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WARNING
Adult and Pediatric:
Intravenous midazolam has been associated with respiratory depression and respiratory arrest, especially when used for sedation in noncritical care settings. In some cases, where this was not recognized promptly and treated effectively, death or hypoxic encephalopathy has resulted. Intravenous midazolam should be used only in hospital or ambulatory care settings, including physicians’ and dental offices, that provide for continuous monitoring of respiratory and cardiac function, ie, pulse oximetry. Immediate availability of resuscitative drugs and age- and size-appropriate equipment for bag/valve/mask ventilation and intubation, and personnel trained in their use and skilled in airway management should be assured (see
WARNINGS
). For deeply sedated pediatric patients, a dedicated individual, other than the practitioner performing the procedure, should monitor the patient throughout the procedures.
The initial intravenous dose for sedation in adult patients may be as little as 1 mg, but should not exceed 2.5 mg in a normal healthy adult. Lower doses are necessary for older (over 60 years) or debilitated patients and in patients receiving concomitant narcotics or other central nervous system (CNS) depressants. The initial dose and all subsequent doses should always be titrated slowly; administer over at least 2 minutes and allow an additional 2 or more minutes to fully evaluate the sedative effect. The use of the 1 mg/mL formulation or dilution of the 1 mg/mL or 5 mg/mL formulation is recommended to facilitate slower injection. Doses of sedative medications in pediatric patients must be calculated on a mg/kg basis, and initial doses and all subsequent doses should always be titrated slowly. The initial pediatric dose of midazolam for sedation/anxiolysis/amnesia is age, procedure, and route dependent (see
DOSAGE AND ADMINISTRATION
for complete dosing information).
Neonates:
Midazolam should not be administered by rapid injection in the neonatal population. Severe hypotension and seizures have been reported following rapid IV administration, particularly with concomitant use of fentanyl (see
DOSAGE AND ADMINISTRATION
for complete information).
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MIDAZOLAM SUMMARY
Midazolam hydrochloride is a water-soluble benzodiazepine available as a sterile, nonpyrogenic parenteral dosage form for intravenous or intramuscular injection. Each mL contains midazolam hydrochloride equivalent to 1 mg or 5 mg midazolam compounded with 0.8% sodium chloride and 0.01% disodium edetate, with 1% benzyl alcohol as preservative; the pH is 3 (2.5 to 3.5) and is adjusted with hydrochloric acid and, if necessary, sodium hydroxide.
Midazolam is a white to light yellow crystalline compound, insoluble in water. The hydrochloride salt of midazolam, which is formed
in situ
, is soluble in aqueous solutions.
Midazolam injection is indicated:
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intramuscularly or intravenously for preoperative sedation/anxiolysis/amnesia;
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intravenously as an agent for sedation/anxiolysis/amnesia prior to or during diagnostic, therapeutic or endoscopic procedures, such as bronchoscopy, gastroscopy, cystoscopy, coronary angiography, cardiac catheterization, oncology procedures, radiologic procedures, suture of lacerations and other procedures either alone or in combination with other CNS depressants;
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intravenously for induction of general anesthesia, before administration of other anesthetic agents. With the use of narcotic premedication, induction of anesthesia can be attained within a relatively narrow dose range and in a short period of time. Intravenous midazolam can also be used as a component of intravenous supplementation of nitrous oxide and oxygen (balanced anesthesia);
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continuous intravenous infusion for sedation of intubated and mechanically ventilated patients as a component of anesthesia or during treatment in a critical care setting.
Midazolam is associated with a high incidence of partial or complete impairment of recall for the next several hours (see
CLINICAL PHARMACOLOGY
).
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NEWS HIGHLIGHTS
Published Studies Related to Midazolam
A placebo-controlled trial of midazolam as an adjunct to morphine
patient-controlled analgesia after spinal surgery. [2014]
morphine... CONCLUSIONS: Patients who received both midazolam and morphine experienced a more
A double-blind, randomised, placebo-controlled trial of oral midazolam plus oral
ketamine for sedation of children during laceration repair. [2014]
oral midazolam and ketamine in children requiring laceration repair... CONCLUSIONS: No difference was found in pain assessment during local anaesthetic
Prophylactic midazolam and clonidine for emergence from agitation in children
after emergence from sevoflurane anesthesia: a meta-analysis. [2013]
sevoflurane anesthesia... CONCLUSIONS: This meta-analysis suggests that prophylactic administration of
Midazolam in flexible bronchoscopy premedication: effects on patient-related and
procedure-related outcomes. [2013]
or nurse-reported feasibility of bronchoscopy... CONCLUSIONS: In our study, premedication with midazolam increased the
Intravenous droperidol or olanzapine as an adjunct to midazolam for the acutely
agitated patient: a multicenter, randomized, double-blind, placebo-controlled
clinical trial. [2013]
rapid patient sedation... CONCLUSION: Intravenous droperidol or olanzapine as an adjunct to midazolam is
Clinical Trials Related to Midazolam
Drug-Drug Interaction Study of Qualaquin and Midazolam [Completed]
This is an open label non-randomized single sequence, single group two way drug interaction
study in healthy adult volunteers to determine the extent to which quinine, an inducer of
cytochrome p450 CYP 3A4, affects the pharmacokinetics of midazolam, an accepted probe drug
for CYP 3A4. The study will also determine the extent to which midazolam affects the
pharmacokinetics of quinine.
