Azepam

Diazepam is used clinically for its anxiolytic, muscle relaxant, hypnotic, appetite stimulant, and anticonvulsant activities. It is also used in preanesthesia protocols for neuroleptanalgesia.

Use cautiously in patients with hepatic or renal disease and in debilitated or geriatric patients. The drug should be administered to patients in coma, shock, or with significant respiratory depression very cautiously. It is contraindicated in patients with known hypersensitivity to the drug. Diazepam should be used very cautiously, if at all, in aggressive patients, as it may disinhibit the anxiety that may help prevent these animals from aggressive behavior.
Benzodiazepines may impair the abilities of working animals. If administering the drug IV, be prepared to administer cardiovascular or respiratory support.

The subcortical levels (primarily limbic, thalamic, and hypothalamic), of the CNS are depressed by diazepam and other benzodiazepines thus producing the anxiolytic, sedative, skeletal muscle relaxant, and anticonvulsant effects seen. The exact mechanism of action is unknown, but postulated mechanisms include: antagonism of serotonin, increased release of and/or facilitation of gamma-aminobutyric acid (GABA) activity, and diminished release or turnover of acetylcholine in the CNS. Benzodiazepine specific receptors have been located in the mammalian brain, kidney, liver, lung, and heart. In all species studied, receptors are lacking in the white matter.

The following drug interactions have either been reported or are theoretical in humans or animals receiving diazepam and may be of significance in veterinary patients:
AMITRIPTYLINE: Diazepam may increase levels
ANTACIDS: May decrease oral diazepam absorption
ANTIFUNGALS, AZOLE (itraconazole, ketoconazole, etc.): May increase diazepam levels
CIMETIDINE: May decrease metabolism of benzodiazepines
CNS DEPRESSANT DRUGS (barbiturates, narcotics, anesthetics, etc.): If diazepam administered with other CNS depressant agents additive effects may occur
DEXAMETHASONE: May decrease diazepam levels
DIGOXIN: Diazepam may increase digoxin levels
ERYTHROMYCIN: May decrease the metabolism of benzodiazepines
MINERAL OIL: May decrease oral diazepam absorption
OMEPRAZOLE: May inhibit the metabolism of diazepam and increase levels
PHENOBARBITAL: May decrease diazepam concentrations
PHENYTOIN: May decrease diazepam concentrations
QUINIDINE: May increase diazepam levels
RIFAMPIN: May induce hepatic microsomal enzymes and decrease the pharmacologic effects of benzodiazepines

Sedation & ataxia most prevalent. Dogs: CNS excitement, increased appetite; Cats: Hepatic failure or behavior changes; Horses: Muscle fasciculations

Inject intravenously slowly. This is particularly true when using a small vein for access or in small animals; diazepam may cause significant thrombophlebitis. Rapid injection of intravenous diazepam in small animals or neonates may cause hypotension/cardiotoxicity secondary to the propylene glycol in the formulation. Intra-carotid artery injections must be avoided. Use of diazepam in cats is  controversial, primarily because of case reports of serious hepatotoxicity. Some are of the opinion that the drug should not be used chronically in cats.

should be stored between 15–30°C (59–86°F) and protected from light.