Diazepam (Valium): Independent Evidence on Anxiety, Side Effects & Withdrawal

Table of contents

• Evidence summary
• What diazepam is
• How it works
• What it is prescribed for
• What works and what does not
• Benefits by claim
• Risks and all side effects
• All interactions
• Who should avoid diazepam
• Dosage and how to take it
• Follow the money: who makes it and who funded the evidence
• Related research
• Frequently asked questions
• Sources and funding notes

Evidence summary

This table sets out the main claims made about diazepam and how strong the human evidence behind each one is. The funding column shows who paid for each source.

Independent evidence and credibility scorecard

Independence tiers: 1 = government regulator or public body; 2 = academic work with no relevant industry funding; 3 = academic work with some industry ties, or resting on trials mostly run by manufacturers; 4 = manufacturer or seller. The credibility grade (A–D) combines method quality with independence.

What diazepam is

Class and names. Diazepam is a benzodiazepine, a class of medicines the FDA describes as slowing brain activity by binding to GABA receptors (FDA). The best-known brand is Valium. In the US it is also sold as a rectal gel (Diastat) and a nasal spray (Valtoco) for seizure clusters (FDA list of benzodiazepines). In the UK it comes as 2 mg, 5 mg and 10 mg tablets and as a rectal tube, and it is usually dispensed as a generic (NHS).

History. Leo Sternbach, a chemist at Hoffmann-La Roche, identified the first benzodiazepine, chlordiazepoxide (Librium), in 1955. Roche launched Librium by 1960 and followed it with Valium in 1963. In the mid-to-late 1970s, benzodiazepines "topped all 'most frequently prescribed' lists" (Wick, Consult Pharm 2013). The FDA first approved Valium tablets (NDA 013263) on 15 November 1963 (Drugs@FDA via openFDA).

Originator. F. Hoffmann-La Roche was founded in Basel, Switzerland, in 1896 (Roche).

Generics and legal status. Diazepam has long been off-patent. openFDA lists 24 generic (ANDA) application records for diazepam (openFDA query, September 2026).

• US: a Schedule IV controlled substance (FDA label).
• UK: a Class C drug in Schedule 4 Part 1 of the Misuse of Drugs Regulations (Home Office controlled drugs list).
• Both countries: prescription only (NHS).

How it works

The US label describes diazepam as having "anxiolytic, sedative, muscle-relaxant, anticonvulsant and amnestic effects". It says most of these effects are thought to come from boosting the action of GABA, the brain's main inhibitory (calming) chemical messenger (FDA label). One mechanism produces all five effects, so a person taking it for muscle spasm also gets its sedation and memory effects.

What the body does with it: why "long-acting" matters

These figures are all from the US label (FDA label).

• Absorption: more than 90% of an oral dose is absorbed. Peak blood levels come on average 1–1.5 hours after a dose. A moderately fatty meal slows absorption to about 2.5 hours.
• Breakdown: the liver enzymes CYP3A4 and CYP2C19 convert diazepam into active metabolites: N-desmethyldiazepam (nordazepam), temazepam and oxazepam.
• How long it lasts: diazepam's terminal half-life is up to 48 hours. Its main active metabolite has a half-life of up to 100 hours, so diazepam builds up with repeated doses.
• Age: the half-life rises by about 1 hour for each year of age, starting from about 20 hours at age 20.
• Liver disease: in cirrhosis the half-life rises on average 2- to 5-fold, and individual half-lives of more than 500 hours have been reported.

This long action cuts both ways:

• Next-day effects: the UK SmPC warns that impaired function and sedation may occur "the following morning and for several days after" (UK SmPC). Older people and people with liver disease are at particular risk of build-up.
• Tapering: blood levels fall slowly, and that is why long-acting benzodiazepines are useful when reducing a dose. NICE's dependence guideline says that if a person is withdrawing from a benzodiazepine with a short half-life, prescribers should "consider switching to a benzodiazepine with a longer half-life" (NICE NG215, 1.5.13). NICE does not name a particular drug. Diazepam's long half-life fits that description.
• Switching the other way: the UK SmPC warns against switching from a long-acting to a short-acting benzodiazepine, because withdrawal symptoms may develop (UK SmPC).

What it is prescribed for

Licensed uses

Sources: UK SmPC, NHS, FDA Valium label.

