Is Diazepam (Valium) effective as a muscle relaxant?

From the Guidelines

Diazepam (Valium) is not a recommended first-line treatment for muscle relaxation due to its limited efficacy and significant risks of dependence and adverse events. When considering the use of diazepam as a muscle relaxant, it is essential to weigh the potential benefits against the risks. According to a higher-quality Cochrane review of skeletal muscle relaxants 1, diazepam was found to be no more effective than placebo in one trial for acute low back pain, and its efficacy did not differ from other muscle relaxants like tizanidine and cyclobenzaprine in head-to-head trials. Some key points to consider when evaluating the use of diazepam for muscle relaxation include:

• Limited efficacy: Diazepam was found to be no more effective than placebo in some trials, and its efficacy did not differ from other muscle relaxants in head-to-head trials 1.
• Significant risks: Diazepam carries significant risks of dependence and withdrawal, and its use can lead to adverse events such as somnolence, fatigue, and lightheadedness 1.
• Alternative options: Non-benzodiazepine options like cyclobenzaprine or baclofen may be considered as first-line treatments due to their lower risk of dependence and similar efficacy 1.
• Short-term use: If diazepam is prescribed, it should be used for short-term periods only, typically 1-2 weeks, to minimize dependency risks.
• Dosing and administration: Typical dosing ranges from 2-10 mg taken 2-4 times daily, with treatment usually lasting 1-2 weeks.
• Common side effects: Drowsiness, dizziness, and impaired coordination are common side effects, making it unsafe to drive or operate machinery while taking diazepam.
• Contraindications: Diazepam should not be combined with alcohol, opioids, or other central nervous system depressants as this can cause dangerous respiratory depression.

From the FDA Drug Label

Diazepam is a useful adjunct for the relief of skeletal muscle spasm due to reflex spasm to local pathology (such as inflammation of the muscles or joints, or secondary to trauma), spasticity caused by upper motor neuron disorders (such as cerebral palsy and paraplegia), athetosis, and stiff-man syndrome Diazepam is a benzodiazepine that exerts anxiolytic, sedative, muscle-relaxant, anticonvulsant and amnestic effects.

Diazepam is effective as a muscle relaxant. It can be used to relieve skeletal muscle spasm due to various conditions, and it has muscle-relaxant effects. However, it is often used as an adjunct to other treatments, rather than as a sole therapy.

• The drug label explicitly states its use for muscle spasm relief
• The mechanism of action includes muscle-relaxant effects 2 2

From the Research

Effectiveness of Diazepam as a Muscle Relaxant

• The effectiveness of Diazepam as a muscle relaxant is compared to other muscle relaxants in several studies 3, 4, 5, 6.
• A study from 1988 found that cyclobenzaprine had a more rapid onset of action than diazepam in relieving the signs and symptoms of acute skeletal muscle spasm 3.
• Another study from 1981 compared the myotonolytic activity of a new muscle-relaxant, DS 103-282, with that of diazepam and found that DS 103-282 was significantly superior to diazepam in 5 out of the evaluated parameters 4.
• A review of centrally acting oral skeletal muscle relaxants in 1980 found that there are inadequate data to support the superiority of any one drug, including diazepam, and that unique clinical efficacy of any oral SMR in comparison to nonspecific sedation has not been established 5.
• A Cochrane review from 2012 found that benzodiazepines, including diazepam, do not appear to be beneficial in improving pain over 24 hours or one week in patients with rheumatoid arthritis, and that even short-term muscle relaxant use is associated with significant adverse events 6.

Comparison to Other Muscle Relaxants

• Diazepam is compared to other muscle relaxants, such as cyclobenzaprine, DS 103-282, and zopiclone, in terms of efficacy and safety 3, 4, 6.
• The studies suggest that other muscle relaxants may be more effective or have a faster onset of action than diazepam 3, 4.
• However, the evidence is limited, and more research is needed to determine the relative efficacy and safety of different muscle relaxants, including diazepam 5, 6.

Safety and Adverse Events

• The use of diazepam as a muscle relaxant is associated with significant adverse events, including drowsiness and dizziness 6.
• A study from 2017 found that benzodiazepine withdrawal and discontinuation syndrome can be distressing and protracted, with users experiencing anxiety, depression, and physical distress 7.
• The safety and adverse event profile of diazepam should be carefully considered when prescribing it as a muscle relaxant 6, 7.