This article describes possible interactions with diazepam oral tablet. Interactions can cause a drug to have a different effect on the body than expected. Interactions can occur due to medications, alcohol, or certain health conditions.
Diazepam comes as tablets that you’ll swallow. It’s also available as an oral liquid solution, a rectal gel, and a liquid solution for injection. Interactions of diazepam may vary depending on the form of diazepam you’re prescribed.
Boxed warnings
This drug has boxed warnings about the risk of serious effects if taken with opioids and the risk of misuse and addiction. It also has a boxed warning about the risk of dependence and withdrawal. A boxed warning is the most serious warning from the Food and Drug Administration (FDA).
See the end of this article for more information about these warnings.
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Other drugs and diazepam
The drugs in the list below may interact with diazepam oral tablet. This article doesn’t include all drugs that may interact with diazepam. Talk with your doctor to learn more about what medications you should not take with diazepam.
Drug classes or drugs that may interact with diazepam oral tablet include:
- antipsychotic drugs:
- catechol-O-methyl transferase (COMT) inhibitors:
- drug examples: entacapone (Comtan), tolcapone (Tasmar)
- what might happen: can increase the risk of side effects of diazepam and the COMT inhibitor
- monoamine oxidase inhibitors (MAOIs):
- drug examples: phenelzine (Nardil), tranylcypromine (Parnate)
- what might happen: can increase the risk of side effects of diazepam and the MAOI drug
- opioids:*
- drug examples: fentanyl (Fentora, others), morphine (MS Contin, others)
- what might happen: can increase the risk of side effects of diazepam and the opioid drug
- other benzodiazepines (diazepam is a benzodiazepine):
- drug examples: clobazam (Sympazan, Onfi), alprazolam (Xanax)
- what might happen: can increase the risk of side effects of diazepam and the other benzodiazepine
- sedative/hypnotics:
- drug examples: zolpidem (Ambien, Edluar), eszopiclone (Lunesta)
- what might happen: can increase the risk of side effects of diazepam and the sedative/hypnotic drug
- tricyclic antidepressants (TCAs):
- drug examples: amitriptyline, desipramine (Norpramin)
- what might happen: can increase the risk of side effects of diazepam and the TCA drug
- certain antihistamines:
- drug examples: hydroxyzine (Vistaril), chlorpheniramine
- what might happen: can increase the risk of side effects of diazepam and the antihistamine
- esketamine (Spravato):
- what might happen: can increase the risk of side effects of diazepam and esketamine
- calcium/magnesium/potassium/sodium oxybate (Xywav):
- what might happen: can increase the risk of side effects of diazepam and Xywav
* Diazepam has a boxed warning about use with opioids. See the “Boxed warnings for diazepam” section at the end of this article to learn more.
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When to avoid diazepam
Certain health conditions or other factors could increase some risks with diazepam oral tablet. Because of this, doctors may not prescribe diazepam in these cases. These health conditions or other factors are called contraindications.
Here’s a list of contraindications for diazepam oral tablet:
- Myasthenia gravis: If you have myasthenia gravis (a type of autoimmune disorder that affects your muscles), you may have a higher risk of serious side effects from taking diazepam.
- Severe breathing problems: If you have a severe breathing problem, you may have a higher risk of side effects from taking diazepam. Examples of these breathing problems include severe asthma or chronic obstructive pulmonary disease (COPD).
- Sleep apnea: If you have sleep apnea, you may have a higher risk of side effects from taking diazepam.
- Severe liver conditions: If you have a severe liver condition, you may have a higher risk of side effects from taking diazepam. Diazepam may also worsen your condition.
- Acute narrow angle glaucoma: You should not use diazepam if you’re experiencing sudden narrow angle glaucoma (a type of eye condition that affects the optic nerve).
- Children under age 6 months: Doctors will not prescribe diazepam to children under 6 months old.
- Past allergic reaction to diazepam: If you’ve ever had an allergic reaction to diazepam oral tablet, taking it again may cause another allergic reaction.
Before you start taking diazepam, tell your doctor if anything listed above relates to you. They can recommend whether you should take diazepam.
Alcohol and diazepam
Diazepam oral tablet is known to interact with alcohol. Your doctor will likely suggest you avoid alcohol while taking diazepam.
Taking diazepam oral tablet and drinking alcohol may cause or worsen serious side effects, including:
If you drink alcohol and have concerns about avoiding it while taking diazepam oral tablet, talk with your doctor.
Other interactions and diazepam
Interactions can occur with supplements, foods, vaccines, and some lab tests. Below you can learn whether diazepam oral tablet has these interactions.
The information below doesn’t include all other possible interactions with diazepam.
Diazepam and supplements
Before taking diazepam oral tablet, tell your doctor and pharmacist about any herbs you take, as well as vitamins and supplements. Doing so may help you avoid interactions.
If you have questions about interactions that may affect you, talk with your doctor or pharmacist.
Diazepam interactions and herbs
Diazepam oral tablet may interact with valerian. Valerian is used to aid sleep. Taking diazepam and using valerian can increase your risk of certain side effects, including drowsiness and problems with balance and coordination.
Diazepam oral tablet may also interact with St. John’s wort. This herb is used to boost mood and ease symptoms of depression. Taking diazepam with St. John’s wort can make diazepam less effective.
Because of this, ask your doctor or pharmacist before using any of these products while taking diazepam oral tablet.
Diazepam interactions and vitamins
Diazepam oral tablet isn’t known to interact with any vitamins. But this doesn’t mean interactions with vitamins can’t happen or won’t be identified later.
