[Toby]

Paxum® is a psychotherapeutic agent of the most popular and widely used benzodiazepine derivative, diazepam. In many individuals, it produces satisfactory anxiolytic effect in doses that do not cause clinically important sedation or impairment of psychomotor function. Other than its use as an anxiolytic agent, diazepam is also used as an anticonvulsant and a sedative and skeletal muscle relaxant. In addition to these therapeutic actions the drug lacks significant side effects outside of Central Nervous System and has low toxicity factors that have contributed to its wide-spread clinical use.

Paxum (Diazepam) is presumed to act on the parts of the limbic system, thalamus and hypothalamus producing a state of calmness and has no demonstrable blocking action on the peripheral autonomic nervous system. Although the exact mechanisms of action are not fully understood, several processes are believed to be involved to exert their therapeutic effects. Part of the mechanisms of action of Paxum may be explained by its interaction with gamma aminobutyric acid (GABA) in the brain. The drug appears to facilitate synaptic GABA-ergic inhibitory mechanisms. It is also suggested that

(a) in some cells, can induce their own forms of inhibition directly by producing an effect much like that evoked by GABA,

(b) the drug can also inhibit the release of neurotransmitters and

(c) an effect that might involve potentiation of GABA actions at presynaptic sites.

Paxum is rapidly absorbed after oral ingestion and peak plasma levels are reached in about an hour in adults and in 15 to 30 minutes in children. The effect is more rapid after i.v. administration; i.m. administration, however, produces lower peak plasma level than oral or i.v. administrations. Like other benzodiazepine derivatives diazepam is highly lipid soluble, widely distributed in the body tissues and is highly bound to plasma protein.

Both the gastrointestinal and cardiovascular systems are well known to be affected by stress, anxiety and autonomic activity and Paxum is reported to offer significant beneficial effects in regard of both psychic and somatic clusters. I.V. Paxum is used to produce sedation in psychiatric emergencies and in the treatment of drug induced systemic reactions, status epilepticus, tetanus and as an anaesthetic agent.

Suicidal tendencies may be present in those patients with accompanying degree of depression and least amount of drug feasible should be administered. In elderly or debilitated patients and in children initial dosage should be small and increments made gradually. Patients on prolonged therapy should have periodic blood counts and liver function tests. Alcohol may alter the patients response to diazepam. Diazepam readily crosses the placenta and due care should be taken in using it in late pregnancy. I.V. administration should be done slowly to avoid the risk of apnoea. Withdrawal of the drug from patients receiving very high doses or for prolonged period of time should be gradual. The drug should not be mixed with i.v. fluids or solutions of other drugs. Safety and efficacy of parenteral diazepam has not been established in the neonates.