Diazepam and Propranolol
Diazepam and Propranolol
Diazepam and propranolol are two different drugs that can be used for the same purpose which is treating anxiety.
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They are also used for other reasons.
Diazepam and propranolol can be used individually and in combination with each other.
Using them in combination increases the effect of diazepam being more effective in treating anxiety than diazepam on its own.
So, let’s get to know diazepam and propranolol.
Family, uses, and indications:
Propranolol is from a drug family called beta-blockers, which are usually used to treat hypertension (high blood pressure) and heart problems, and used off-label in treating anxiety, and diazepam belongs to a drug family called benzodiazepines, a family used to treat anxiety.
So, diazepam and propranolol are common in treating anxiety.
Propranolol and beta-blockers are used for the physical symptoms (symptoms occurring to the body) of anxiety-like fast heart rate, chest tightness, and sweating, they are not related to the psychological and emotional symptoms like worrying and stress feeling.
Diazepam and benzodiazepines cause sedation, but they can be taken during acute bouts of anxiety and panic attacks, relieving stress and worry.
How do diazepam and propranolol work?
Beta-blockers and propranolol block certain neurotransmitters called epinephrine and norepinephrine, which help in dilating blood vessels, and decreasing heart rate and blood pressure.
Benzodiazepines and diazepam work by enhancing the activity of certain neurotransmitters called GABA (Gama Amino-butyric acid) that produces a calming effect on the brain and nerves.
Side effects:
There are common side effects between diazepam and propranolol and uncommon ones.
Common side effects are diarrhea, rash, blurred vision, diplopia (double vision), insomnia (sleeping problem), muscle spasms and stiffness, and fatigue.
The uncommon side effects of propranolol different from diazepam are stomach cramps, nausea, vomiting, disorientation (loss of sense of direction), hair loss, weakness, sexual dysfunction.
Uncommon side effects of diazepam different from propranolol are drowsiness, euphoria (intense excitement and happiness), loss of balance, excitability due to paradoxical reactions, rage, confusion, and speech problems.
Withdrawal symptoms:
Diazepam and propranolol are common in another aspect, both of them should not be stopped suddenly, they must be withdrawn gradually or they may cause withdrawal symptoms.
Propranolol may cause withdrawal symptoms like heart attacks, worsened chest pain (angina), serious abnormal rhythm of the heart, or even sudden death.
Diazepam may also cause withdrawal symptoms, especially after long use, like insomnia, headaches, nausea, vomiting, lightheadedness, sweating, anxiety, fatigue, and seizures.
Warning: Diazepam may cause dependency and addiction, especially when using high doses for a long duration, also a trigger effect when you have a history of abuse or addiction to any drugs or alcohol.
Drug-drug interactions with diazepam and propranolol:
Propranolol interactions
- Propranolol with thioridazine or chlorpromazine may cause a decrease in blood pressure (hypotension) and abnormal rhythms of the heart because they interfere with the elimination of propranolol and increase the concentration of the drug in the blood.
- Combination with clonidine may cause a dangerous increase in blood pressure, that’s why close monitoring should be done after the starting or stopping of the concurrent use of clonidine and propranolol, as stopping them suddenly may also cause an increase in blood pressure.
- Phenobarbital and similarities increase the breaking and blood levels of propranolol which may reduce the effectiveness of the drug.
- Aspirin and NSAIDs (Non-steroidal anti-inflammatory drugs) may reduce the effects of propranolol by reducing the effects of prostaglandins that help in controlling the blood pressure.
- Propranolol elongates hypoglycemia (low blood sugar) and masks the symptoms in diabetic patients.
Diazepam interactions
- CNS (Central Nervous System) depressants that cause sedation to increase the sedative effects of diazepam, alcohol can cause the same effects.
- Drugs that inhibit the liver enzymes responsible for eliminating diazepam and causing prolongation of their effects, their doses may be decreased if concomitantly used like:
- cimetidine
- ketoconazole
- itraconazole
- omeprazole
- erythromycin
- clarithromycin
- darunavir
- fluvoxamine
- fluoxetine
- On the opposite, drugs increasing the elimination of diazepam by liver enzymes and decreasing the levels of diazepam, like carbamazepine, rifampin, and St. John’s wort.
