Directly conjugated with glucuronic acid. References consider it safe

(To be edited, initial data ST OCT 04) Benzodiazepine with anxiolytic, sedative and muscle relaxing properties. Rapidly and directly glucuronidated due to an active OH-group( not present in diazepam, clopoxide or nitrazepam). Does not form any active metabolites and is eliminated by the kidneys with a half time of 10 hours. Conflicting experimental evidence of porphyrinogenicity (Martindale). MFM James, RJ Hift. Porphyrias. Br J Anaesth 2000; 85, 143-53: use with care (benzodiazepines) Australian list: unsafe (conflicting evidence) South African list: use with care French list: use. Thunell, patient inquiry: tolerated (n=1).

Uneventful use reported in 20 patients with acute porphyria.