Priory GP Practice CIC
WHY IS MY DIAZEPAM PRESCRIPTION BEING CHANGED?
DIAZEPAM TABLET ADJUSTMENTS
Why is my Diazepam prescription being changed?
First: the science bit…
DIAZEPAM belongs to a class of medications called BENZODIAZEPINES.
These medications exert their effect on parts of the brain and central nervous system (the limbic system, thalamus, hypothalamus and cerebral cortex) and were originally introduced to treat the short term and acute symptoms of anxiety.
Diazepam is highly protein bound and fat soluble meaning that it becomes widely distributed throughout the body after it is taken: in the brain, muscles, fat and tissue.
When the liver processes Diazepam, the products (“metabolites”) are potent benzodiazepines in themselves and include nordiazepam, temazepam and oxazepam.
The half-life (the time for the liver to reduce the concentration by half) of Diazepam can range from 1-3 days, metabolites such as nordiazepam can be twice that again and can be prolonged depending on age, liver function and body mass.
This means that with regular, ongoing dosing, concentrations tend to accumulate and build to higher concentrations within the body than the actual consumed dose that day.
The Law, Clinical Governance and Patient Safety:
In the UK, Diazepam is a SCHEDULE 3 CONTROLLED DRUG (class C for criminal purpose/classification)
5mg tablets have a significant history in NI of redirection and possess significant “street value”. Organised criminals have even been dyeing and marking synthetic and counterfeit tablets to mimic 5mg tablets.
In the 10 years to 2022, there were 591 deaths in Northern Ireland where Diazepam was mentioned in the coroner report. This accounts for approx. 1 in 3 (34.5%) of all drug related deaths reported by the coroner.
5mg tablets will be changed to 2mg tablets. For those taking a total dose of 5mg daily, this will be changed to 2x 2mg tablets. Although this is a small decrease, it is clinically appropriate and ultimately negligible due to the prolonged effects and metabolite activity as explained above. If you are taking more than 5mg daily, you will be advised of your planned dose changeover individually.
The side effects of long-term use include dependence, sedation, memory impairment (including earlier onset dementia), depression, emotional blunting and even paradoxical effects such as insomnia, restlessness and aggression. This medication is no longer recommended for ongoing/long term use due to the above reasons. We are aware many patients may have been taking Diazepam regularly for many years, even decades. However, as evidence updates and changes, it is the responsibility of the GP practice to prescribe safely and with your overall health in mind. If you would like to begin reducing your Diazepam in a slow and gradual manner, please arrange an appointment.
This tablet change is not specific to Priory Surgery. Other practices in the North Down locality and across Northern Ireland have already enacted this change.