(FDA approved in bold)

• Seizure disorders. Adjunctively and to control bouts of increased seizure activity
  
• Anxiety disorders
  
• Acute alcohol withdrawal
  
• Muscle relaxant
  
• Preoperative medication
  
• Status epilepticus
  
• Tetanus
  
• Insomnia
  
• Agitation
  
• Stiff person syndrome
  
• Spasticity due to upper motor neuron disorders
  
• Irritable bowel syndrome
  
• Panic attacks
  
• Nausea and vomiting (from chemotherapy)
  
• Emergency treatment of preeclampsia
  
• Dystonia
  
• Vertigo
  
• Opioid or other drug withdrawal
  
• Acute mania in bipolar disorder

• Benzodiazepines bind to and potentiate the effect of GABA-A receptors, boosting chloride conductance through GABA-regulated channels, and other inhibitory neurotransmitters. There are at least 2 benzodiazepine receptors, 1 of which is associated with sleep mechanisms, the other with memory, sensory and cognitive functions. They act at spinal cord, brainstem, cerebellum, and limbic and cortical areas

• Works quickly (minutes-hours depending on formulation) in the treatment of seizures, acute anxiety, drug withdrawal, and muscle relaxation. In patients with chronic disorders such as spasticity, dystonia or generalized anxiety it may take weeks to determine optimal dose for maximal therapeutic benefit

• Seizures – rectal diazepam is used intermittently as an adjunctive for patients with known epilepsy with increased seizure frequency. Intravenous diazepam is used for status epilepticus in conjunction with intravenous maintenance anticonvulsants. In patients with epilepsy who benefit from oral diazepam as an adjunctive medication, consider tapering the medication after 2 years without seizures, depending on the type of epilepsy
  
• Spasticity – used as an adjunct medication. The cause of spasticity usually determines the duration of use. For acute muscle spasm, change to as needed use 1–3 weeks after onset
  
• Anxiety – generally used on a short-term basis. Consider adding an SSRI or SNRI for long-term treatment

• Epilepsy: For acute use only. Status epilepticus is a medical emergency requiring immediate medical attention. After using diazepam, start maintenance AEDs such as phenytoin and evaluate for cause of worsening seizures
  
• Spasticity: If not effective change to another agent
  
• Anxiety: Consider a secondary cause, mania or substance abuse. Change to another agent or add an augmenting agent

• Epilepsy: often used in combination with other AEDs for optimal control but sedation can increase
  
• Spasticity: tizanidine, baclofen, and other CNS depressants may be used
  
• Anxiety: SSRI, SNRIs or tricyclic antidepressants are helpful for chronic anxiety. In most cases it is best to avoid combining with other benzodiazepines
  
• Insomnia: may be combined with low-dose tricylic antidepressants (amitriptyline), or tetracyclics (trazodone, mirtazapine)

• None required