Where guidelines place it

• Generalised anxiety disorder: NICE says "Do not offer a benzodiazepine for the treatment of GAD in primary or secondary care except as a short-term measure during crises" (1.2.26). NICE's first-line options are psychological therapy and SSRIs such as sertraline (NICE CG113). Not recommended for ongoing use.
• Panic disorder: NICE says benzodiazepines "are associated with a less good outcome in the long term and should not be prescribed" (1.3.20). Antidepressants "should be the only pharmacological intervention used in the longer-term management of panic disorder" (NICE CG113). Not recommended.
• WHO (GAD and panic disorder): "Benzodiazepines are not recommended". Emergency use for acute, severe anxiety may be considered "only as a short-term (3–7 days maximum) measure". This is a strong recommendation based on low-certainty evidence. WHO's remarks note that diazepam was one of the benzodiazepines studied for panic disorder (WHO mhGAP 2023, ANX6).
• Alcohol withdrawal: NICE says "Consider offering a benzodiazepine or carbamazepine", with clomethiazole as an inpatient-only alternative (NICE CG100, 1.1.3.1). A recognised first-line option.
• Convulsive status epilepticus in the community: NICE says to give "a benzodiazepine (buccal midazolam or rectal diazepam) immediately". Buccal midazolam is the first choice, and rectal diazepam is the alternative if agreed or if midazolam is unavailable (NICE NG217). Second choice to midazolam in the community.
• Sciatica: NICE says "Do not offer … benzodiazepines for managing sciatica as there is no overall evidence of benefit and there is evidence of harm" (NICE NG59, 1.2.16). Not recommended.
• Dependence-forming medicines generally: before starting a benzodiazepine, NICE says to make sure all suitable options, "including non-pharmacological approaches and watchful waiting", have been discussed and offered (NICE NG215, 1.2.1). Since January 2026 the MHRA has asked prescribers to agree a plan for reducing or ending treatment before it starts (MHRA 2026).

What works and what does not

Benefits by claim

Anxiety and panic: fast, real, short-lived and costly to tolerate

The largest independent Cochrane review of benzodiazepines for panic disorder included 24 double-blind trials with 4,233 participants (Breilmann et al., Cochrane 2019).

• Response: RR 1.65 (95% CI 1.39–1.96), a number needed to treat of 4.
• Remission: RR 1.61.
• Harms: more people dropped out because of adverse effects (RR 1.58), and more had at least one adverse effect (RR 1.18).

The authors rated all of this as low-quality evidence and gave several reasons:

• "possible unmasking of allocated treatments". Sedation makes it easy for patients and assessors to guess who is on the drug.
• high dropout rates
• "probable publication bias"
• short trials that did not look at long-term effectiveness, dependence or withdrawal

Two further points matter for diazepam. Only 2 of the 24 trials used diazepam, and in both it ran alongside alprazolam, which was the drug most often tested. And the reviewers judged all but one trial to be at unclear risk of bias on funding, because they "were sponsored or supported by pharmaceutical companies marketing benzodiazepines (Hoffmann-La Roche; Upjohn, Bristol-Myers Squibb), or there was no information on study sponsoring". A subgroup analysis found no substantial differences between individual benzodiazepines.

For generalised anxiety disorder, an unfunded network meta-analysis of 89 trials with 25,441 patients found that benzodiazepines were "effective but also poorly tolerated" compared with placebo. Duloxetine, pregabalin, venlafaxine and escitalopram worked with "relatively good acceptability" (Slee et al., Lancet 2019). When benzodiazepines were compared directly with antidepressants for panic disorder, Cochrane found "no difference" in response (RR 0.99). That result rested on only 2 studies with 215 participants and low-quality evidence (Bighelli et al., Cochrane 2016).

A dissenting view. A 2013 meta-analysis from the University of Bologna argued that the shift from benzodiazepines to antidepressants "has occurred without supporting evidence". In 10 trials in panic disorder, it found benzodiazepines slightly more effective than tricyclic antidepressants at reducing panic attacks (RR 1.13) and better tolerated (Offidani et al., Psychother Psychosom 2013). Most of its comparisons were with older tricyclics rather than SSRIs, and its funding is not stated in the PubMed record. We include it because it is a serious argument, but it has not changed NICE or WHO guidance.

