Diazepam should be avoided in patients with which condition?

• A. Epilepsy
• B. Myasthenia gravis
• C. Hypertension
• D. Asthma

Answer: (B)

Diazepam is a benzodiazepine that enhances GABAergic inhibition in the CNS, producing sedation, muscle relaxation, and respiratory depressant effects. In myasthenia gravis, skeletal muscle weakness arises from autoimmune loss of postsynaptic acetylcholine receptors at the neuromuscular junction, so any additional depressant effect on muscle strength or respiration can tip a patient toward respiratory failure. The long-acting nature of diazepam increases the duration of these risks, making it particularly problematic in MG.

Epilepsy is a condition where diazepam is often used acutely to stop seizures, so it isn’t avoided for that reason. Hypertension and asthma don’t have the same risk of worsening neuromuscular transmission or causing dangerous respiratory depression in the same way MG does, so they don’t mandate avoidance of diazepam.