Benzodiazepine — Anxiolytic / Muscle Relaxant Pregnancy: Avoid — neonatal withdrawal syndrome ('floppy infant'); crosses placenta freely. Use only in emergency.

Diazepam (Burns — Procedural Anxiolysis)

Brand names: Valium, Diazemuls (IV emulsion)

Adult dose

Dose: Oral anxiolysis: 2–10 mg 1–2 hours before dressing change; IV procedural: 2.5–5 mg IV titrated

Route: Oral / IV / Rectal

Frequency: As needed pre-procedure

Max: 20 mg single dose (oral); 10 mg IV slowly

Used for procedural anxiolysis before burns dressing changes — combined with analgesics for comprehensive procedural analgesia. IV Diazemuls (lipid emulsion) less painful than diazepam solution. Long half-life (20–100h) — accumulates with repeated dosing. Controlled drug (Schedule 4 Part 1).

Paediatric dose

Dose: 0.1–0.3 mg/kg

Route: Oral / IV / Rectal

Frequency: Pre-procedure

Max: 10 mg

Procedural anxiolysis: 0.1–0.3 mg/kg oral 1 hour before procedure. Rectal: 0.5 mg/kg. Febrile seizures: 0.5 mg/kg rectal (max 10 mg).

Dose adjustments

Renal

No specific adjustment — use lowest effective dose. Active metabolites may accumulate.

Hepatic

Significant caution — prolonged half-life in hepatic impairment. Reduce dose and frequency.

Paediatric weight-based calculator

Patient weight (kg)

Procedural anxiolysis: 0.1–0.3 mg/kg oral 1 hour before procedure. Rectal: 0.5 mg/kg. Febrile seizures: 0.5 mg/kg rectal (max 10 mg).

Clinical pearls

Antidote: flumazenil 200 mcg IV, then 100 mcg every 60 seconds if needed (max 1 mg) — short-acting (half-life 60 min) — resedation possible with long-acting benzodiazepines like diazepam; patient must be monitored for at least 2 hours after flumazenil
Long half-life advantage: single oral dose provides prolonged anxiolysis for extended dressing procedures — but accumulation risk with repeated use
Paradoxical reaction: agitation and aggression instead of sedation — more common in children and elderly. If occurs, stop benzodiazepine and manage behaviourally.

Contraindications

Respiratory depression without ventilatory support
Sleep apnoea
Myasthenia gravis
Severe hepatic impairment
Phobic or obsessional states (paradoxical disinhibition)

Side effects

Sedation and drowsiness
Respiratory depression (additive with opioids)
Anterograde amnesia
Paradoxical agitation (especially elderly and children)
Dependence (prolonged use)
Confusion in elderly

Interactions

Opioids (marked respiratory depression — MHRA alert)
CNS depressants (additive)
CYP3A4 inhibitors — fluconazole, erythromycin (increase diazepam levels)
Alcohol (fatal CNS depression)

Monitoring

Respiratory rate and SpO2
Sedation score
Level of consciousness
Paradoxical agitation assessment

Reference: BNFc; BNF 90; BBA Burns Dressing Change Analgesia Protocol; BNFc; MHRA Benzodiazepine Safety Update. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators