Harmful interactions can occur when taking Valium with antipsychotics, sleep medications, SSRIs and more.
Valium (diazepam) is a benzodiazepine prescription drug most frequently recommended for people with anxiety, seizures, muscle spasms or alcohol withdrawal.
Benzodiazepine drugs are Schedule IV drugs, according to the DEA, which means their potential for abuse and addiction is low.
Valium acts on the central nervous system by slowing down electrical impulses in the brain. This results in a calming, soothing and quieting effect. Its tranquilizing effects are also known to assist with seizure prevention, muscle spasms like restless leg syndrome, and abnormal body movement. Additionally, it is sometimes used to help with alcohol withdrawal side effects. Valium makes the individual feel drowsy and can alter moods as well.
When taken as prescribed, Valium is a relatively safe drug with a risk of minor side effects. However, when one combines Valium with drugs or substances that affect the central nervous system, there is a significant increase in the risk of side effects, including drowsiness, memory loss and confusion, breathing problems, hallucinations, depression, rage reactions, overdose, coma and even death.
Valium Drug Interactions
The most common drug interactions associated with Valium are pharmacodynamic interactions. Here, the effects of one drug are additive to the effects of another. Since Valium is a central nervous system (CNS) depressant, other drugs that are CNS depressants will enhance this effect.
Several drug groups pose significant risk of adverse interactions when taken with Valium.
Phenothiazines are a group of medications that can be used to treat nausea or symptoms of psychosis. Common examples include chlorpromazine, thioridazine, fluphenazine and prochlorperazine. When taken with Valium, these drugs pose an extremely high risk of drowsiness, dizziness, falls and memory loss.
Antipsychotics are also known as neuroleptics or major tranquilizers, and they’re prescribed to manage psychosis symptoms of bipolar disorder, schizophrenia and schizoaffective disorder. Examples include haloperidol, aripiprazole, risperidone, paliperidone, olanzapine, clozapine, lurasidone, ziprasidone, quetiapine and paliperidone.
All antipsychotic medications are CNS depressants to a certain extent, with some causing more depressant effects than others. When combined with Valium, side effects can include loss of coordination, confusion, drowsiness and weakness.
Anxiolytics are prescribed to treat symptoms of anxiety. There are different groups of medications that can treat anxiety, including SSRIs and SNRIs. Other anxiety medications, like benzodiazepines, should not be mixed with Valium since Valium itself is a benzodiazepine. Examples include Ativan, Xanax, Librium and Klonopin. Combining these drugs may result in extreme CNS depression.
Sleep medications can be prescribed or purchased over-the-counter (OTC). Prescription sleep aids include zolpidem, eszopiclone, Dayvigo, Belsomra and zaleplon. OTC sleep medications typically include either doxylamine or diphenhydramine.
Like other drug interactions, combining Valium with sleep medications increases the risk of CNS depression. The only non-sedating sleep medication that is safe to combine with Valium is Ramelteon, by prescription only, and melatonin, available over the counter.
Commonly called “narcotics”, this group of medicines includes opiates and opioids. They relieve acute and chronic severe pain by binding to opioid receptors. Drugs include morphine, hydrocodone, codeine, fentanyl, methadone, tramadol, oxycodone and oxymorphone.
It is extremely dangerous to take narcotic pain medications along with benzodiazepines like Valium. The FDA recently required additional boxed warnings to warn the public of the increased risk of overdose and death when combining these two types of drugs.
Antihistamines are typically used to manage allergic reactions and sometimes cases of itching. However, a side effect of some of these drugs is that they can have sedative properties. Drugs include diphenhydramine (Benadryl), chlorpheniramine and hydroxyzine. Follow your doctor’s instructions for these drugs cautiously while taking Valium and watch for symptoms of drowsiness, loss of coordination, confusion and sedation.
Anticonvulsants are used to treat or prevent seizures in people with seizure disorders. Valium itself can be used to treat seizures, so sometimes it will be prescribed in combination with these types of drugs, but Valium can often be used safely if managed by a healthcare professional. Examples of anticonvulsants include gabapentin, valproic acid, barbiturates, benzodiazepines, carbamazepine, oxcarbazepine, tiagabine, topiramate, phenytoin, fosphenytoin, primidone, ethosuximide and zonisamide.
If you are taking anticonvulsants, you should speak with your healthcare provider about the potential risks of drug interactions with Valium.
Monoamine Oxidase (MAO) Inhibitors
MAOIs are antidepressant drugs that elevate the levels of norepinephrine, serotonin and dopamine in the brain. Drugs include Parnate, Nardil, Marplan and Emsam. While MAOIs have an extremely high number of drug interactions, they do not interact with Valium. However, anyone taking MAOIs should use caution before changing their drug regimen.
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs are commonly prescribed to treat anxiety and depression. Common examples include fluoxetine (Prozac), citalopram (Celexa), sertraline (Zoloft), paroxetine (Paxil) and escitalopram (Lexapro).
Most SSRIs have no interactions with Valium and can be used safely at the same time. However, fluoxetine can cause an increased potency of Valium when taken together. There is an increased risk of sedation, confusion and loss of coordination when taking Valium and fluoxetine together.
Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
There are two commonly prescribed SNRIs: venlafaxine (Effexor) and duloxetine (Cymbalta). SNRIs can be used to treat anxiety or depression and can also be used to treat certain types of nerve pain.
There are no known interactions between SNRIs and Valium.
Noradrenergic and Specific Serotonergic Antidepressants (NaSSAs)
The only NaSSA available by prescription in the United States is mirtazapine (Remeron). Mirtazapine is indicated for the treatment of depression, but may also be used for anxiety in some people.
Mirtazapine causes a significant level of CNS depression, so it can increase the risk of drowsiness, loss of coordination, confusion and somnolence when taken with Valium.
Alcoholic beverages should never be combined with benzodiazepines like Valium. Alcohol, like many other drugs on this list, is a CNS depressant. However, the risk of overdose is significantly increased when taking Valium and alcohol together.
Signs and symptoms of overdose may include:
- Cold or clammy skin
- Low body temperature
- Trouble breathing or irregular breathing
- Slowed heart rate
- Slow responses
Harmful interactions can occur when using Valium and any of the drugs listed above. Additionally, combining these drugs with Valium presents a greater chance of developing a chemical dependence and addiction.
If you or a loved one are concerned about Valium use in combination with other medications or substances, speak with your doctor, who can address any concerns and help mitigate risk associated with your unique situation. If you suspect signs of a substance use disorder, contact us at The Recovery Village, where we have all the tools you need for long-term recovery.
Drug Enforcement Agency (DEA). “Benzodiazepines.” April 2020. Accessed November 9, 2021.
Food and Drug Administration (FDA). “FDA requiring boxed warning updated t[…]epine drug class.” September 2020. Accessed November 9, 2021.
Food and Drug Administration (FDA). “Valium Package Insert.” 2016. Accessed November 9, 2021.
Drugs.com. “Valium (diazepam) Interactions.” Accessed November 9, 2021.
National Institute on Alcohol Abuse and Alcoholism (NIAAA). “Understanding the Dangers of Alcohol Overdose.” May 2021. Accessed November 9, 2021.
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