Warnings and precautions:
- Before taking propranolol, you have to tell your doctor if you have:
- Asthma
- Bradycardia (very slow heartbeats)
- Sick sinus syndrome (a serious heart condition) or another heart problem called AV block (a condition that needs a pacemaker)
- Muscle disorder
- Breathing problems like bronchitis or emphysema
- Diabetes or low blood pressure
- Congestive heart failure
- Depression
- Liver or kidney problems
- A thyroid disorder
- A condition caused by a tumor of the adrenal gland called pheochromocytoma
- Raynaud’s syndrome (circulation problem)
Before taking diazepam, you have to tell your doctor if you have:
- Myasthenia gravis (a condition causing weakness of muscles)
- A severe breathing problem
- Sleep apnea (breathing stops for a short period during sleep)
- Eye problems like narrow-angle glaucoma or uncontrolled open-angle glaucoma
- Severe liver diseases
The combination between diazepam and propranolol may be effective due to increasing the medical effects of diazepam but also should be taken with care as the side effects also may increase.
Omeprazole and Diazepam
Omeprazole and Diazepam
Omeprazole and diazepam are two completely different drugs, with different uses, and mechanisms of action.
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So, what happens when combining omeprazole and diazepam?
First, we have to understand the nature of both drugs.
Omeprazole is a proton pump inhibitor drug, a family of drugs that help to reduce the production of acid in the stomach.
Acid is responsible for ulcers in the esophagus, stomach, and duodenum.
Decreasing the acid prevents the formation of ulcers, and if they are already formed, they help in their healing.
Omeprazole also helps in relieving acid reflux, heartburn, swallowing difficulties, and persistent cough.
It is available in many dosage forms, packets, suspension, delayed-release tablets, delayed-release capsules, and orally disintegrating tablets, with many concentrations.
It takes from 1 to 4 days to work and has a full effect.
Omeprazole can be used as an over-the-counter drug, that’s why you have to read the package instructions carefully, and don’t take it for more than 14 days unless you reviewed the case with a doctor.
It can be taken concomitantly with antacids like sucralfate.
Side effects:
Common side effects
- Headache
- Abdominal pain
- Diarrhea
- Nausea
- Vomiting
- Flatulence
- Dizziness
- Upper respiratory infection
- Acid regurgitation
- Constipation
- Rash
- Cough
Less common side effects
- Fracture of bone because of it increases the chance of osteoporosis
- Hepatotoxicity
- Agranulocytosis (life-threatening medical condition concluding low white blood cells)
- Anorexia (eating disorder related to a mental health condition)
- Gastric polyps (abnormal growth of the stomach lining)
- Hip fracture
- Alopecia (hair loss)
- Atrophic gastritis (inflammation of the gastric mucosa)
- Interstitial nephritis (kidney problem)
- Pancreatitis (inflammation in the pancreas)
- Rhabdomyolysis (a serious medical condition caused by muscle injury)
- Metallic taste
- Abnormal dreams
- Toxic epidermal necrolysis (a very serious and rare skin condition)
Warnings:
- Omeprazole may cause a serious hypersensitivity reaction, take care of any signs of hives, blisters, and swelling of the face, lips, and tongue.
- Omeprazole and proton pump inhibitors family may cause a serious condition of diarrhea called CDAD
- If you are suffering from liver disease, you will need to decrease the dosage.
- Omeprazole was proven to cause carcinoid tumors with increased doses in rats, but this condition was not confirmed in humans.
- It may decrease the activity of Clopidogrel (a drug used to prevent blood clots).
Pregnancy:
While the woman is pregnant, it is always better to treat any conditions like indigestion without using drugs.
Indigestion can be managed by eating smaller meals and avoid spicy and fatty meals.
However, omeprazole can be taken safely in pregnancy.