Long-term use. A 2019 meta-analysis found only 8 studies (N = 1,228) that lasted 13 weeks or more. HAM-A score changes did not differ significantly between benzodiazepines and placebo. The authors also found no significant differences from antidepressants in people who had responded to the first 8 weeks of treatment (Shinfuku et al. 2019).

What this means in practice. Diazepam can take the edge off acute, severe anxiety within hours. That is a real benefit in a crisis. There is little good evidence that the benefit lasts, while the risks (dependence, falls, memory effects, interactions) build up with time. For this reason WHO reached a strong recommendation against routine use despite low-certainty evidence, concluding "that the risks of the intervention outweighed the benefits" (WHO mhGAP 2023).

Alcohol withdrawal

A Cochrane review of 64 trials (4,309 participants) found that benzodiazepines protected against withdrawal seizures compared with placebo: RR 0.16 (0.04–0.69), from 3 studies with 324 people. The authors concluded that benzodiazepines showed "a protective benefit against alcohol withdrawal symptoms, in particular seizures". They also said "no definite conclusions" on overall effectiveness and safety were possible because the trials differed so much. Among the benzodiazepines, chlordiazepoxide "performed better", but this did not reach statistical significance (Amato et al., Cochrane 2010). NICE lists a benzodiazepine or carbamazepine as options (NICE CG100). Alcohol withdrawal can be dangerous, and its treatment should always be medically supervised.

Seizures and status epilepticus

In a Cochrane review of 18 trials (2,755 participants), the following all reduced the risk that seizures would not stop (Prasad et al., Cochrane 2014):

• IV diazepam vs placebo: RR 0.73. It also reduced the need for ventilatory support (RR 0.39).
• Diazepam gel vs placebo: RR 0.43.
• IV lorazepam vs IV diazepam: lorazepam was better (RR 0.64).

This fits NICE's approach: IV lorazepam in hospital, and buccal midazolam or rectal diazepam in the community (NICE NG217). As an ongoing oral epilepsy treatment, the US label says diazepam "has not proved useful as the sole therapy" (FDA label).

Muscle spasm and back pain

Diazepam is licensed for muscle spasm, but the best independent trial in a common real-world use was negative. In 114 emergency-department patients with acute low back pain, adding diazepam 5 mg to naproxen gave the same improvement in disability score as adding placebo (11 points in each group). At one week, 32% of the diazepam group reported moderate or severe pain compared with 22% of the placebo group, and adverse events were 21% vs 15% (Friedman et al. 2017). NICE advises against benzodiazepines for sciatica (NICE NG59). We did not review evidence for spasticity in neurological conditions, where diazepam is still licensed.

How quickly it works

Unlike antidepressants, diazepam acts within hours. Peak blood levels come on average 1–1.5 hours after an oral dose, and later after a meal (FDA label). This speed is the reason it is used in crises. It is also part of why it is easy to keep reaching for.

Risks and all side effects

FDA boxed warning

The Valium label's boxed warning covers three risks (FDA Valium label):

1. Use with opioids. The combination "may result in profound sedation, respiratory depression, coma, and death". Prescribers should keep co-prescribing for patients whose alternatives are inadequate, and keep doses and durations to a minimum.
2. Abuse, misuse and addiction. These "can lead to overdose or death". Abuse often involves other medicines, alcohol or illicit drugs.
3. Dependence and withdrawal. Continued use "may lead to clinically significant physical dependence". The risk grows with longer treatment and higher doses. Stopping suddenly or cutting the dose quickly "may precipitate acute withdrawal reactions, which can be life-threatening", so a gradual taper should be used.

The FDA added the opioid warning on 31 August 2016, after a review found that growing combined use had caused "serious side effects, including slowed or difficult breathing and deaths" (FDA 2016, archived). In September 2020 it required the dependence and addiction warning across the whole benzodiazepine class. Its review found that physical dependence "can occur when benzodiazepines are taken steadily for several days to weeks, even as prescribed", and that some patients had withdrawal symptoms "lasting many months". The FDA's data summary also reported (FDA 2020):

• 92 million US benzodiazepine prescriptions dispensed in 2019
• about 50% of patients given oral benzodiazepines in 2018 received them for two months or longer
• benzodiazepine-involved overdose deaths rose from 1,298 in 2010 to 11,537 in 2017, and 55% of these deaths from 2013 to 2017 also involved prescription opioids

