in patients with organic brain disease (particularly arteriosclerosis).
Diazepam should be avoided in cases of loss or bereavement as psychological adjustment may be inhibited by benzodiazepines.
4.5 Interaction With Other Medicinal Products And Other Forms Of Interaction
Sedation, or respiratory or cardiovascular depression may be enhanced if diazepam is combined with centrally acting drugs such as alcohol, anaesthetics, analgesics, antidepressants, hypnotics, neuroleptics and tranquillisers. Concomitant intake with alcohol is not recommended since the sedative effect is increased. Diazepam is primarily metabolised by hepatic microsomal oxidation and drugs which affect liver enzymes, such as cimetidine and phenobarbitone, may alter its pharmacokinetics. Diazepam has been reported to be displaced from protein-binding sites by sodium valproate.
4.6 Pregnancy And Lactation
If the product is prescribed to a woman of childbearing potential, she should be warned to contact her physician regarding discontinuance of the product if she intends to become or suspects that she is pregnant.
If, for compelling medical reasons, the product is administered during the late phase of pregnancy or during labour at high doses, effects on the neonate such as hypothermia, hypotonia and moderate respiratory depression can be expected owing to the pharmacological action of the compound.
Infants born to mothers who took benzodiazepines chronically during the latter stages of pregnancy may have developed physical dependence and may be at some risk for developing withdrawal symptoms in the postnatal period.
Since benzodiazepines are found in the breast milk, benzodiazepines should not be given to breast feeding mothers.
4.7 Effects On Ability To Drive And Use Machines
The side-effects of diazepam, such as sedation and impaired muscle function, may adversely affect the ability to drive or use machines. Insufficient sleep may also increase the likelihood of impaired alertness. (see also interactions, Section 4.5)
4.8 Undesirable Effects
Diazepam may cause drowsiness, sedation, blurring of vision, unsteadiness and ataxia. These may occur after single as well as repeated doses and persist to the following day. Less common effects include vertigo, headache, confusion, slurred speech, visual disturbance, tremor, change in libido, skin rashes and gastro-intestinal upset. Jaundice or blood dyscrasias have been reported rarely. High doses may be associated with respiratory depression or hypotension.
Abnormal psychological reactions to benzodiazepines have been reported. Rare behavioural adverse effects including paradoxical aggressive outbursts, excitement, confusion and the uncovering of depression with suicidal tendencies.
4.9 Overdose
Symptoms
Benzodiazepines commonly cause drowsiness, ataxia, dysarthria and nystagmus. Coma, hypotension and respiratory depression occasionally occur but are seldom serious if these drugs are taken alone. Coma usually lasts only a few hours but in elderly people it may be more protracted and cyclical. Benzodiazepine respiratory depressant effects are more serious in patients with severe chronic respiratory disease.
Benzodiazepines potentiate the effects of other central nervous system depressants, including alcohol.
Management
Consider activated charcoal in adults or children who have taken more than 1 mg/kg within 1 hour, provided they are not too drowsy. Gastric lavage is unnecessary if these drugs have been taken alone. Patients who are asymptomatic at four hours are unlikely to develop symptoms. Institute supportive measures as indicated by the patient's clinical state.
If CNS depression is severe consider the use of flumazenil (Anexate), a benzodiazepine antagonist. This should rarely be required. It has a short half-life (about an hour) and should NOT TO BE USED IN MIXED OVERDOSE OR AS A "DIAGNOSTIC" TEST. It is contraindicated in the presence of drugs that reduce seizure threshold (e.g. tricyclic antidepressants).
5. Pharmacological Properties
5.1 Pharmacodynamic Properties
Diazepam has potent anxiolytic anti-convulsant and central muscle relaxant properties, these effects are probably mediated through special areas of the CNS. Diazepam has little autonomic activity.
5.2 Pharmacokinetic Properties
The following results were obtained following a pharmacokinetic study with healthy volunteers
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5.3 Preclinical Safety Data
None stated
6. Pharmaceutical Particulars
6.1 List Of Excipients
Glycerin, sucrose, microcrystalline cellulose, methyl hydroxybenzoate, propyl hydroxybenzoate, alcohol (96%), sodium carboxymethylcellulose, Flavouring Agent (Framboise/raspberry 50969A), Ponceau 4R (E124), potassium sorbate and purified water.
6.2 Incompatibilities
None Known.
6.3 Shelf Life
24 months.
6.4 Special Precautions For Storage
Store below 25ºC. Protect from light.
6.5 Nature And Contents Of Container
Amber glass bottles with screw caps and plastic inserts.
Pack sizes: 50ml, 100ml, 150ml, 200ml, 250ml, 300ml and 500ml
6.6 Special Precautions For Disposal And Other Handling
Shake well before use.
7. Marketing Authorisation Holder
Sandoz Ltd
Woolmer Way
Bordon
Hampshire
GU35 9QE
8. Marketing Authorisation Number(S)
PL 4416/0067
9. Date Of First Authorisation/Renewal Of The Authorisation
16th April 1984 / 30th January 1995
10. Date Of Revision Of The Text
6 July 2005
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