Breastfeeding:
Omeprazole is known to be secreted in mother’s milk in small amounts, however, it is safe to be taken while breastfeeding.
Back to the relation between omeprazole and diazepam, let’s now talk about diazepam.
Diazepam is a member of the benzodiazepines family.
Benzodiazepines are drugs slowing down the messages between the brain and body, they are also minor tranquilizers.
Diazepam is used in treating anxiety, alcohol withdrawal symptoms, seizures, relaxation of muscle spasms, and to induce sedation before surgeries and dental procedures.
It is available in many dosage forms, tablets, oral solutions, rectal gels, injectable solutions, and intramuscular devices.
Side effects:
Happens in 1 – 10% of patients
- Ataxia (disorder causing symptoms similar to those when you are drunk, problems with balance, speech, and coordination)
- Euphoria (extensive excitement and happiness)
- Incoordination
- Somnolence (drowsiness and sleepiness)
- Rash
- Diarrhea
Common side effects
- Hypotension
- Fatigue
- Muscle weakness
- Respiratory depression
- Urinary retention
- Depression
- Incontinence (inability to control urination and defecation)
- Blurred vision
- Headache
- Changes in salivation
- Muscles responsible for speech are damaged
Warnings:
Opioids are a group of drugs widely known for pain-relieving, like morphine which is naturally produced from the poppy plant, and fentanyl which is synthesized in a laboratory.
A combination of diazepam and opioids is very dangerous, that may result in profound sedation, respiratory depression, coma, and death.
- FDA (Food and drug administration) addressed that benzodiazepines may cause serious addiction, abuse, and misuse.
These may result in overdosing and death.
- Diazepam should not be stopped suddenly, if so, irritating and maybe even life-threatening withdrawal symptoms.
Withdrawal symptoms:
- Tremors
- Anxiety
- Confusion
- Seizures
The withdrawal period may last from 3 to 4 weeks.
- Diazepam using may disable your ability to drive and to perform hazardous activities, you should not do any of them before understanding how your body will react to the drug.
Pregnancy:
Diazepam pregnancy category: D
It should only be used in life-threatening conditions when no other alternative is available.
Breastfeeding:
Diazepam is secreted in human milk and may cause harm to the baby.
It should not be used during lactation, alternative drugs or feeding options may be recommended.
Omeprazole and diazepam should be used together with extreme care, omeprazole may increase the concentration of diazepam in blood, which may cause an increase in the side effects caused by diazepam.
Using them together may need a dose adjustment or monitoring by your medical health provider.
A combination of drugs may be dangerous, need close monitoring, or mildly interacted, always tell your doctor about the drugs you are taking before taking another one.
Diazepam and Asthma
Diazepam and Asthma
Diazepam and asthma can be discussed from two points of view,
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one is the use of Diazepam in respiratory failure associated with Status Asthmaticus who need mechanical ventilation, the other point is that Diazepam and Asthma should be used with extreme caution as it may lead to apnea or cardiac arrest.
But first, before the discussion of the relationship between diazepam and asthma, we have to know about diazepam and asthma.
Asthma is a medical condition where the airways are narrow, swell, and produce extra mucus, which can cause breathing difficulties, triggering cough, and wheezing when breathing.
For some patients, Asthma may be a minor problem, and for others, it is a major problem, which interferes with the quality of life, and can lead to asthmatic attacks which can be life-threatening.
Asthma is a chronic medical condition that has no cure but can be controlled.
Symptoms:
Symptoms of Asthma differ from one patient to another.
They include,
- Short or shallow breathing
- Tightness or pain in the chest
- Wheezing with exhalation, which is especially common in children
- Shortness of breath, coughing, and wheezing can also interfere with your sleeping
- Cold and Flu worsens the coughing and wheezing attacks
Signs of worsened Asthma:
- More frequent signs and symptoms
- Breathing difficulties increase
- The use of a quick-relief inhaler is more frequent
Factors worsening Asthma:
- It may be worsened by exercise
- It may be increased by chemical fumes, gases, and dust
- It also may be increased by allergens like pollen grains, mold spores, cockroach wastes, and others
Asthma attacks can be deadly, always monitor your symptoms with your doctor to control the symptoms and avoid the worsening of them.