UK regulator warnings

• MHRA, 18 March 2020: benzodiazepines and opioids should be prescribed together "only … if there is no alternative", at the lowest doses for the shortest time, with close monitoring. With methadone, monitoring should last at least 2 weeks after starting or changing treatment. The update followed a coroner's report of a death involving clonazepam and methadone (MHRA).
• MHRA, 8 January 2026: after independent advice from the Commission on Human Medicines, the MHRA concluded that the existing warnings "did not sufficiently communicate the extent of the known risks of addiction, dependence, withdrawal and tolerance". It is strengthening product information and packaging. It says these effects "can also occur with short-term use at recommended therapeutic doses", and that tapering from a high dose "may take weeks or months" (MHRA 2026).

Common side effects

The NHS lists these common side effects (NHS):

• feeling less alert
• increased anxiety and depression
• drowsiness
• tiredness
• low blood pressure

The US label says the side effects "most commonly reported were drowsiness, fatigue, muscle weakness, and ataxia" (unsteadiness) (FDA label). The UK SmPC adds numbed emotions, confusion, headache, dizziness and double vision. These occur mainly at the start of treatment and usually fade (UK SmPC).

Other reported effects:

• Nervous system and senses: slurred speech, tremor, vertigo, blurred vision
• Digestive: constipation, nausea
• Urinary and sexual: incontinence or urinary retention, changes in libido
• Other: dry mouth or excess saliva, skin reactions

(FDA label)

Serious risks

Driving and the law

Diazepam is one of 8 "medicinal" drugs with a legal blood limit for drivers in England and Wales. The limit is 550 µg/L of blood, and the rules came into force on 2 March 2015. The government says it "is unable to provide any guidance on what amounts of dosage would equate to being over the specified limits" (Department for Transport).

You can drive above the limit only if all three of these apply (GOV.UK):

• the medicine was prescribed for you
• you took it as advised
• it is not making you unfit to drive

It is illegal anywhere in the UK to drive while impaired by any drug. A conviction brings at least a 1-year ban, an unlimited fine, up to 6 months in prison and a criminal record (GOV.UK). The UK SmPC warns that effects on alertness can last into the next day, even after a single dose (UK SmPC).

How widely it is used

In England in 2017–18, 1.4 million adults (3%) had a benzodiazepine prescription dispensed. Prescription numbers "continue to fall". About 82% of people starting a benzodiazepine received prescriptions for 3 months or less, and about 5% received them continuously for at least 12 months. Some 120,000 people received benzodiazepines continuously from April 2015 to March 2018. Public Health England noted that guidelines say benzodiazepines "should not usually be prescribed for longer than 2 to 4 weeks" (PHE prescribed medicines review, 2019).

All interactions

Diazepam interacts in two ways. First, its sedative effects add to those of other drugs that slow the brain and breathing. Second, drugs that block or speed up the liver enzymes CYP3A4 and CYP2C19 raise or lower its levels. This table combines the UK SmPC (SmPC 4.5), the US label (FDA label) and the NHS page (NHS). It is not a substitute for a pharmacist's check.

Who should avoid diazepam

Contraindications (UK SmPC). Diazepam should not be used by people with (UK SmPC 4.3):

• allergy to diazepam or other benzodiazepines
• phobic or obsessional states, or chronic psychosis
• acute pulmonary insufficiency, respiratory depression, or severe respiratory insufficiency
• myasthenia gravis
• sleep apnoea
• severe liver insufficiency
• acute porphyria
• depression, or anxiety with depression, if diazepam would be the only treatment

It should also not be used by people planning a pregnancy or who are pregnant, unless there are compelling reasons.

Contraindications (US label). The US label adds babies under 6 months and acute narrow-angle glaucoma (FDA label).

Use with extra caution. The NHS says diazepam may not be suitable if you have (NHS):

• long-term kidney, liver, heart or breathing problems
• certain mental health conditions
• a history of alcohol or recreational drug misuse

The SmPC advises "extreme caution" in people with personality disorders (UK SmPC).

Pregnancy. The NHS says not to take diazepam during pregnancy unless a doctor advises it (NHS).

