Why Diazepam More than Other Benzodiazepines is Unsuitable for Neonates?

Abstract

Nevertheless, their use may be associated with a number of adverse effects such as sedation, amnesia, cognitive impairment, ataxia, and dependence, contraindicating their long-term prescription. Due to the predominance of their advantages over documented side effects, progressive long-term use of benzodiazepines has been noted [27,28]. This still often occurs in current clinical practice, but not without consequences. As a matter of fact, adverse effects and their severity may vary from one benzodiazepine to another, according to specific pharmacological characteristics that differentiate them [27]. All benzodiazepines fundamentally have the same mechanism of action and may only vary in few points from each other such as receptor binding sites or subunits, the time onset of action, duration of action and adverse effects [29]. However, diazepam is among the first discovered benzodiazepines. It’s the most commonly used molecule of the kind, and seems to be the prototype of the pharmacological class, being involved in most clinical trials and experiments. Recent research findings have led to better understanding of the mechanism of action of benzodiazepines and significant milestones in the explanation of reported side effects are being noted. In the following paragraphs, we will give a simplistic but essential description of current knowledge about benzodiazepine-receptors interaction. Emphasis will be laid on diazepam specificities and the reasons for its contraindication in neonates illustrated. Abstract For physician has learnt about the contraindication of diazepam and perhaps benzodiazepines at large in the management of neonatal seizures. However, very few scientific publications give account about underlying pathophysiological and pharmacological insights of mechanism involved. As a result, a non or poorly understood categorization of neonatal anticonvulsants is sometimes observed in daily clinical pediatric practice in some settings, with each physician going by his own way of managing seizures in neonates. This with more or less success and consequent adverse effects. This review is intended to contribute to a better understanding of phenomena implicated in the unsuitable use of diazepam beyond other benzodiazepines in the management of neonatal seizures.