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Valium: "Not to be used by persons with Parkinson's disease or multiple sclerosis."?? Dear Dr. Cynthia: MS patient's use of Valium troubles cousin Tuesday, March 30, 2004 Dear Dr. Cynthia: I have a 50-year-old cousin who has multiple sclerosis and uses a wheelchair. He has been taking Valium for at least five years now for the muscle spasms in his legs. He insists it helps, but I do not notice any improvement. I have read that Valium is intended for short-term use only and that the body can develop a tolerance to it. I also know that he is being prescribed Valium by up to four different doctors. I worry that he may be becoming addicted. Also, I read about Valium at a pharmacy Web site, and it warned "Not to be used by persons with Parkinson's disease or multiple sclerosis." Your insight into this matter would be greatly appreciated. Anonymous Dear Anonymous: Much as we would like to believe to the contrary (mostly because it would make life so much simpler), few things in this life are black or white. Most fall into that grey zone -- somewhere between 100 percent good and 100 percent bad -- where we have to rely on our abilities to think clearly, prioritize, and use reasonable judgment to make good decisions. Valium usage falls into this grey zone. Valium by itself is neither good nor bad. Its generic name is diazepam and it is one of a group of drugs known as benzodiazepines, which exert their effects directly on the brain, causing sedation, lessening of anxiety and muscle relaxation. It is used to produce anesthesia and amnesia for surgical procedures, and to treat many medical conditions, including anxiety disorders, acute alcohol withdrawal, seizures, and skeletal muscle spasms. It is, therefore, one of the drugs used to treat the muscle spasticity experienced by multiple sclerosis patients such as your cousin. Your concerns about Valium are not, however, unwarranted. Valium, like all benzodiazepines, can cause significant side effects such as drowsiness, fatigue, unsteadiness and mental confusion. The likelihood of experiencing a side effect is increased by the concomitant use of certain medications, alcohol, and even grapefruit juice. In addition, benzodiazepines should be used with caution, if at all, in persons with chronic diseases such as Parkinson's (since they affect motor tone and control) and Alzheimer's (since they have great potential to increase mental confusion and delirium). In fact, because of the way Valium is metabolized and eliminated from the body (and since it tends to hang around the body for a long time), it should probably be avoided entirely in the elderly. In addition to all of this, Valium, and benzodiazepines in general, produce tolerance (needing more of a drug to get a certain effect) and physical dependence (feeling down and other symptoms of withdrawal when the drug is not available). Both tolerance and physical dependence are normal physiological consequences of taking benzodiazepines over a long time. The real question, it seems to me, is whether or not your cousin is deriving more benefit from the Valium than harm and whether or not his Valium usage is being monitored appropriately. The relief of muscle spasticity from multiple sclerosis is a legitimate indication for using Valium. He may be experiencing symptom relief that is not immediately apparent to you. On the other hand, Valium is in a class of drugs with an undeniable potential for misuse and abuse. Getting prescriptions from four different doctors greatly enhances that potential. I would strongly recommend that you have a heart-to-heart talk with your cousin. Tell him that you are concerned and want to make sure he is getting the best treatment possible. One physician, either his primary care physician or a neurologist, should be monitoring his medical condition and prescribing his medications. SOURCE: Pittsburgh Post Gazette, PA http://www.post-gazette.com/pg/04090/293211.stm * * * ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn