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Midazolam Dosage

Applies to the following strength(s): 2 mg/mL ; 5 mg/mL ; 1 mg/mL ; 1 mg/mL preservative-free ; 5 mg/mL preservative-free ; 1 mg/mL-NaCl 0.9% ; 1 mg/mL-D5% ; 1 mg/mL preservative-free-D5% ; 0.5 mg/mL-D5% ; 0.5 mg/mL preservative-free-D5% ; 0.5 mg/mL-NaCl 0.9% ; 2 mg/mL-NaCl 0.9%

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

Usual Adult Dose for Light Sedation

Patients younger than 60 years:
IM:
-Usual dose: 0.07 to 0.08 mg/kg IM once, up to 1 hour before surgery

IV:
-Usual dose: 1 to 2.5 mg slow IV every 2 minutes as necessary for sedation
-Maintenance dose: After thorough clinical evaluation, additional doses may be given in increments of 25% of the initial dose used to reach sedation.
-Maximum dose: 2.5 mg/dose

Comments:
-Some patients respond to IV doses of 1 mg.
-A total IV dose over 5 mg is usually not necessary.
-The need for continued sedation with maintenance doses should be carefully considered.

Uses:
-Preoperative sedation/anxiolysis/amnesia
-Agent for sedation/anxiolysis/amnesia prior to/during diagnostic, therapeutic/endoscopic procedures (e.g., bronchoscopy, gastroscopy, cystoscopy, coronary angiography, cardiac catheterization, oncology procedures, radiologic procedures, suture of lacerations and other procedures alone/in combination of with other central nervous system depressants)

Usual Adult Dose for Light Anesthesia

Patients younger than 55 years:
Premedicated patients:
-Usual dose: 0.25 mg/kg IV once, administered over 20 to 30 seconds. Healthcare providers should allow 2 minutes for effect.

Unpremedicated patients:
-Initial dose: 0.3 to 0.35 mg/kg IV once, administered over 20 to 30 seconds. Healthcare providers should allow 2 minutes to for effect. If induction is not complete after 2 minutes, inhalation anesthetics and/or further doses of this drug in increments of 25% of the initial dose may be given.
-Maximum dose: 0.6 mg/kg

Comments:
-When used concomitantly with other drugs used to induce anesthesia, initial doses may be reduced by to up to 25%.
-Total doses of 0.6 mg/kg may be used in unpremedicated, resistant patients, but the dose could prolong recovery.
-Doses between 0.15 and 0.35 mg/kg have been used in premedicated patients.
-Fentanyl, used as premedication, should be administered 5 minutes before induction. Other narcotics used for premedication should be administered approximately 1 hour prior to induction.

Uses:
-Induction of general anesthesia before administration of other anesthetic agents
-Component of IV supplementation of nitrous oxide and oxygen (balanced anesthesia)

Usual Geriatric Dose for Light Sedation

60 years and older:
IM:
-Usual dose: 0.02 to 0.05 mg/kg IM once up to 1 hour before surgery

IV:
-Usual dose: 1 mg slow IV every 2 minutes as needed for sedation
-Maintenance dose: 25% of the dose used to reach desired sedation level

Comments:
-Some patients may achieve sufficient sedation with an IM dose of 1 mg if the intensity and duration of sedation is less critical.
-IM dosing is intended for patients who are not receiving concomitant narcotic or central nervous system depressants; lower doses should be considered in patients older than 60 years who are receiving narcotic or CNS depressants.
-A total IV dose greater than 3.5 mg is usually not necessary.
-The need for continued sedation with maintenance dosing should be carefully considered.

Uses:
-Preoperative sedation/anxiolysis/amnesia
-Agent for sedation/anxiolysis/amnesia prior to/during diagnostic, therapeutic/endoscopic procedures (e.g., bronchoscopy, gastroscopy, cystoscopy, coronary angiography, cardiac catheterization, oncology procedures, radiologic procedures, suture of lacerations and other procedures alone/in combination of with other central nervous system depressants)

Usual Geriatric Dose for Light Anesthesia

Over 55 years:
Premedicated patients:
-Usual dose: 0.2 mg/kg IV once, administered over 20 to 30 seconds

Unpremedicated patients:
-Usual dose: 0.2 to 0.3 mg/kg IV once, administered over 20 to 30 seconds

Comments:
-Initial doses of 0.15 mg/kg have been sufficient in inducing anesthesia in patients, especially in those with severe systemic disease or debilitation.
-Fentanyl, used as premedication, should be administered 5 minutes before induction. Other narcotics used for premedication should be administered approximately 1 hour prior to induction.