How about Diazepam?
Diazepam is one of the benzodiazepines family, that works by inducing the effect of some neurotransmitters in the brain which produces a calming effect.
It is used in treating anxiety disorders, alcohol withdrawal symptoms, muscle spasms and stiffness, and as adjunctive therapy in treating seizures.
It is also used in inducing sedation before having surgery or having an endoscopy.
According to our first point of view about Diazepam and Asthma, Diazepam is used in inducing sedation in the ICU (Intensive Care Unit) to put the patient on mechanical ventilation to treat the respiratory failure associated with Status Asthmaticus to help to restore ventilation and gas exchange.
Diazepam is given by a dosage of 0.2 – 0.3 mg/Kg every 1 – 3 hours.
Dosing and administration:
Diazepam is available in many dosage forms, tablets, oral solutions, rectal gels, injectable solutions, and intramuscular devices.
Oral solutions are only taken with the calibrated dropper coming with the drug, or with any special measuring device.
Don’t use the household spoons to avoid incorrect dosing.
If you are going to use the injectable methods, inspect the product for particulates, and for change in color before administration.
If you are using the intravenous injection, ensure there are facilities to assist respiration if needed.
Don’t use the small veins found in the hand or wrist, and inject it slowly for 1 minute for each 5 mg.
Storage:
When using the oral solution, throw the bottle after 90 days of opening.
Store it away from light.
Store it at a temperature between 68 and 77 degrees F.
Contraindications and precautions:
- If you experienced extreme hypersensitivity to diazepam or other benzodiazepines.
- When using the intravenous method, inject it very slowly, and don’t use small veins, to avoid venous thrombosis (a blood clot in the vein), phlebitis (inflammation of the vein), and irritation at the site of injection.
- Diazepam may cause depression and suicidal thoughts, if they already exist, they may be worsened by the use of diazepam, and so, you have to be monitored carefully if you are going to use diazepam or other anti-epileptic drugs.
- The doctor prescribes the smallest dose effective to reduce the risk of side effects and overdose.
- Activities requiring mental alertness should not be done when using drugs causing CNS (Central Nervous System) depression without understanding the effect of the drug on your mental alertness, activities like operating heavy machinery, and driving, as this may lead to bad falls, and dangerous accidents.
- Using diazepam with other CNS depressants such as opioids may cause severe side effects like profound sedation (unconsciousness where the patient can’t be awakened easily), respiratory depression, coma, and death.
The other point of view of Diazepam and Asthma, diazepam is not used in patients with severe respiratory problems and sleep apnea (Inability to breathe while sleeping for a short period), and used with extreme caution in patients with asthma, pneumonia, or neurologic damage as they may cause apnea (stop of breathing) or cardiac arrest.
So, diazepam is a life-saving drug when used when mechanical ventilation is needed to induce sedation in case of very severe status asthmaticus, and if it is going to be used with asthmatic patients, it should be used with extreme caution as it may cause severe side effects.
Diazepam and Tramadol
Diazepam and Tramadol
Mixing diazepam and tramadol may lead to serious side effects, but first, we should know about diazepam and tramadol individually.
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What is tramadol?
Tramadol is a synthetic opioid analgesic that has narcotic-like painkiller action, used in treating moderate to severe pain cases in adults.
Warnings:
- Seizures were reported in patients using tramadol.
They happen more frequently if you are taking higher doses more than recommended if you already suffer from a seizure disorder, or with those taking antidepressants or opioid medications.
- If you have ever suffered from suicidal thoughts, behaviors, or if you are susceptible to addiction or abuse, you shouldn’t use tramadol in these cases.
- You should not also use it if you have severe breathing problems, stomach or intestines blockage.
