Diazepam alternatives: What can I take instead of diazepam?

In this article:

• Diazepam alternatives
• Clonazepam
• Lorazepam
• Escitalopram
• Duloxetine
• Venlafaxine extended release
• Natural alternatives
• How to switch
• Choosing the right treatment

In this article

• Diazepam alternatives
• Clonazepam
• Lorazepam
• Escitalopram
• Duloxetine
• Venlafaxine extended release
• Natural alternatives
• How to switch
• Choosing the right treatment

Diazepam (brand name Valium) is a prescription medication used to treat several conditions, including anxiety disorders and acute alcohol withdrawal. This drug can also be used for anxiety relief prior to surgical procedures, skeletal muscle spasm, and as additional treatment for seizure disorders (epilepsy) alongside anticonvulsants. Diazepam belongs to a class of medications called benzodiazepines that work to slow down the central nervous system. Diazepam is available in several different dosage formulations, including oral tablets and liquid. Benzodiazepines (also referred to as benzos) can be habit-forming and have risks of abuse, misuse, and addiction. While diazepam can be effective, some people may seek an alternative treatment.

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What can I take instead of diazepam?

There are other options available to treat conditions such as anxiety disorders and acute alcohol withdrawal that do not improve with diazepam. Benzodiazepines are the preferred medication management for alcohol withdrawal as they are well-documented for their efficacy in reducing the signs and symptoms of withdrawal. On the other hand, anxiety disorders are typically first treated with the antidepressant drugs selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). When considering alternative treatment, factors like the specific condition being treated and the potential for abuse are important to keep in mind. Assessing abuse potential could include a history of drug misuse or abuse, alcohol dependence, or a history of placement in treatment programs.

Alternatives include other benzodiazepines, SSRIs, SNRIs, and the anti-anxiety drug buspirone. These treatment options may be more suitable for certain individuals due to their different uses, side effect profiles, and dosages.

​​RELATED: Diazepam side effects and how to avoid them

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Top 5 diazepam alternatives

The following are some of the most common alternatives to diazepam.

1. Clonazepam

Clonazepam (brand name Klonopin) is a generic benzodiazepine medication similar to diazepam. This alternative can be used for a variety of conditions, including anxiety disorders such as panic attacks, seizure disorders, and acute alcohol withdrawal. Benzodiazepines vary in how long they last in the body, and clonazepam has a long duration of action (about 18 to 50 hours), similar to diazepam (about 20 to 80 hours). For anxiety treatment, guidelines prefer antidepressants like SSRIs and SNRIs, however, clonazepam can be used short-term at the beginning of anxiety treatment. Clonazepam and other benzodiazepines should be avoided or carefully monitored when also using opioids, which can cause extreme sedation, respiratory depression, coma, and death. This may be a suitable alternative for those who prefer a longer-acting benzodiazepine.

2. Lorazepam

Lorazepam (brand name Ativan) is another generic benzodiazepine drug and is used for several different conditions, including anxiety and alcohol withdrawal syndrome. Being the preferred treatment for acute alcohol withdrawal, lorazepam and diazepam are two of the most frequently used benzodiazepines for this condition by healthcare providers. This alternative is a relatively fast-acting benzodiazepine as it usually starts working within 20 to 30 minutes and can relieve anxiety quickly. Lorazepam shares similar side effects to diazepam, such as fatigue, drowsiness, psychomotor impairment, and reduced memory. This alternative may be suitable for those who prefer a fast-acting benzodiazepine.

RELATED: Lorazepam vs. diazepam: Differences, similarities, and which is better for you

3. Escitalopram (Lexapro)

Escitalopram (brand name Lexapro) is an antidepressant drug that belongs to a group called selective serotonin reuptake inhibitors (SSRIs). This alternative is commonly used for generalized anxiety disorder (GAD) and depression. SSRIs are the mainstay of drug therapy for anxiety disorders as they are typically well-tolerated and effective. About 60-75% of people respond to SSRI antidepressant treatment compared to placebo  (40-60% response). On average, antidepressants like escitalopram take four weeks to become effective. The most common side effects are insomnia, headache, restlessness, sexual dysfunction, and gastrointestinal complaints like nausea and diarrhea. In older adults, escitalopram is one of the preferred antidepressants for anxiety disorders. This may be a suitable long-term alternative for treating anxiety disorders while avoiding the side effects and risks of benzodiazepines.

