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Because of its widespread use as an anxiolytic, muscle relaxant, preoperative sedative, and seizure medication, diazepam Valium is one of the most commonly encountered drugs on urine toxicology reports. The metabolism and excretion of diazepam is somewhat convoluted; however, with a basic understanding of the excretion toxicology, providers will be able to easily identify patterns of recent diazepam use and distinguish these from patterns drug noncompliant benzodiazepine use.

Background Diazepam toxicology is often the cause of much confusion in the field of compliance monitoring. This is largely due to the fact that patients who are prescribed or using diazepam will not actually test positive test the parent drug but rather for one, test a combination of, its three metabolites. The three metabolites of diazepam—nordiazepam, temazepam, and oxazepam—are quickly recognized as individual benzodiazepines, which can be prescribed for a variety of medical conditions.

It is imperative that providers be able to identify patterns of recent diazepam use and distinguish these from patterns of separate nordiazepam, temazepam, and oxazepam use so that patients are not accused of using nonprescribed medications. Toxicology Following administration, diazepam is extensively metabolized via oxidative pathways into three pharmacologically active metabolites. The primary urinary metabolite, nordiazepam desmethyldiazepamundergoes subsequent metabolic transformation into oxazepam.

Temazepam, another active metabolite of diazepam, also undergoes further metabolic transformation into oxazepam. Figure 1 details the metabolic pathways of can valium into nordiazepam, temazepam, and oxazepam. Metabolic transformation pathways of diazepam into nordiazepam, temazepam, and oxazepam. As seen in Do you have to eat with phentermine drug, oxazepam is the final metabolic product of the two primary metabolites and therefore can be thought of as the end product of diazepam metabolism similar to the role of morphine in heroin metabolism.

Toxicology report showing recent use of diazepam. Urine toxicology reports of daily or frequent diazepam users will most likely indicate detected presence of all three metabolites and therefore allow for easy identification of the textbook diazepam pattern. However, the urine of infrequent or recreational users often produces slightly different patterns that providers also must be able to recognize. The most commonly encountered of these patterns is shown in Figure 3.

Toxicology report test trace levels of oxazepam, a metabolite of diazepam, which indicates semi-recent use of the latter agent. As the end product of diazepam metabolism, oxazepam often is present at slightly higher concentrations in the urine than nordiazepam and temazepam. Thus, oxazepam often remains detectable test the urine for a day or can valium after the other metabolites have been fully eliminated.

Although the presence of only oxazepam is quite different from the textbook diazepam pattern discussed above, it test be recognized as a pattern of semi-recent diazepam use because of test large number of drug in can valium test be detected a who use this medication on a prescribed-as-needed PRN basis. If detected urinary concentrations of oxazepam are not recognized as a possible pattern of diazepam use, patients may be incorrectly accused of using oxazepam Serax.

Summary Although the xanax for anxiety in the elderly personality of nordiazepam, temazepam, and oxazepam in the urine of a patient may be explained by the use of three individual benzodiazepines, it also should be recognized as the textbook pattern of recent diazepam use. Patients using diazepam on an infrequent or PRN basis may not exhibit the textbook pattern because of the different excretion profiles of the individual metabolites.

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Understanding the Toxicology of Diazepam. Welcome to Focus on Screens, a is valium allowed on planes monthly column that will address toxicology testing both urine and blood relating to pain medications. Each month we will present an image of an actual toxicology report, with pertinent results highlighted.

Our expert toxicologists will then explain the results of the screen, why they are important, and what they mean. We hope this new column will help put toxicology screening tramadol 50 mg for cats focus. Volume 18, Issue 7. Volume 18, Issue 6.

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