Uses:
-Induction of general anesthesia before administration of other anesthetic agents
-Component of IV supplementation of nitrous oxide and oxygen (balanced anesthesia)

Usual Pediatric Dose for Light Sedation

Oral:
6 months to 16 years:
-Usual dose: 0.25 to 1 mg/kg orally once before the procedure
-Maximum dose: 20 mg

Parenteral:
IM ADMINISTRATION:
-Usual dose: 0.1 to 0.15 mg/kg IM once, with some patients requiring doses of 0.5 mg/kg
-Maximum total dose: 10 mg

IV ADMINISTRATION:
6 months to 5 years:
-Initial dose: 0.05 to 0.1 mg/kg IV injection, with evaluation for sedation. If an optimal sedation levels is not reached after 2 to 3 minutes, doses may be readministered every 2 to 3 minutes, up to a maximum dose of 0.6 mg/kg.
-Maximum total dose: 6 mg

6 years to 12 years:
-Initial dose: 0.025 to 0.05 mg/kg IV injection, with evaluation for sedation. If an optimal sedation level is not reached, doses may be readministered every 2 to 3 minutes, up to a maximum dose of 0.4 mg/kg.
-Maximum total dose: 10 mg

12 years and older:
-Usual dose: 1 to 2.5 mg slow IV every 2 minutes as necessary for sedation
-Maintenance dose: After thorough clinical evaluation, additional doses may be given in increments of 25% of the initial dose used to reach sedation.
-Maximum total dose: 10 mg

Comments:
-Less cooperative and/or younger (e.g., less than 6 years) patients may require oral doses up to 1 mg/kg. -Oral doses of 0.25 mg/kg usually suffice for cooperative and/or patients 6 to 16 years, especially when sedation duration and intensity are less critical.
-IV injection doses should be administered over 2 to 3 minutes. Maximum IV doses typically do not exceed 6 mg (patients 6 months to 5 years) or 10 mg (patients 6 years and older), and maximum IM doses typically do not exceed 10 mg.
-Lower doses should be considered in patients with cardiac/respiratory compromise, high-risk surgical patients, and/or those who have received narcotics/CNS depressants.

Uses:
-Sedation, anxiolysis, and amnesia prior to diagnostic, therapeutic, or endoscopic procedures or before induction of anesthesia
-Preoperative sedation/anxiolysis/amnesia
-Agent for sedation/anxiolysis/amnesia prior to/during diagnostic, therapeutic/endoscopic procedures (e.g., bronchoscopy, gastroscopy, cystoscopy, coronary angiography, cardiac catheterization, oncology procedures, radiologic procedures, suture of lacerations and other procedures alone/in combination of with other central nervous system depressants)

Usual Pediatric Dose for ICU Agitation

Parenteral:
CONTINUOUS INFUSION:
Preterm and term neonates:
Less than 32 weeks with tracheal intubation:
-Initial dose: 0.03 mg/kg/hr (0.5 mcg/kg/min) IV

Over 32 weeks with tracheal intubation:
-Initial dose: 0.06 mg/kg/hr (1 mcg/kg/min) IV

Non-neonates and children:
Unpremedicated patients with tracheal intubation:
-Loading dose: 0.05 to 0.2 mg/kg IV once, administered over 2 to 3 minutes
-Initial dose: 0.06 to 0.12 mg/kg/hr (1 to 2 mcg/kg/min)

Premedicated patients with tracheal intubation:
-Initial dose: 0.06 to 0.12 mg/kg/hr (1 to 2 mcg/kg/min)

Hemodynamically compromised patients:
-Loading dose: The usual loading dosed should be increased in small increments.

Comments:
-To establish therapeutic plasma levels in neonates, the infusion should be run more rapidly for the first several hours.
-Infusion rates should be reassessed to ensure that the lowest effective dose is used, especially after the first 24 hours.
-Extreme caution should be used in current/former preterm patients who do not have tracheal intubation.
-The rate of continuous infusion may be increased or decreased (e.g., usually by 25% of the initial/subsequent rate) as necessary in premedicated non-neonates. Supplemental IV doses may be given to increase/maintain the desired effect.
-Patients should be monitored closely for hemodynamic instability, respiratory rate, and oxygen saturation, especially when this drug is used in those with hemodynamic instability.

Use: Sedation of intubated and mechanically ventilated patients during treatment in a critical care setting

Renal Dose Adjustments

No adjustment recommended.

Liver Dose Adjustments

Chronic hepatic dysfunction: The dose should be titrated to the desired response.

Dose Adjustments

Obese patients:
-Dosing should be calculated based on the patient's ideal body weight.