4. Duloxetine (Cymbalta)

Duloxetine (brand name Cymbalta) is a commonly used antidepressant that is a serotonin-norepinephrine reuptake inhibitor (SNRI). Along with generalized anxiety disorder and depression, this alternative can be used for chronic musculoskeletal pain, nerve pain associated with diabetes, and fibromyalgia. SNRIs are another standard drug treatment for anxiety disorders because of their tolerability and effectiveness. SNRIs have similar side effects to SSRIs. Common side effects of duloxetine include nausea, headache, fatigue, insomnia, dry mouth, and diarrhea. This alternative may be appropriate for long-term therapy for anxiety disorders.

5. Venlafaxine extended release (Effexor XR)

Venlafaxine extended release (brand name Effexor XR) is another antidepressant that belongs to the group of SNRIs. This alternative can be used for a variety of mental health conditions, such as generalized anxiety disorder, depression, panic disorder, and social anxiety disorder. Venlafaxine is another reasonable first treatment option for anxiety disorders, as it is effective. This alternative can increase blood pressure as a side effect, along with causing nausea, fatigue, dry mouth, sweating, sexual dysfunction, and constipation. Caution is advised in people with hypertension (high blood pressure). This alternative may be suitable for chronic treatment of anxiety disorders in those without cardiovascular issues, such as elevated blood pressure.

Natural alternatives to diazepam

Alternative remedies are important to the overall approach for anxiety treatment. Lifestyle interventions and psychotherapy are recommended to add to treatment plans. The American College of Clinical Pharmacy states that lifestyle interventions are part of this approach, which includes diet modifications, regular exercise, and avoidance of caffeine or other nonprescription drugs that can cause anxiety (such as marijuana or psychostimulants).

RELATED: 6 mental health conditions that exercise improves

Psychotherapy techniques include cognitive behavioral therapy (CBT), which aims to modify patterns of thinking and behavior to bring about a beneficial change in mood and way of living. Clinical studies have found that CBT is effective in the acute phase of generalized anxiety disorder.

How to switch to a diazepam alternative

1. Do not suddenly stop taking diazepam

Diazepam discontinuation is associated with withdrawal syndrome, typically in people using it for prolonged periods. The withdrawal intensity can depend on the dose, length of treatment, and duration of the taper period (process of gradually reducing the drug dose). Withdrawal symptoms can include irritability, panic attacks, sleep disturbance, increased tension and anxiety, hand tremor, sweating, difficulty in concentration, nausea, some weight loss, palpitations, headache, and muscular pain and stiffness. Abrupt discontinuation of diazepam may cause status epilepticus (a seizure requiring immediate medical attention).

2. Discuss all health conditions with a healthcare provider

When switching to an alternative medication, a healthcare professional should review the patient’s health conditions and history. This step helps to ensure prescribers can make appropriate medication recommendations.

3. Discuss all prescription and over-the-counter medications with a healthcare provider

Certain alternative medications for diazepam have serious drug interactions when combined with other prescription drugs and over-the-counter (OTC) medications or supplements. Pharmacists are great resources to ask about drug interactions and to get other helpful medical advice.

Choosing the right path for anxiety treatment

Managing anxiety is different person to person, as treatment approaches can include a variety of different options. There are a variety of pharmaceutical treatments, along with natural remedies, that are often used together. Antidepressants are typically prescribed first for long-term anxiety treatment, while benzodiazepines are only used for short-term treatment for certain people. The preferred antidepressants for anxiety include selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). Discuss with a healthcare provider options for developing an individualized treatment plan.