• The UK SmPC says it should not be used in the first and third trimesters. It notes a possible small increase in oral cleft risk with first-trimester benzodiazepine use, although "a causal relationship has not been established" (UK SmPC 4.6).
• The US label says recent adjusted observational studies "do not report a clear association" with major birth defects. It warns of sedation and withdrawal in newborns after use late in pregnancy (FDA label).
• Do not stop suddenly if you find you are pregnant. Speak to your prescriber promptly.

Breastfeeding. The sources differ in tone:

• The US label says breastfeeding "is not recommended".
• The UK SmPC says benzodiazepines "should not be given to breast-feeding mothers".
• The NHS says to check with a pharmacist or doctor. Short, low-dose use may be advised if the benefits outweigh the risks.

Sedation and poor feeding have been reported in exposed infants (FDA label; UK SmPC; NHS).

Older adults. The 2023 AGS Beers Criteria list diazepam among the benzodiazepines to avoid. They note that "older adults have increased sensitivity to benzodiazepines and decreased metabolism of long-acting agents". They also say "shorter-acting ones are not safer than long-acting ones" for falls (AGS Beers 2023). If an older person is prescribed diazepam:

• The US label advises starting at 2–2.5 mg once or twice a day, and notes "extensive accumulation" with long-term use (FDA label).
• The UK SmPC halves the usual doses (UK SmPC).

Liver and kidney disease. In liver impairment, diazepam "may precipitate coma", so the dose should be reduced or another drug considered. Severe liver insufficiency is a contraindication. In severe kidney impairment the dose should be reduced (UK SmPC).

Children. Children have their own licensed uses and doses under specialist direction. This article covers adults.

Dosage and how to take it

Your prescriber sets the dose and how long you take it. The ranges below are the official licensed adult ranges, reproduced for information only. They are not a guide to self-dosing.

Sources: UK SmPC 4.2; FDA Valium label.

How long. The NHS says up to 4 weeks (NHS). The UK SmPC says the patient must be re-evaluated after no more than 4 weeks. "In general, treatment must not last any longer than 8-12 weeks, including the tapering off process", with longer use only after a fresh evaluation. Epilepsy is an exception, where the drug is used "for as long as the prescriber considers it necessary" (UK SmPC). Before starting, the prescriber should agree a plan for ending treatment with you (MHRA 2026).

How to take it. The NHS gives this advice (NHS):

• Swallow tablets whole with water, with or without food. Doses can be spread through the day.
• If you miss a dose, skip it. Never double up.
• Rectal tubes are single-use. If seizures do not stop, a second dose can usually be given after 10 minutes, as directed.

How it is stopped. After regular use, diazepam should be reduced gradually and only with your prescriber (NHS). The official guidance says:

• "No standard benzodiazepine tapering schedule is suitable for all patients". The plan should be patient-specific, with monitoring and support (FDA 2020).
• If withdrawal reactions develop, pause the taper or go back to the previous dose, then reduce more slowly (FDA label).
• Reduce in slow steps "proportionate to the existing dose, so that decrements become smaller as the dose is lowered". Tapering from a high dose "may take in excess of weeks or months" (UK SmPC).
• Do not stop abruptly except in exceptional medical circumstances. For people on a short half-life benzodiazepine, consider switching to a longer-acting one. Keep treating the underlying condition during withdrawal (NICE NG215).

Follow the money: who makes it and who funded the evidence

Who makes and sells it

• Originator: F. Hoffmann-La Roche, founded in Basel, Switzerland, in 1896 (Roche). Roche's chemist Leo Sternbach discovered the benzodiazepine class, and Roche launched Valium in 1963 (Wick 2013).
• US licence today: openFDA lists the original Valium tablet application (NDA 013263, approved 15 November 1963) under Waylis Therapeutics. The August 2024 label says "Distributed by: Waylis Therapeutics LLC, Rahway, NJ". Roche's separate Valium injection application (NDA 016087, 1966) is listed as discontinued (Drugs@FDA via openFDA; DailyMed). DailyMed also still lists a separate Valium tablet label under Roche Laboratories Inc. (published 10 December 2025) (DailyMed Valium listings). We could not verify when or on what terms the US rights moved from Roche, or who owns Waylis.
• Canada: Roche still holds the Valium product monograph, with Hoffmann-La Roche Ltd, Mississauga, as sponsor (revised June 2021) (Roche Canada monograph).
• UK: diazepam is supplied mainly as generics. For example, the SmPC used in this article belongs to Waymade plc, trading as Sovereign Medical, of Basildon, England (UK SmPC).
• Generics: openFDA lists 24 generic (ANDA) application records for diazepam in the US (openFDA). With so many generic makers, no single company has a large commercial stake in diazepam tablets today.
• Revenue: we found no current published sales figure for Valium or generic diazepam.

