Rapid recovery from massive diazepam overdose

Two patients were hospitalized in moderately deep coma after ingestion of large doses of diazepam (500 and 2,000 mg) with suicidal intent. Neither patient experienced important complications; both recovered fully and were discharged within 48 hours. Concentrations of diazepam and its three pharmacologically active metabolites (desmethyldiazepam, temazepam, and oxazepam) were determined in multiple samples drawn during and after hospitalization. High concentrations of all four compounds were present in early samples, then declined slowly during the next one to two weeks. Rapid clinical recovery after diazepam overdose is not attributable to rapid elimination of active compounds from the body, but more likely to adaptation or tolerance to their depressant effects. (JAMA240:1872-1874, 1978)