Valium (diazepam) vs. midazolam: What's the difference

What are diazepam and midazolam?

Diazepam is a benzodiazepine used to treat anxiety, alcohol withdrawal symptoms, seizures, for relief of muscle spasms in some neurological diseases, and for sedation during surgery. Diazepam and other benzodiazepines act by enhancing the effects of gamma-aminobutyric acid (GABA) in the brain. GABA is a neurotransmitter (a chemical that nerve cells use to communicate with each other) that inhibits activity in the brain. Excessive activity in the brain may lead to anxiety or other psychiatric disorders.

Midazolam is a benzodiazepine used for sedation. Excessive activity of nerves in the brain may cause anxiety and other psychological disorders. Gamma-aminobutyric acid (GABA) is a neurotransmitter, a chemical that nerves in the brain use to send messages to one another. GABA reduces the activity of nerves in the brain. Midazolam and other benzodiazepines may act by enhancing the effects of GABA in the brain.

Other benzodiazepines include lorazepam (Ativan), diazepam (Valium), alprazolam (Xanax), clonazepam (Klonopin), flurazepam (Dalmane), and others.

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What are the side effects of diazepam and midazolam?

Diazepam

The most common side effects of diazepam are:

Other important side effects include:

  • Paradoxical reactions with excitability
  • Muscle spasm
  • Lack of sleep
  • Rage
  • Confusion
  • Speech problems
  • Double vision

Possible serious side effects:

Midazolam

The most common side effects associated with midazolam are:

  • Sedation
  • Difficulty breathing
  • Nausea
  • Vomiting
  • Pain at the injection site

What is the dosage of diazempam vs. midazolam?

Diazepam

  • Diazepam may be taken with or without food.
  • Diazepam is disposed of by the liver and excreted mainly by the kidney. Dosages of diazepam may need to be lowered in patients with abnormal kidney function.
  • The usual oral diazepam dose for anxiety or seizures is 2 to 10 mg given 2 to 4 times daily.
  • The usual rectal dose is 0.2 to 0.5 mg/kg and depends on the age of the patient.

Midazolam

Midazolam is given by intramuscular or intravenous injection. The dose for sedation during surgery is 0.5 to 1 mg given over 2 minutes and not to exceed 2.5 mg per dose. Doses may be repeated after 2 to 3 minutes. Total doses greater than 5 mg usually are not needed. The dose for starting anesthesia is 200 to 350 mcg/kg injected intravenously over 20 to 30 seconds.

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What drugs interact with diazepam and midazolam?

Diazepam

Alcohol or medications that cause sedation may add to the sedative effects of diazepam. Patients taking benzodiazepines should avoid such combinations.

The following drugs may prolong the effects of diazepam by inhibiting liver enzymes that eliminate diazepam:

Dosages may need to be decreased when these drugs are used with diazepam.

Carbamazepine (Tegretol), rifampin (Rifadin), and St. John's Wort decrease levels of diazepam by increasing the elimination of diazepam by liver enzymes.

Midazolam

Midazolam and all benzodiazepines interact with other medications and drugs that slow the brain's processes such as alcohol, barbiturates, narcotics, and tranquilizers. Boceprevir (Victrelis), itraconazole (Sporanox), nelfinavir (Viracept), and telaprevir (Incivek) increase blood level of midazolam by reducing its breakdown in the liver and, therefore, can increase the side effects of midazolam.

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Are diazepam and midazolam safe to use while pregnant or breastfeeding?

Diazepam

  • Benzodiazepines, including diazepam, can cause fetal abnormalities and should not be used during pregnancy.
  • Diazepam is excreted in breast milk and can affect nursing infants. Therefore, diazepam should not be used by women who are nursing.

Midazolam

Midazolam and other benzodiazepines have been associated with fetal damage, including congenital malformations, when taken by pregnant women in their first trimester. Midazolam is best avoided if at all possible in the first trimester and probably throughout pregnancy.

Midazolam is secreted in breast milk.

Summary

Diazepam (Valium) and midazolam are benzodiazepines used for sedation during surgery and to treat seizures. Diazepam is also used to treat anxiety, alcohol withdrawal symptoms, and for relief of muscle spasms in some neurological diseases.

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Medically Reviewed on 6/19/2019
References
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