Who funded the evidence

Manufacturer-generated evidence. Valium was approved in 1963. We could not find the original registration trials in public sources.

• The modern US label says that effectiveness beyond 4 months "has not been assessed by systematic clinical studies" (FDA label).
• In the Cochrane panic review, the reviewers judged all but one trial to be at unclear risk of bias on funding. The reason was that the trials were sponsored or supported by benzodiazepine makers, namely Hoffmann-La Roche, Upjohn (maker of alprazolam) and Bristol-Myers Squibb, or did not say who sponsored them (Breilmann 2019).
• The reviewers planned sensitivity analyses excluding company-funded trials. They explained that "funding strongly affects outcomes of research studies".

Independent evidence. The reviews that carry the most weight in this article were paid for by public bodies or had no funding:

• Cochrane panic review (Breilmann 2019): no internal or external funding. One author declared lecture and consultancy fees from several drug companies, none of them diazepam makers (Breilmann 2019).
• Cochrane alcohol-withdrawal review (Amato 2010): funded by AIFA, Italy's public medicines regulator, with no conflicts (Amato 2010, sources of support).
• Cochrane status-epilepticus review (Prasad 2014): academic institutions in India and Bahrain, with no conflicts known (Prasad 2014).
• Slee 2019 GAD network meta-analysis: "No funding was received" (Slee 2019).
• Friedman 2017 back-pain trial: an academic clinical-research grant, with no conflicts (Friedman 2017).

These reviews still depend on trials that were largely run by manufacturers.

Who pays the regulators. The regulators whose warnings we rely on are publicly accountable but not free of industry money. About 77% of the FDA's human-drug review costs in FY2025 came from industry user fees (FDA PDUFA financial report). NICE receives about 70% of its funding from government, and some fees from companies for technology appraisals (NICE accounts). For an old generic like diazepam, the incentives mostly point towards caution rather than promotion. No company has a strong commercial reason to defend it.

Integrity events. We found no documented fraud, settlement or data-suppression case involving diazepam in the sources reviewed. The main historical concern is the scale of use. In the 1970s, benzodiazepines topped "most frequently prescribed" lists, and "by the 1980s … the specter of abuse and dependence" had emerged (Wick 2013). The FDA's 2020 and MHRA's 2026 decisions to strengthen warnings, decades after launch, show how slowly the understanding of dependence caught up with prescribing.

Related research

• Stress, anxiety and depression prevention guide: the non-drug foundations, including CBT skills, exercise, sleep and support
• Stress, anxiety and depression supplements: the evidence
• Sleep prevention guide and sleep supplements evidence: diazepam's sleep benefit fades within weeks
• Melatonin
• L-theanine
• Magnesium
• Ashwagandha: evidence and safety: sedating herbs can add to diazepam's effects
• St John's wort: can lower diazepam levels through enzyme induction
• Sibling medicine reviews: lorazepam, alprazolam, clonazepam, temazepam, pregabalin, buspirone, sertraline, escitalopram, zopiclone, zolpidem