Because of this, ask your doctor or pharmacist before using any of these products while taking diazepam oral tablet.
Diazepam and food
Diazepam oral tablet may interact with grapefruit and grapefruit juice.
Consuming grapefruit or grapefruit juice affects how your body metabolizes (breaks down) diazepam after taking a dose. It could increase the amount of diazepam in your system. This can increase your risk of side effects, such as drowsiness and problems with coordination.
Because of this, talk with your doctor or pharmacist about what foods you should avoid while taking diazepam oral tablet.
Diazepam and vaccines
Diazepam oral tablet isn’t known to interact with any vaccines. But this doesn’t mean interactions with vaccines can’t happen or won’t be identified later.
Because of this, talk with your doctor or pharmacist before receiving any vaccines while taking diazepam oral tablet.
Diazepam and lab tests
Diazepam oral tablet isn’t known to interact with lab tests. But this doesn’t mean interactions with lab tests can’t happen or won’t be identified later.
Because of this, talk with your doctor or pharmacist before having any tests while taking diazepam oral tablet.
Diazepam and cannabis or CBD
Studies of cannabis (commonly called marijuana) and cannabis products have been shown to interact with diazepam. Cannabidiol (CBD) is an example of a cannabis product.
Taking diazepam and using cannabis can increase your risk of side effects, including problems with balance, coordination, thinking, and drowsiness.
Before you take diazepam, tell your doctor and pharmacist if you use cannabis. Doing so may help prevent possible interactions.
Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.
Health factors and diazepam
Certain medical conditions or other health factors may increase the risk of interactions with diazepam oral tablet. Keep in mind that interactions could lead to side effects or affect how well the drug works. Before taking diazepam, tell your doctor about your health history. They’ll determine whether diazepam is right for you.
These health conditions or other factors might interact with diazepam oral tablet:
Suicide prevention
If you or someone you know is in crisis and considering suicide or self-harm, please seek support:
If you’re calling on behalf of someone else, stay with them until help arrives. You may remove weapons or substances that can cause harm if you can do so safely.
If you are not in the same household, stay on the phone with them until help arrives.
Preventing diazepam interactions
You may be able to help avoid certain interactions with diazepam oral tablet. Before taking this drug, you may want to discuss possible interactions with your doctor and pharmacist.
Things to consider include:
- Whether you drink alcohol or use cannabis.
- Other medications and herbs you take, as well as vitamins and supplements. Your doctor or pharmacist can help you fill out a medication list.
- What to do if you’re prescribed a new drug while taking diazepam oral tablet.
Taking diazepam exactly as prescribed can also help prevent interactions.
What to ask your doctor
If you have questions about diazepam and possible interactions, talk with your doctor.
Questions you may want to ask your doctor include:
- How do interactions of diazepam compare with other benzodiazepines, such as alprazolam?
- Do other drugs for treating anxiety have similar interactions as diazepam?
- Does my risk of interactions depend on my dosage of diazepam?
- If I take diazepam and have certain health conditions, will I be monitored more closely during treatment?
Boxed warnings for diazepam
This drug has boxed warnings about the risk of serious effects if taken with opioids and the risk of misuse and addiction. It also has a boxed warning about the risk of dependence and withdrawal. A boxed warning is the most serious warning from the FDA.
Serious effects if taken with opioids. Serious harm can occur if diazepam is taken with an opioid drug. Opioid drugs are prescribed to relieve moderate to severe pain. Examples include morphine (MS Contin, others), fentanyl (Fentora, others), and methadone (Methadose).
Both diazepam and opioids depress activity in your central nervous system (CNS). (Your CNS is made up of your brain and spinal cord, and it controls numerous activities throughout your body.) Combining diazepam and an opioid can cause serious CNS depression. This can result in harmful, serious side effects, such as respiratory depression (slow, shallow, ineffective breathing) and life threatening overdose.
Due to these risks, doctors avoid prescribing opioids and benzodiazepines, such as diazepam, together unless there are no other suitable treatments. If they must prescribe this combination, they’ll prescribe the lowest dose of both medications for the shortest time needed to treat your condition. They’ll also likely prescribe you naloxone (Narcan). This drug is used to reverse an opioid overdose long enough for emergency medical responders to arrive.
Risk of misuse and addiction. Like other benzodiazepines, diazepam has a risk of misuse and addiction. Misuse refers to taking a drug in a way other than how it’s prescribed, such as taking a drug to feel “high.” And addiction occurs when you continue taking or misusing a substance despite it causing harm, such as interfering with work or school activities.
Diazepam misuse and addiction can cause serious side effects, including respiratory depression and coma. It also raises the risk of life threatening overdose. Due to these risks, diazepam is classified as a controlled substance. This means there are strict rules and regulations in place about how the medication is prescribed and dispensed. These rules are in place to help prevent misuse and addiction.
Risk of dependence and withdrawal. Like other benzodiazepines, diazepam treatment has a risk of dependence and withdrawal. With dependence, your body physically needs a drug in your system in order to feel and function as usual. When you stop taking a drug that your body is physically dependent on, withdrawal symptoms can occur. These can include sweating, fast heart rate, nausea, and tremors.
Your risk of dependence and withdrawal increases with long-term use of diazepam, especially at higher dosages. You can lower your risk of withdrawal by slowly stopping treatment with diazepam rather than suddenly stopping it. If you’d like to stop taking diazepam, talk with your doctor. They can design a drug taper for you to follow. This is a plan that slowly lowers your drug dosage over time until it’s safe for you to stop taking it entirely.
To learn more about these warnings, talk with your doctor.
Disclaimer: Optum Perks has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
