(Bold for FDA approved)
• Binds to benzodiazepine receptors at the GABA-A ligand-gated chloride channel complex
• Enhances the inhibitory effects of GABA
• Boosts chloride conductance through GABA-regulated channels
• Inhibitory actions in sleep centers may provide sedative hypnotic effects
• Intravenous injection: onset 3–5 minutes
• Intramuscular injection: onset 15 minutes, peak 30–60 minutes
• Oversedation, impaired recall, agitation, involuntary movements, headache
• Nausea, vomiting
• Hiccups, fluctuation in vital signs, irritation/ pain at site of injection
• Hypotension
• Respiratory depression, apnea, respiratory arrest
• Cardiac arrest
unusual
common
• Wait
• Switch to another agent
• Administer flumazenil if side effects are severe or life-threatening
• Intravenous (adults): 1–2.5 mg
• Liquid (age 16 and under): 0.25–1.0 mg/kg
• Syrup 2 mg/mL
• Nasal 5 mg/spray
• Intravenous 1 mg/mL, 5 mg/mL
• Intramuscular solution 50 mg/10 mL (5 mg/mL)
• Not generally intended for long-term use
• Some patients may develop dependence and/or tolerance; risk may be greater with higher doses
• History of drug addiction may increase risk of dependence
• May have longer elimination half-life, prolonging time to recovery
• Longer elimination half-life; clearance is reduced
• Longer elimination half-life; clearance is reduced
• Longer elimination half-life; clearance is reduced
• Intravenous: 1–3.5 mg; maximum 1.5 mg within 2 minutes
• In most pediatric populations, pharmacokinetic properties are similar to those in adults
• Seriously ill neonates have reduced clearance and longer elimination half-life
• Hypotension has occurred in neonates given midazolam and fentanyl
• Intravenous dose: dependent on age, weight, route, procedure
• Effective June 30, 2015, the FDA requires changes to the content and format of pregnancy and lactation information in prescription drug labels, including the elimination of the pregnancy letter categories; the Pregnancy and Lactation Labeling Rule (PLLR or final rule) applies only to prescription drugs and will be phased in gradually for drugs approved on or after June 30, 2001
• Controlled studies have not been conducted in pregnant women
• Midazolam crosses the placenta
• Neonatal flaccidity has been reported in infants whose mother took a benzodiazepine during pregnancy
• Some drug is found in mother’s breast milk
• Effects on infant have been observed and include feeding difficulties, sedation, and weight loss
• Midazolam can be used to relieve postoperative pain after cesarean section
Based on data Published online by Cambridge University Press
Compiled by Dr. Jash Ajmera