Diazepam Sodium valproate

Benzodiazepines are the evidence-based treatment of choice for uncomplicated alcohol withdrawal.17 Barbiturates are not recommended because of their low therapeutic index due to respiratory depression. Some of the anticonvulsants have also been used to treat uncomplicated withdrawal (particularly car-bamazepine and sodium valproate). Although anticonvulsants provide an alternative to benzodiazepines, they are not as well studied and are less commonly used. The most commonly employed benzodiazepines are chlordiazepoxide, diazepam, lorazepam, and oxazepam. They differ in three major ways (1) their pharmacokinetic properties, (2) the available routes for their administration, and (3) the rapidity of their onset of action due to the rate of gastrointestinal absorption and rate of crossing the blood-brain barrier. 

It is a benzodiazepine useful in the treatment of petitmal epilepsy, myoclonic seizures and infantile spasms. It is used in the treatment of petitmal epilepsy not responding to ethosuximide and sodium valproate. Clonazepam and diazepam act by increasing the effectiveness of the inhibitory neurotransmitter GABA, within the central nervous system. 

Electrophysiological studies show that benzodiazepines, barbiturates and sodium valproate facilitate GABAergic transmission in the animal brain. Further evidence comes from studies on the GABA-benzodiazepine receptor complex, the order of potency of a series of benzodiazepines to displace [3H] diazepam from its receptor site being clearly correlated with the antagonism of pentylenetetrazol seizures, but not with electroconvulsive seizures. However, most classes of anticonvulsants appear to facilitate... 

Koulu M, Lammintausta R, Kangas L, Dahlstrom S. The effect of methysergide, pimozide and sodium valproate on the diazepam-stimulated growth hormone secretion in man. J Clin Endocrinol Metab 1979 48 119-22. 

Sodium valproate increased the serum levels of free diazepam twofold in 6 healthy subjects. ... 

Chen L, Feng P, Wang J, Liu L, Zhou D. Intravenous sodium valproate in mainland China for the treatment of diazepam refractory convulsive status epilepticus. J Clin Neurosci 2009 16(4) 524-6. 

In cell culture preparations, diphenylhydantoin, carbamazepine and valproate have been shown to reduce membrane excitability at therapeutically relevant concentrations. This membrane-stabilizing effect is probably due to a block in the sodium channels. High concentrations of diazepam also have similar effects, and the membrane-stabilizing action correlates with the action of these anticonvulsants in inhibiting maximal electroshock seizures. Intracellular studies have shown that, in synaptosomes, most anticonvulsants inhibit calcium-dependent calmodulin protein kinase, an effect which would contribute to a reduction in neurotransmitter release. This action of anticonvulsants would appear to correlate with the potency of the drugs in inhibiting electroshock seizures. The result of all these disparate actions of anticonvulsants would be to diminish synaptic efficacy and thereby reduce seizure spread from an epileptic focus. 

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