A Study on the Effects of Midazolam on Delirium After Sevoflurane Anesthesia in Pediatric Strabismus Surgery [Completed]
Sevoflurane with its rapid induction and emergence, hemodynamic stability, and nonirritating
airway properties, has acquired widespread acceptance in children. However, sevoflurane has
been reported to be associated with emergence agitation in children, with a reported
incidence of up to 80%.
The purpose of this study is to verify that the prophylactic use of midazolam, which is a
GABA A receptor inhibitor, given five minutes before the end of strabismus surgery reduces
the incidence of emergence agitation after sevoflurane anesthesia in children.
Simultaneously, this study aims to find out the proper dose of midazolam with minimum
disturbance to patient's emergence time.
Safety and Efficacy of Oral Midazolam for Perioperative Anxiety Relief of Patients Undergoing Mohs Micrographic Surgery [Completed]
Midazolam is an approved sedative medication used for medical procedures. This study was
being done to document the safety and efficacy of midazolam in improving anxiety, heart
rate, and blood pressure in patients prior to undergoing Mohs micrographic surgery for the
treatment of skin cancer (basal cell carcinoma or squamous cell carcinoma). Midazolam may
make a patient relaxed and sleepy, and lower blood pressure. These effects last for about 2
hours.
This study had two parts. In the first part, eligible patients were randomized to either
receiving one standard dose of midazolam syrup or placebo syrup before their surgery, with
neither the patient nor the study team knowing which patient received the study drug. In
the second part, patients who were not eligible to participate in the randomized study or
who refused to participate in the randomized study were enrolled in a prospective arm where
they knew they were receiving midazolam syrup. In the prospective arm, the doses were based
on the patient's weight, and patients were given additional doses of midazolam syrup as
necessary to control their anxiety.
The primary hypothesis of this study was that a single dose of oral midazolam syrup to
patients prior undergoing outpatient Mohs micrographic surgery for skin cancer would result
in lower anxiety scores at 60 minutes compared to placebo. In addition, the second
hypothesis of this study was that patients given oral midazolam would have the rate of
adverse events that was not worse than 25% higher than in the placebo group.
A Drug-Drug Interaction Study To Investigate The Potential For Multiple Doses Of Palbociclib (PD-0332991) To Alter The Pharmacokinetics Of Oral Midazolam In Adult Healthy Women of Non-Childbearing Potential. [Completed]
This is a drug-drug interaction study to compare the pharmacokinetics of a 2 mg oral dose of
midazolam in adult healthy women of non-childbearing potential when administered alone and
when administered along with 8 daily 125 mg doses of PD-0332991. Volunteers will be
randomized to one of two sequences. Volunteers in sequence 1 will receive midazolam alone in
treatment period 1, followed by multiple dose PD-0332991 and midazolam in treatment period
2. Volunteers randomized to sequence 2 will receive multiple dose PD-0332991 and midazolam
in treatment period 1, and following a washout period of no less than 14 days they will
receive midazolam alone in treatment period 2.
Morphine-Midazolam in Pre-hospital Traumatic Patients With Severe Acute Pain [Completed]
Administration of midazolam with morphine in patients with severe acute pain is a routine
practice in the management of pre- and post-operative patients but has not been evaluated in
pre-hospital setting. The investigators aim to evaluate the co-analgesic effect of midazolam
in the pre-hospital management of traumatic patients with severe acute pain.
In a multicenter prospective randomized double-blind placebo-controlled trial, the
investigators would like to compare the analgesic effect and safety of the intravenous
morphine 0. 10 mg/kg and midazolam 0. 04 mg/kg with the intravenous morphine 0. 10 mg/kg and
placebo in pre-hospital traumatic adults. Assessment will be done at the baseline using a
validated numeric rating scale (NRS).
The primary outcome will be the proportion of patients with a pain score less than or equal
to 3 after 20 minutes. The secondary outcomes will be in between-group comparison of: the
treatment safety, pain score every 5 minutes during 30 minutes and the total morphine dose
required until obtaining a pain score less than or equal to 3.
Reports of Suspected Midazolam Side Effects
Drug Rash With Eosinophilia and Systemic Symptoms (27),
Toxicity TO Various Agents (15),
Bradycardia (15),
Disseminated Intravascular Coagulation (13),
Serotonin Syndrome (13),
Ventricular Tachycardia (13),
Intentional Overdose (12),
Drug Interaction (12),
Circulatory Collapse (12),
Coma (11), more >>
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Page last updated: 2015-08-10
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