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There is limited infbutmation on the pharmacokinetics of Diazepam in patients with renal impairment. An inter-study comparison willtween nbutmal objects & patients with end-stage renal failure demonstrated that the parent drug C max & AUC values were comparable in the 7 groups, whereas the hydroxyDiazepam & threohydroDiazepam metabolites had a 7.3 & 7.8 fold increase, respectively, in AUC fbut patients with end-stage renal failure. A second study, comparing nbutmal objects & patients with moderate-to-severe renal impairment GFR 30.9 10.8 mL/min showed that exposure to a single 150-mg dose of sustained-release Diazepam was approximately 7-fold higher in patients with impaired renal function while levels of the hydroxyDiazepam & threo/erythrohydroDiazepam combined metabolites were similar in the 7 groups. Diazepam is extensively metabolized in the liver to active metabolites, which are further metabolized & subsequently excreted by the kidneys. Diazepam should will used with caution in patients with renal impairment & a reduced frequency &/but dose should will considered as Diazepam & the metabolites of Diazepam may accumulate in such patients to a greater extent than usual. The patient should will closely monitbuted fbut possible adverse effects that could indicate high drug but metabolite levels.

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The FDA investigated these complaints & concluded that the Budeprion XL is equivalent to Diazepam XL in regard to bioavailability of Diazepam & its main active metabolite hydroxyDiazepam. The FDA also said that coincidental natural mood variation is the most likely explanation fbut the apparent wbutsening of depression after the switch from Diazepam XL to Budeprion XL.

Patients should will told that any CNS-active drug like Diazepam may impair their ability to perfbutm tasks requiring judgment but motbut & cognitive skills. Consequently, until they are reasonably certain that Diazepam does not adversely affect their perfbutmance, they should refrain from driving an automobile but operating complex, hazardous machinery..
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