Frequently asked questions

Sources and funding notes

• NHS. Diazepam (page last reviewed 2 June 2026): UK public health service; no commercial funding.
• Diazepam 2 mg Tablets, Summary of Product Characteristics (emc; revised 11 November 2025): text from the licence holder (Waymade plc t/a Sovereign Medical, UK), approved by the regulator.
• Valium (diazepam) tablets, US prescribing information and Medication Guide (DailyMed; Waylis Therapeutics LLC): manufacturer-maintained label approved by the FDA (label text revised August 2024; DailyMed version published 14 August 2026).
• DailyMed. Valium label listings (Waylis Therapeutics and Roche Laboratories): US National Library of Medicine database.
• Drugs@FDA via openFDA: Valium applications NDA 013263 and NDA 016087: US government data.
• openFDA query: diazepam ANDA (generic) records: US government data, counted September 2026.
• FDA Drug Safety Communication (23 September 2020): boxed warning updated for the benzodiazepine class: US regulator.
• FDA Drug Safety Communication (31 August 2016): opioids with benzodiazepines (archived copy): US regulator; the live page is no longer available.
• FDA PDUFA financial report FY2025: US regulator's own accounts.
• MHRA Drug Safety Update (18 March 2020): benzodiazepines and opioids: UK regulator.
• MHRA Drug Safety Update (8 January 2026): improving information supplied with gabapentinoids, benzodiazepines and Z-drugs: UK regulator, with independent Commission on Human Medicines advice.
• NICE CG113: Generalised anxiety disorder and panic disorder in adults (last updated June 2020): publicly funded UK guideline.
• NICE CG100: Alcohol-use disorders, physical complications: publicly funded UK guideline.
• NICE NG215: Medicines associated with dependence or withdrawal symptoms (2022): publicly funded UK guideline.
• NICE NG217: Epilepsies, chapter 7 (status epilepticus and prolonged seizures): publicly funded UK guideline.
• NICE NG59: Low back pain and sciatica: publicly funded UK guideline.
• NICE annual report and accounts 2024/25: public body's accounts.
• WHO. mhGAP guideline for mental, neurological and substance use disorders, 3rd edition (2023), recommendation ANX6: WHO-funded international guideline.
• Breilmann J et al. Benzodiazepines versus placebo for panic disorder in adults. Cochrane Database Syst Rev 2019;CD010677: Germany/Italy; no funding. One author declared fees from Eli Lilly, Janssen, MSD, Pfizer and others. The included trials were mostly sponsored by benzodiazepine makers or did not disclose their funder.
• Bighelli I et al. Antidepressants and benzodiazepines for panic disorder in adults. Cochrane 2016;CD011567: Italy; no funding stated. One author was an expert witness for Accord Healthcare, and another declared fees from several companies.
• Amato L et al. Benzodiazepines for alcohol withdrawal. Cochrane 2010;CD005063: Italy; funded by AIFA (public regulator); no conflicts.
• Minozzi S et al. Anticonvulsants for alcohol withdrawal. Cochrane 2010;CD005064: Italy; no conflicts.
• Prasad M et al. Anticonvulsant therapy for status epilepticus. Cochrane 2014;CD003723: India/Bahrain; academic support; no conflicts known.
• Slee A et al. Pharmacological treatments for generalised anxiety disorder: network meta-analysis. Lancet 2019: UK; "No funding was received".
• Shinfuku M et al. Effectiveness and safety of long-term benzodiazepine use in anxiety disorders. Int Clin Psychopharmacol 2019: Japan; funding not stated in the PubMed record.
• Offidani E et al. Benzodiazepines versus antidepressants in anxiety disorders. Psychother Psychosom 2013: Italy; funding and conflicts not stated in the PubMed record.
• Friedman BW et al. Diazepam is no better than placebo when added to naproxen for acute low back pain. Ann Emerg Med 2017: USA; academic translational-research grant (UL1TR001073); no conflicts.
• American Geriatrics Society 2023 Beers Criteria Update Expert Panel. J Am Geriatr Soc 2023: USA; professional society. Some panel members consult for LexiComp, UnitedHealthcare and others, and one spouse holds AbbVie and Abbott shares.
• Department for Transport. Changes to drug driving law (table of limits): UK government.
• GOV.UK. Drugs and driving: the law: UK government.
• Home Office. List of most commonly encountered controlled drugs (updated 1 April 2025): UK government.
• Public Health England. Prescribed medicines review: summary (2019): UK government.
• Cochrane. Commercial sponsorship policy: Cochrane's own policy.
• Wick JY. The history of benzodiazepines. Consult Pharm 2013: USA (University of Connecticut); funding not stated.
• Roche. About Roche: company source; used only for founding date and location.
• Hoffmann-La Roche Ltd (Canada). Valium product monograph, consumer information (revised June 2021): company document; used only to confirm Roche is the current Canadian sponsor.

Last reviewed: 26 September 2026. Educational information from Pure City Research, not medical advice. Medicine decisions belong with a qualified prescriber.