midazolam (Injection route)

Pronunciation

MID-ay-zoe-lam

Injection route(Solution)

Midazolam has been associated with respiratory depression and respiratory arrest, especially when used for sedation in noncritical care settings. Use only in settings that can provide for continuous monitoring of respiratory and cardiac function. The initial dose and all subsequent doses should always be titrated slowly. Midazolam injection should not be administered by rapid injection in the neonatal population as severe hypotension and seizures have been reported .

Commonly used brand name(s)

In the U.S.

  • Versed

In Canada

  • Midazolam

Available Dosage Forms:

  • Solution

Therapeutic Class: Anesthetic Adjunct

Pharmacologic Class: Benzodiazepine, Short or Intermediate Acting

Uses For midazolam

Midazolam is used to produce sleepiness or drowsiness and to relieve anxiety before surgery or certain procedures. Midazolam is also given to produce amnesia (loss of memory) so that the patient will not remember any discomfort or undesirable effects that may occur after a surgery or procedure . It is also used to produce loss of consciousness before and during surgery. Midazolam is sometimes used in patients in hospital intensive care units to cause unconsciousness. This may allow the patient to withstand the stress of being in the intensive care unit and help the patient cooperate when a machine must be used to assist with breathing.

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Midazolam is given only by or under the immediate supervision of a doctor trained to use midazolam. If you will be receiving midazolam during surgery, your doctor or anesthesiologist will give you the medicine and closely follow your progress.

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although this use is not included in the product labeling, midazolam is used in certain patients with the following medical condition:

  • Epilepsy

Before Using midazolam

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For midazolam, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to midazolam or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Newborn babies may be especially sensitive to the effects of midazolam. This may increase the chance of side effects during the use of midazolam. Also, the time it takes to completely recover after midazolam is given may be longer in very ill newborn babies.

Geriatric

Elderly people are especially sensitive to the effects of midazolam. This may increase the chance of side effects during the use of midazolam. Also, the time it takes to completely recover after midazolam is given may be slower in the elderly than in younger adults.

Pregnancy

Pregnancy Category Explanation
All Trimesters D Studies in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy in a life threatening situation or a serious disease, may outweigh the potential risk.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking midazolam, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using midazolam with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Amprenavir
  • Atazanavir
  • Boceprevir
  • Cobicistat
  • Darunavir
  • Delavirdine
  • Efavirenz
  • Fosamprenavir
  • Indinavir
  • Itraconazole
  • Lopinavir
  • Nelfinavir
  • Ritonavir
  • Saquinavir
  • Telaprevir
  • Tipranavir

Using midazolam with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Alfentanil
  • Amobarbital
  • Anileridine
  • Aprobarbital
  • Butabarbital
  • Butalbital
  • Carbinoxamine
  • Carisoprodol
  • Chloral Hydrate
  • Chlorzoxazone
  • Codeine
  • Conivaptan
  • Dabrafenib
  • Dantrolene
  • Eslicarbazepine Acetate
  • Ethchlorvynol
  • Fentanyl
  • Fospropofol
  • Hydrocodone
  • Hydromorphone
  • Levorphanol
  • Meclizine
  • Meperidine
  • Mephenesin
  • Mephobarbital
  • Meprobamate
  • Metaxalone
  • Methocarbamol
  • Methohexital
  • Morphine
  • Morphine Sulfate Liposome
  • Nilotinib
  • Orlistat
  • Oxycodone
  • Oxymorphone
  • Pentobarbital
  • Phenobarbital
  • Piperaquine
  • Posaconazole
  • Primidone
  • Propoxyphene
  • Remifentanil
  • Secobarbital
  • Sodium Oxybate
  • Sufentanil
  • Tapentadol
  • Thiopental
  • Zolpidem

Using midazolam with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Aprepitant
  • Armodafinil
  • Carbamazepine
  • Cimetidine
  • Clarithromycin
  • Crizotinib
  • Cyclosporine
  • Dalfopristin
  • Deferasirox
  • Diltiazem
  • Echinacea
  • Erythromycin
  • Fluconazole
  • Fluvoxamine
  • Fosaprepitant
  • Fosphenytoin
  • Ginkgo Biloba
  • Goldenseal
  • Halothane
  • Ivacaftor
  • Laropiprant
  • Mitotane
  • Perampanel
  • Phenytoin
  • Quinupristin
  • Roxithromycin
  • St John's Wort
  • Telithromycin
  • Theophylline
  • Vemurafenib
  • Verapamil
  • Voriconazole

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using midazolam with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use midazolam, or give you special instructions about the use of food, alcohol, or tobacco.

  • Ethanol

Other Medical Problems

The presence of other medical problems may affect the use of midazolam. Make sure you tell your doctor if you have any other medical problems, especially:

  • Heart disease or
  • Kidney disease or
  • Liver disease or
  • Obesity (overweight)—The effects of midazolam may last longer.
  • Lung disease or
  • Myasthenia gravis or
  • Other muscle or nerve disease—Midazolam may make these conditions worse.

Proper Use of midazolam

Dosing

The dose of midazolam will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of midazolam. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • Your age;
  • Your weight;
  • Your general physical condition;
  • The kind of surgery or other procedure you are having; and
  • Other medicines you are taking or will receive before and during the procedure.

Precautions While Using midazolam

For patients going home within 24 hours after receiving midazolam:

  • Midazolam may cause some people to feel drowsy, tired, or weak for 1 or 2 days after it has been given. It may also cause problems with coordination and one's ability to think. Therefore, do not drive, use machines, or do anything else that could be dangerous if you are not alert until the effects of the medicine have disappeared or until the day after you receive midazolam, whichever period of time is longer.
  • Do not drink alcoholic beverages or take other CNS depressants (medicines that slow down the nervous system, possibly causing drowsiness) for about 24 hours after you have received midazolam, unless otherwise directed by your doctor. To do so may add to the effects of the medicine. Some examples of CNS depressants are antihistamines or medicine for hay fever, other allergies, or colds; other sedatives, tranquilizers, or sleeping medicine; prescription pain medicine or narcotics; medicine for seizures; and muscle relaxants.

midazolam Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. While you are receiving midazolam, your doctor will monitor you closely for the following side effects:

  • Breathing problems
  • confusion

Some side effects may occur that usually do not need medical attention. Most side effects will go away as the effects of midazolam wear off. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

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