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Remimazolam (Intravenous)

Intravenous route(Powder for Solution)

Warning: Personnel and Equipment for Monitoring and Resuscitation, and Risks from Concomitant Use with Opioid Analgesics and Other Sedative-HypnoticsOnly personnel trained in the administration of procedural sedation, and not involved in the conduct of the diagnostic or therapeutic procedure, should administer remimazolam.Administering personnel must be trained in the detection and management of airway obstruction, hypoventilation, and apnea, including the maintenance of a patent airway, supportive ventilation, and cardiovascular resuscitation.Remimazolam has been associated with hypoxia, bradycardia, and hypotension. Continuously monitor vital signs during sedation and through the recovery period.Resuscitative drugs, and age-and size-appropriate equipment for bag/valve/mask assisted ventilation must be immediately available during administration of remimazolam.Concomitant use of benzodiazepines with opioid analgesics may result in profound sedation, respiratory depression, coma, and death. The sedative effect of intravenous remimazolam can be accentuated by concomitantly administered CNS depressant medications, including other benzodiazepines and propofol. Continuously monitor patients for respiratory depression and depth of sedation .

Commonly used brand name(s)

In the U.S.

  • Byfavo

Pharmacologic Class: Benzodiazepine, Short or Intermediate Acting

Uses for remimazolam

Remimazolam injection is used to start and maintain relaxation or sleep in patients undergoing medical procedures lasting 30 minutes or less. Remimazolam is an anesthetic and a sedative.

Remimazolam is to be given only by or under the direct supervision of your doctor.

Before using remimazolam

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 remimazolam, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to remimazolam 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

Because of remimazolam's toxicity (eg, serious unwanted effects on early brain development), use in children is not recommended. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of remimazolam injection in the elderly. However, elderly patients are more sensitive to the effects of remimazolam than younger adults.

Breastfeeding

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 receiving remimazolam, 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 remimazolam 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.

  • Flumazenil

Using remimazolam 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.

  • Acepromazine
  • Alfentanil
  • Alprazolam
  • Amobarbital
  • Anileridine
  • Aripiprazole
  • Aripiprazole Lauroxil
  • Asenapine
  • Baclofen
  • Benperidol
  • Benzhydrocodone
  • Bromazepam
  • Buprenorphine
  • Buspirone
  • Butabarbital
  • Butorphanol
  • Calcium Oxybate
  • Cannabidiol
  • Carbinoxamine
  • Carisoprodol
  • Carphenazine
  • Chloral Hydrate
  • Chlordiazepoxide
  • Chlorpromazine
  • Chlorzoxazone
  • Clobazam
  • Clonazepam
  • Clorazepate
  • Clozapine
  • Codeine
  • Cyclobenzaprine
  • Dexmedetomidine
  • Diacetylmorphine
  • Diazepam
  • Dichloralphenazone
  • Difenoxin
  • Dihydrocodeine
  • Diphenhydramine
  • Diphenoxylate
  • Doxylamine
  • Droperidol
  • Enflurane
  • Esketamine
  • Estazolam
  • Eszopiclone
  • Ethchlorvynol
  • Ethopropazine
  • Ethylmorphine
  • Fentanyl
  • Flibanserin
  • Fluphenazine
  • Flurazepam
  • Fluspirilene
  • Fospropofol
  • Gabapentin
  • Gabapentin Enacarbil
  • Halazepam
  • Haloperidol
  • Halothane
  • Hexobarbital
  • Hydrocodone
  • Hydromorphone
  • Hydroxyzine
  • Isoflurane
  • Ketamine
  • Ketazolam
  • Ketobemidone
  • Levorphanol
  • Lorazepam
  • Loxapine
  • Magnesium Oxybate
  • Meclizine
  • Melperone
  • Meperidine
  • Mephobarbital
  • Meprobamate
  • Meptazinol
  • Mesoridazine
  • Metaxalone
  • Methadone
  • Methdilazine
  • Methocarbamol
  • Methohexital
  • Methotrimeprazine
  • Methylene Blue
  • Midazolam
  • Mirtazapine
  • Molindone
  • Moricizine
  • Morphine
  • Morphine Sulfate Liposome
  • Nalbuphine
  • Nicomorphine
  • Nitrazepam
  • Nitrous Oxide
  • Olanzapine
  • Opium
  • Opium Alkaloids
  • Orphenadrine
  • Oxazepam
  • Oxycodone
  • Oxymorphone
  • Papaveretum
  • Paregoric
  • Pentazocine
  • Pentobarbital
  • Perampanel
  • Perazine
  • Periciazine
  • Perphenazine
  • Phenobarbital
  • Pimozide
  • Piperacetazine
  • Pipotiazine
  • Piritramide
  • Potassium Oxybate
  • Prazepam
  • Pregabalin
  • Primidone
  • Prochlorperazine
  • Promazine
  • Promethazine
  • Propofol
  • Quazepam
  • Quetiapine
  • Ramelteon
  • Remifentanil
  • Remoxipride
  • Secobarbital
  • Sertindole
  • Sodium Oxybate
  • Sufentanil
  • Sulpiride
  • Suvorexant
  • Tapentadol
  • Temazepam
  • Thiethylperazine
  • Thiopental
  • Thiopropazate
  • Thioridazine
  • Tilidine
  • Tizanidine
  • Tolonium Chloride
  • Topiramate
  • Tramadol
  • Triazolam
  • Trifluoperazine
  • Trifluperidol
  • Triflupromazine
  • Trimeprazine
  • Zaleplon
  • Zolpidem
  • Zopiclone
  • Zotepine