Before taking tramadol, you should not take it if:
- You are allergic to tramadol
- You have breathing problems or severe asthma
- You have obstructive stomach or bowel (like paralytic ileus)
- You are consuming alcohol, using sedatives, tranquilizers, and narcotic medications
- You are taking a drug from the group MAO inhibitors or took it in the past 14 days (like isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, or tranylcypromine)
Tramadol is not used in children younger than 12 years old.
It is not given to any patient younger than 18 years old who removed the tonsils or adenoids recently.
Don’t give tramadol to patients between 12 and 18 years old who have breathing problems.
Tramadol and pregnancy are contraindicated.
It may cause withdrawal side effects that may even lead to death.
It was noticed that babies nursing to mothers taking tramadol signs of severe drowsiness and shallow breathing, talk to your doctor about alternative drugs or feeding options.
To make sure tramadol is suitable for your condition, you have to tell your doctor if you have ever had:
- liver problems
- Kidney problems
- Breathing problems like sleep apnea (stop of breathing for a short period while sleeping)
- urination problems
- Gallbladder, pancreas, or thyroid problems
- Stomach problems
- Mental problems
- Suicidal thoughts or behaviors
Mixing alcohol with tramadol cause serious side effects leading to death.
Don’t perform hazardous activities or operate heavy machines while taking tramadol as drowsiness may cause serious falls or accidents.
What is diazepam?
Diazepam is a benzodiazepine drug, used in treating anxiety disorders, alcohol withdrawal symptoms, muscle spasms, and stiffness, and as adjunctive therapy in treating seizures.
It is also used to help you get in relaxation before any surgical or dental procedures.
Diazepam is available in many dosage forms, tablets, oral solutions, rectal gels, injectable solutions, and intramuscular devices.
Warnings:
- Diazepam may cause slow or shallow breathing, especially if used with an opioid medication, alcohol, or other drugs that may cause slow or shallow breathing
- Unfortunately, diazepam may cause addiction, overdose, which may lead to death, use this drug exactly as the doctor prescribed to avoid these side effects
- Diazepam may cause a severe allergic reaction, including swelling of face, lips, and tongue, don’t use it if you have ever experienced allergy with diazepam or other benzodiazepines
- Efficacy and safety have not been established in children younger than 6 months, so they should not be used at that age
Before taking diazepam, you have to tell your doctor if you have ever had:
- Myasthenia gravis (a medical condition causing weakened and tired muscles)
- Severe breathing problems
- Sleep apnea (stop of breathing for a short period while sleeping)
- Narrow-angle glaucoma
- Uncontrolled open-angle glaucoma
- Severe liver problems
Having seizures during pregnancy may harm both mother and baby, but as well diazepam should not be used started not stopped during pregnancy without the doctor’s advice.
It may cause dependence if was used during pregnancy, which may cause deadly withdrawal symptoms in newborn babies.
Diazepam should not be used in breastfeeding mothers, talk to your doctor about alternative drugs or feeding options.
To make sure tramadol is suitable for your condition, you have to tell your doctor if you have ever had:
- Breathing problems
- Glaucoma
- Kidney problems
- Liver problems
- Seizures, unless you are taking it for the same reason
- An addiction to drugs or alcohol
- Depression
- Suicidal thoughts or behaviors
Diazepam and tramadol are CNS (Central Nervous System) depressants.
The combination of diazepam and tramadol abolished seizures, but the CNS depression caused by this combination is very severe.
Serious side effects caused by diazepam and tramadol combination include respiratory distress, coma, and death.
If the combination between them is conditional, dose adjustment or more frequent monitoring must be done to safely use both medications.
But using alternatives is more appropriate.
Consuming alcohol with diazepam and tramadol, or using unprescribed medications can be very dangerous if done without the supervision of your doctor.
Don’t alter the doses, frequency, or duration of use without consultation from your doctor.
Diazepam and tramadol may cause dizziness, drowsiness, concentration difficulties, and judgment, speed, and motor coordination impairment.
So, don’t combine diazepam and tramadol, as it may be really dangerous.
