(a) Diazepam (Valium). Diazepam may be useful in the treatment of
alcohol withdrawal symptoms (for example, delirium tremens, agitation, and so forth.)
This agent produces skeletal muscle relaxant effects in humans and has been used with
limited success in various neurologic and musculoskeletal disorders. Diazepam may be
administered parenterally as a preanesthetic medication to reduce anxiety and to calm
the patient. Diazepam is also administered intravenously in the treatment of status
epilepticus. It is available in tablet form (2, 5, and 10 milligrams) and in injection form
(5 milligrams per milliliter in 2 and 10 milliliter containers). Diazepam is a Note Q
controlled substance in the military.
(b) Meprobamate (Equanil, Miltown). Meprobamate can produce
skeletal muscle relaxant effects in humans; therefore, it has been used with some
success in the treatment of various neurologic and musculoskeletal disorders. It
appears to be less effective than diazepam in the treatment of anxiety and tension. The
most common side effect associated with the agent is drowsiness. It is supplied in
tablet and suspension forms. Meprobamate is a Note Q controlled item in the military.
(c) Other examples of nonbarbiturates used in the treatment of anxiety
disorders include Lorazepam (Ativan), Alprazolam (Xanax), and Buspirone (Buspar).
Lorazepam is used primarily as an antianxiety agent, but is useful for treating insomnia
due to stress and anxiety. Lorazepam is also used as a preanesthetic medication to
produce sedation and decrease the patient's ability to recall events related to the day of
(d) Temazepam (Restoril). Temazepam is administered in a nightly
dose of 15 to 30 mg. It is an effective inducer of sleep with a good safety profile.
Animal studies indicate a potential for Temazepam to cause teratogenic effects.
Therefore, it should not be administered during pregnancy.
Long-Acting Nonbarbiturate Agents.
(1) Background information. These agents depress the central nervous
system. Patients taking these drugs should be cautioned against performing hazardous
activities while under their effects.
Examples of long-acting nonbarbiturate agents.
(a) Chlordiazepoxide hydrochloride (Librium). Chlordiazepoxide is
orally administered as an antianxiety agent. It is also effective when administered
parenterally in the treatment of alcohol withdrawal. Side effects associated with the
agent include drowsiness, ataxia, and lethargy.
(b) Oxazepam (Serax). Oxazepam is generally less effective than
either diazepam or chlordiazepoxide in the treatment of tension and anxiety.
Drowsiness is the most common side effect associated with this agent.