Valium is diazepam, a Schedule 5 benzodiazepine in 2 mg, 5 mg and 10 mg tablets and as an injection. It is used for severe anxiety, muscle spasm, alcohol withdrawal, seizures and sedation before procedures. It is habit-forming and intended for short courses.
What is Valium?
The South African Medicine Price Registry lists Valium as Schedule 5:
| Product | Form | Strength |
|---|---|---|
| Valium 2 mg | Tablet | Diazepam 2 mg |
| Valium | Tablet | Diazepam 5 mg |
| Valium | Tablet | Diazepam 10 mg |
| Valium 2 ml | Injection | Diazepam 10 mg / 2 ml |
Diazepam is a benzodiazepine. It enhances the effect of GABA, the brain’s main inhibitory signal, producing reduced anxiety, muscle relaxation, sedation and anticonvulsant activity. Those four effects are why one medicine appears in so many different situations.
Its defining feature is how long it lasts. Diazepam has a half-life of 20 to 50 hours, and its active breakdown products persist longer still — up to about 100 hours. That has three consequences:
It accumulates with repeated dosing, particularly in older people, where the effects can build over days.
Withdrawal is gentler than with short-acting benzodiazepines such as alprazolam, because levels fall slowly. This is why diazepam is often used to taper people off other benzodiazepines.
Next-day drowsiness is common, and it is a genuine driving risk rather than a theoretical one.
What is Valium commonly used for?
- Severe anxiety, short-term, where symptoms are disabling.
- Muscle spasm — back spasm, neck spasm, and spasticity in neurological conditions.
- Alcohol withdrawal, where benzodiazepines prevent seizures and delirium tremens. This is a genuinely life-saving use.
- Seizures and status epilepticus, given by injection or rectally as emergency treatment.
- Sedation before procedures, including endoscopy and dental work.
- Febrile convulsions in children, in specific circumstances and on medical direction.
- Insomnia, occasionally and short-term, though other options are usually preferred.
- Tapering off other benzodiazepines, using its long duration.
It is not treatment for ongoing anxiety. Benzodiazepines lose effect over weeks as tolerance develops, and dependence follows. What works over time is an SSRI or SNRI and cognitive behavioural therapy — CBT’s benefit persists after treatment ends, which medication’s does not.
Courses are meant to be short — typically two to four weeks including the taper.
For back spasm specifically, diazepam is sometimes prescribed alongside analgesia. The evidence is modest, and the sedation is substantial — and staying active is the single most important thing in acute back pain. A muscle relaxant that keeps you in bed is working against the outcome.
How Valium fits into this medicine category
| Group | Examples | Role |
|---|---|---|
| Long-acting benzodiazepines | Diazepam (Valium) | Anxiety, spasm, withdrawal, seizures; used for tapering |
| Short-acting benzodiazepines | Alprazolam, oxazepam, lorazepam | Faster relief; higher dependence risk |
| SSRIs / SNRIs | Escitalopram, sertraline | First-line long-term treatment for anxiety |
| Muscle relaxants | Cyclobenzaprine, baclofen, orphenadrine | Spasm and spasticity |
| Anti-epileptics | Carbamazepine, valproate, levetiracetam | Ongoing seizure control |
| Sleep agents | Zolpidem and related | Short-term insomnia |
| Tricyclics | Amitriptyline (Trepiline) | Depression, nerve pain |
See the mental health and neurology medicines hub.
What to check before using Valium
Do not drink alcohol with it. This is the most important check. Alcohol and benzodiazepines both suppress breathing and consciousness, and together the effect is more than additive. The combination is a common cause of preventable deaths.
Tell your doctor or pharmacist if you:
- Take opioid painkillers — tramadol, codeine, morphine. Combining opioids with benzodiazepines significantly raises the risk of dangerously slowed breathing, and needs a deliberate prescribing decision.
- Take other sedating medicines — sleeping tablets, sedating antihistamines, some antipsychotics, gabapentin or pregabalin.
- Take cimetidine, omeprazole, ketoconazole, erythromycin or some HIV medicines, which raise diazepam levels.
- Have breathing problems, particularly sleep apnoea or severe COPD.
- Have myasthenia gravis or severe liver disease — diazepam is cleared by the liver and accumulates markedly in liver impairment.
- Have a history of dependence on alcohol, benzodiazepines or other substances.
- Are pregnant, planning pregnancy or breastfeeding.
- Are older. This matters: diazepam accumulates in older people and substantially increases the risk of falls, fractures and confusion. Shorter-acting alternatives are usually preferred.
Do not drive or operate machinery until you know how it affects you — and remember it can still affect you the next day.
Ask about a stopping plan at the first prescription. That single question prevents most of the problems below.
Possible cautions and when to ask a pharmacist or doctor
Common effects are drowsiness, unsteadiness, confusion, dizziness, reduced concentration and memory problems. Less commonly some people experience agitation, irritability or aggression — more likely in older adults and children, and worth reporting.
Dependence and withdrawal are the defining risks. With regular use over weeks the body adapts: the same dose does less, and stopping causes withdrawal — rebound anxiety, insomnia, tremor, sweating, and in severe cases seizures.
Never stop diazepam abruptly after regular use. Ask your doctor to plan a gradual reduction. Its long half-life makes tapering easier than with shorter-acting benzodiazepines, but stopping suddenly is still genuinely dangerous.
Get emergency help for:
- Very slow or shallow breathing, extreme drowsiness or unresponsiveness — particularly with alcohol or an opioid.
- Seizures, especially after stopping or reducing.
- Severe confusion or agitation.
- A fall with a head injury, particularly in an older person.
- Swelling of the face, lips or tongue, or difficulty breathing.
Contact your doctor if:
- Symptoms are not improving, or you feel you need more than prescribed.
- The course is nearing its end with no plan for what follows.
- You notice memory gaps or marked confusion.
- You are drowsy the next day, which affects driving and work.
- You have been on it longer than a few weeks.
- You are struggling to stop. This is common, it is not a failure of willpower, and there are established tapering approaches.
- An older relative on it has become unsteady, confused or has fallen.
Related medicine guides
Frequently asked questions
What are Valium tablets used for? Severe anxiety, muscle spasm, alcohol withdrawal, seizures and sedation before procedures. It contains diazepam.
How long does it stay in the body? A long time — a half-life of 20 to 50 hours, with active breakdown products lasting up to about 100 hours. That is why next-day drowsiness is common.
Is it addictive? Yes. Dependence develops with regular use, which is why courses are kept short and it is Schedule 5.
Can I stop when I feel better? After a few days, usually yes. After regular use, no — ask your doctor to plan a gradual reduction. Stopping suddenly can cause severe withdrawal including seizures.
Can I drink alcohol on it? No. The combination dangerously suppresses breathing and consciousness.
Can I drive on it? Not until you know how it affects you, and be aware it can still affect you the next day.
Why is it used to come off other benzodiazepines? Its long half-life means levels fall slowly, which makes withdrawal gentler and tapering easier.
Is it suitable for older people? Usually not as a first choice. It accumulates in older adults and substantially increases the risk of falls, fractures and confusion.