Convulsions, hallucinations, delirium, and paranoia also can occur. Benzodiazepines should be withdrawn cautiously and gradually, using a very gradual dosage-tapering schedule. Diazepam is usually chosen as the agent for controlled tapering in all cases of benzodiazepine withdrawal. Diazepam should not be administered parenterally to patients with acute ethanol intoxication, shock, or coma because the drug can worsen CNS depression. Diazepam should be used with extreme caution in patients with myasthenia gravis because the drug can exacerbate this condition.
Diazepam is occasionally beneficial for patients with major depression or psychosis.
It can, however, induce paradoxical effects in these patients and in those with suicidal ideation. The drug should be administered to such patients with careful monitoring. Diazepam is classified as pregnancy category D because it can cause harm to the fetus when administered to pregnant women. Positive evidence of human fetal risk exists based on investigational, marketing, or human studies, but the potential benefit to the mother may outweigh the potential risks to the fetus. Diazepam is distributed into breast milk and can cause sedation, feeding difficulties, and weight loss in the nursing infant.