Using remimazolam 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.

  • Rifapentine
  • St John's Wort
  • Theophylline

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. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other medical problems

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

  • Allergy to dextran 40 or products containing dextran 40, history of—Should not be used in patients with this condition.
  • Heart problems or
  • Lung or breathing problems—Use with caution. May make these conditions worse.
  • Liver disease, severe—Use with caution. The effects may be increased because of the slower removal of the medicine from the body.
  • Sleep apnea—Use with caution. May increase risk for more side effects.

Proper use of remimazolam

A nurse or other trained health professional will give you remimazolam in a medical facility. Remimazolam is given through a needle placed into one of your veins.

Precautions while using remimazolam

It is very important that your doctor check your progress closely while you are receiving remimazolam to make sure remimazolam is working properly and to check for unwanted effects.

Check with you doctor right away if you have bluish lips or skin, blurred vision, choking, confusion, dizziness, fainting, or lightheadedness when getting up suddenly from a lying or sitting position, drowsiness, pale skin, sweating, trouble breathing or speaking, or unusual tiredness or weakness after receiving remimazolam. These could be symptoms of a serious heart or lung problem and may worsen when used with certain medicines (eg, benzodiazepine, opioid analgesic medicine).

Tell your doctor if you are pregnant or planning to become pregnant during treatment with remimazolam. Receiving remimazolam during the later part of a pregnancy can cause serious unwanted effects (eg, excessive drowsiness, breathing problems, unusual tiredness or weakness) in the newborn baby. Talk to your doctor if you have concerns.

Remimazolam may cause serious allergic reactions, which can be life-threatening and require immediate medical attention. Tell your doctor right away if you start to have a rash, itching, hoarseness, trouble breathing or swallowing, or any swelling of your hands, face, mouth, or throat after receiving remimazolam.

Check with your doctor before receiving remimazolam with alcohol or other medicines that affect the central nervous system. The use of alcohol or other medicines that affect the CNS with remimazolam may worsen the side effects of remimazolam, such as dizziness, poor concentration, drowsiness, unusual dreams, and trouble with sleeping. Some examples of medicines that affect the CNS are antihistamines or medicine for allergies or colds, sedatives, tranquilizers, or sleeping medicines, medicine for depression, medicine for anxiety, prescription pain medicine or narcotics, medicine for attention deficit and hyperactivity disorder, medicine for seizures or barbiturates, muscle relaxants, or anesthetics, including some dental anesthetics.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Remimazolam side effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

More common

  • Blurred vision
  • chest pain or discomfort
  • confusion
  • dizziness, fainting, or lightheadedness when getting up suddenly from a lying or sitting position
  • drowsiness
  • fast, slow, pounding, or irregular heartbeat or pulse
  • headache
  • nausea
  • nervousness
  • pounding in the ears
  • sweating
  • trouble breathing
  • unusual tiredness or weakness
  • vomiting

Less common

  • Body aches or pain
  • chills
  • cough
  • ear congestion
  • fever
  • loss of voice
  • runny or stuffy nose
  • sneezing
  • sore throat

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose

  • Difficulty sleeping
  • disorientation
  • drowsiness to profound loss of consciousness
  • irregular, fast or slow, or shallow breathing
  • mood or other mental changes
  • pale or blue lips, fingernails, or skin
  • seeing, hearing, or feeling things that are not there
  • shakiness and unsteady walk
  • unsteadiness, trembling, or other problems with muscle control or coordination
  • unusual drowsiness, dullness, or feeling of sluggishness

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.