Benzodiazepine — Anxiolytic / Muscle Relaxant Pregnancy: The safety of diazepam in human pregnancy has not been established; it should not be used in the first and third trimesters, and pregnancy (unless there are compelling reasons) and planning a pregnancy are listed as contraindications. There may be a small increase in the risk of congenital malformation, particularly oral cleft, with first-trimester benzodiazepine use, although causality is not established. Administration in the late phase of pregnancy or during labour at high doses can cause neonatal hypothermia, hypotonia ('Floppy Infant Syndrome'), heart rate irregularities, poor suckling and moderate respiratory depression; infants of mothers taking benzodiazepines chronically in late pregnancy may develop physical dependency and neonatal withdrawal. Benzodiazepines are found in breast milk with a risk of accumulation in the breast-fed child and should not be given to breast-feeding mothers.

Diazepam (Burns — Procedural Anxiolysis)

Brand names: Valium, Diazemuls (IV emulsion)

Diazepam is a long-acting benzodiazepine used for procedural anxiolysis and muscle relaxation around painful burns dressing changes and procedures.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Oral premedication before surgery: 5 mg-20 mg

Route: Oral

Frequency: Single premedication dose. (Oral premedication in dental patients: 5 mg the night before, 5 mg on waking and 5 mg two hours before the appointment.)

Fetched UK SPC is Diazepam 10 mg Tablet (https://www.medicines.org.uk/emc/product/101913/smpc) — ORAL ONLY. The SPC contains NO intravenous or rectal regimen, so if this page's burns protocol uses IV diazepam for dressing changes or procedural sedation, that dose must be sourced separately from the parenteral SPC — do not extrapolate from the oral figures above. Other adult regimens in §4.2: anxiety states, obsessive-compulsive neuroses and other psychiatric disorders 5-30 mg daily in divided doses; alcohol withdrawal 5-20 mg, repeated if necessary in 2-4 hours; insomnia associated with anxiety 5-15 mg before bedtime; muscle spasm of varied aetiology, fibrositis, cervical spondylosis 5-15 mg daily in divided doses; cerebral palsy and upper motor neurone spasticity 5-60 mg daily in divided doses; adjunct in some types of epilepsy 2-60 mg daily in divided doses. As an anxiolytic, use the lowest dose that can control symptoms; treatment should not be continued beyond 4 weeks and long-term chronic use is not recommended; always taper off gradually (patients on benzodiazepines long term may need a longer reduction period). Before starting, agree a strategy for ending treatment to minimise the risk of dependence, addiction and drug withdrawal syndrome. Elderly and debilitated patients: doses should be HALF the recommended doses above. Hepatic impairment: use may precipitate coma — reduce the dose or consider an alternative drug. PAEDIATRIC (no per-kg dose is stated in this SPC): alternative presentations of diazepam are recommended for paediatric usage in order to obtain suitable doses of less than 5 mg; oral premedication before surgery 2 mg-10 mg; spastic children with minimal brain damage 5-40 mg daily in divided doses. Verify any under-18 dosing against a children's formulary. Increased salivary and bronchial secretion has been reported, in particular in children.

Dose adjustments

Renal

In severe renal impairment the dose should be reduced (§4.2/§4.4). US labelling adds that metabolites are substantially excreted by the kidney, so the risk of toxic reactions may be greater in impaired renal function — take care in dose selection and consider monitoring renal function.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance, other benzodiazepines or any of the excipients
Phobic or obsessional states; chronic psychosis; hyperkinesis (paradoxical reactions may occur)
Acute pulmonary insufficiency; respiratory depression; acute or chronic severe respiratory insufficiency (ventilatory failure may be exacerbated)
Myasthenia gravis; sleep apnoea (both may be exacerbated)
Severe hepatic insufficiency; acute porphyria
Monotherapy in patients with depression or with anxiety and depression (suicide may be precipitated)
Planning a pregnancy, and pregnancy unless there are compelling reasons

Side effects

Drowsiness (very common); ataxia, impaired motor ability and tremor (common); confusion (common)
Anterograde amnesia (uncommon) — risk increases at higher doses and may be associated with inappropriate behaviour
Respiratory depression (uncommon); respiratory arrest and increased bronchial secretion (rare); apnoea (frequency not known)
Hypotension and syncope (rare); bradycardia, heart failure including cardiac arrest (rare)
Paradoxical reactions — excitation, restlessness, agitation, irritability, aggressiveness, delusion, rages, hallucinations, nightmares, inappropriate behaviour (rare, more likely in children and the elderly)
Drug dependence with chronic use even at therapeutic doses, with withdrawal or rebound phenomena on discontinuation; increased risk of falls and fractures in elderly patients

Interactions

Opioids — concomitant use increases the risk of respiratory depression; limit dosage and duration and monitor closely for respiratory depression and sedation (US label; the eMC §4.5 was not captured in this fetch)
Alcohol — concomitant use is not recommended due to enhancement of the sedative effect
Other centrally acting agents — phenothiazines, antipsychotics, anxiolytics/sedatives, hypnotics, anticonvulsants, narcotic analgesics, anaesthetics, sedative antihistamines, barbiturates, MAO inhibitors and other antidepressants may potentiate or be potentiated by diazepam
Antacids — diazepam peak concentrations are 30% lower with concurrent administration, although the extent of absorption is unchanged

Clinical monograph

How it works

It enhances the inhibitory action of GABA at the GABA-A receptor, increasing chloride conductance to produce anxiolysis, sedation, and skeletal-muscle relaxation.

Prescribing in practice

Combined with opioids used for burns analgesia, diazepam causes additive respiratory depression and sedation, so monitoring and resuscitation facilities must be available.
It has a long half-life with active metabolites, so accumulation and prolonged sedation are likely with repeated dosing, especially in the elderly and the frail.
It provides anxiolysis and sedation but no analgesia, so adequate pain relief must be given separately.

Monitoring

Monitor conscious level, respiratory rate, and oxygen saturation during and after procedural sedation.

Counselling the patient

This medicine reduces anxiety and helps relax muscles around the procedure but does not relieve pain.
Do not drive or operate machinery and avoid alcohol while drowsiness persists.

Evidence & guidelines

Benzodiazepines such as diazepam are standard agents for procedural anxiolysis; combined use with opioids is a recognised cause of respiratory depression.

Reference: BBA Burns Dressing Change Analgesia Protocol; MHRA Benzodiazepine Safety Update; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators