Which of the following is a rare side effect of diazepam?

• A. Respiratory depression
• B. Hypotension
• C. Sedation
• D. Paradoxical agitation (rare)

Answer: (D)

Diazepam is a benzodiazepine, so its primary effects are CNS depression: relief of anxiety, sedation, muscle relaxation, and anticonvulsant effects. In typical use, sedation is common, and respiratory depression or hypotension can occur mainly with overdose or when combined with other depressants or IV administration factors. However, a rare and paradoxical reaction can occur in a minority of patients, where instead of calming, they become agitated, irritable, or even aggressive. This paradoxical agitation is not dose-dependent and is more likely in certain groups (such as the elderly or children) or in people with underlying psychiatric or developmental conditions. Because the question asks for a rare side effect, paradoxical agitation fits best, even though most patients experience sedation and the other effects are more common under specific circumstances.