In 1978 Americans got through more than 2 billion Valium tablets
Valium was America's best-selling medicine for fifteen years, from 1968 to 1982, and in 1978 alone more than 2 billion tablets were sold. The same drug, diazepam, still calms seizures, eases alcohol withdrawal and helps people wean themselves off other benzodiazepines, while carrying real risks of dependence.
Hoffmann-La Roche patented diazepam in 1959 and launched it in 1963, and it has been among the world's most prescribed drugs ever since. The patent ran out in 1985; today more than 500 brands exist, and the WHO lists it as an essential medicine. American doctors still wrote over 2 million prescriptions for it in 2023, ranking it 183rd nationally.
Chemically it is a benzodiazepine that boosts the action of GABA, the brain's main calming neurotransmitter. That explains its broad menu of uses: anxiety and panic, insomnia, muscle spasms, restless legs, and symptoms of withdrawal from alcohol, opioids and other benzodiazepines. It is also used to sedate patients and blur memory before procedures such as endoscopy, and in more specialised settings for tetanus, stiff person syndrome, organophosphate poisoning and stimulant overdoses. Given into a vein it acts within one to five minutes; by mouth it takes 15 to 60.
Its long half-life makes it the favourite tool for tapering people off benzodiazepine dependence, since doses can be stepped down more smoothly. In 2020 US regulators approved a nasal spray to stop seizures in people with epilepsy. For the emergency of continuous seizures, intravenous diazepam and lorazepam are both first-line, though lorazepam stops seizures more often and protects for longer. Diazepam is rarely used for long-term epilepsy control because tolerance to its anti-seizure effect usually builds within six to twelve months.
Drowsiness and poor coordination are the common side effects. Rarer dangers include slowed breathing, raised suicide risk, agitation, and more seizures when overused in epilepsy. Long-term use brings tolerance and dependence, stopping suddenly can be hazardous, and cognitive effects may linger for six months or more afterwards. It is not recommended in pregnancy or breastfeeding.
Source: Diazepam