Parenteral:
IM:
PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE, HIGHER-RISK SURGICAL PATIENTS, OR THOSE WHO RECEIVED CONCOMITANT NARCOTICS OR CENTRAL NERVOUS SYSTEM (CNS) DEPRESSANTS:
-Dosing should be reduced in patients receiving this drug for sedation.

DEBILITATED/CRITICALLY ILL PATIENTS AND/OR THOSE OVER 60 YEARS WHO RECEIVED CONCOMITANT NARCOTICS/CNS DEPRESSANTS:
-Patients should be given approximately 50% of the IM dose recommended for healthy adult patients.
-Maintenance dose: Approximately 25% of the IM dose first used to reach optimal sedation; however, the need for continued sedation with maintenance dosing should be carefully considered.

IV:
ADULT PATIENTS WHO RECEIVED CONCOMITANT NARCOTICS/CNS DEPRESSANTS:
-Patients should be given approximately 30% less of the dose than in patients who did not receive premedications.
-Maintenance dose: Approximately 25% of the dose first used to reach optimal sedation; however, the need for continued sedation with maintenance dosing should be carefully considered.

PREMEDICATED PATIENTS WITH SEVERE SYSTEMIC DISEASE/DEBILITATION:
-Usual dose: 0.15 mg/kg IV once may provide sufficient anesthesia

Precautions

US BOXED WARNINGS:
-CONCOMITANT USE OF OPIOIDS: Concomitant use with opioids may result in profound sedation, respiratory depression, coma, and/or death. Use should be limited to patients for whom alternative treatment options are inadequate, and the dose and duration should be as low and short as possible. Patients should be monitored for respiratory depression and sedation.
-INTRAVENOUS USE: Intravenous use has been associated with respiratory depression and respiratory arrest, particularly when used for sedation in noncritical care settings. Death or hypoxic encephalopathy has resulted in some cases where this was not recognized promptly and treated effectively. Intravenous midazolam should only be used in settings that provide for continuous monitoring of respiratory and cardiac function. Immediate availability of age-appropriate resuscitative equipment and personnel trained in resuscitation should be assured. For deeply sedated patients, a dedicated individual, other than the practitioner performing the procedure, should monitor the patient throughout the procedure.
-USE IN ADULTS: The initial dose for sedation should not exceed 2.5 mg in a normal, healthy adult. Lower doses are recommended in patients over 60 years, debilitated patients, and patients on concomitant narcotics or other CNS depressants. The initial dose and all subsequent doses should always be titrated slowly and administered over at least 2 minutes, with at least 2 minutes allowed to elapse 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.
-USE IN PEDIATRICS: Doses should be calculated on a mg/kg basis. Initial doses and all subsequent doses should be titrated slowly. The initial pediatric dose for sedation/anxiolysis/amnesia is age, procedure, and route dependent.
-USE IN NEONATES: Rapid injection is not recommended. Severe hypotension and seizures have been reported following rapid IV administration, particularly with concomitant use of fentanyl.

Safety and efficacy of oral syrup formulations have not been established in patients younger than 6 months.

Consult WARNINGS section for additional precautions.

US Controlled Substance: Schedule IV

Dialysis

Data not available

Other Comments

Administration advice:
-IV formulations should be administered slowly (e.g., over 2 minutes), and the patient's sedation level should be evaluated for at least 2 minutes before administering another dose.
-Oral syrup: Once the correct dose is measured, the oral syrup should be administered directly into the mouth. Dilution with other liquids should be avoided.
-Oromucosal solution: The solution should be inserted slowly into the space between the gum and cheek. Smaller patients and/or larger volumes may receive half of the dose in one side of the mouth, and the rest of the dose in the other side of the mouth.
-Parenteral solution: Prior to administration, this drug should be inspected for particulate matter and discoloration. This formulation should be given IV or IM, and extravasation should be avoided.
-Rectal formulations: Rectal solutions should be administered with a plastic applicator fixed on the end of a syringe. If the volume of the solution is too small, water may be added to a total volume of 10 mL.

Storage requirements:
-Oral syrup: Once the correct dose is measured, the oral dispenser/syringe may be covered with a cap tip.
-Parenteral solution: At 0.5% concentrations, this drug is compatible with 5% dextrose in water and 0.9% sodium chloride for up to 24 hours and with lactated Ringer's solution for up to 4 hours.

Reconstitution/preparation techniques:
-Parenteral solution: A 1 mg/mL solution may be diluted with 0.9% sodium chloride or 5% dextrose in water.

IV compatibility:
-The parenteral solution may be mixed in the same syringe with morphine sulfate, meperidine, atropine sulfate, or scopolamine.

General:
-This drug does not protect against increases in intracranial pressure or heart rate/blood pressure rise associated with endotracheal intubation under light general anesthesia.
-Limitations of use: This drug should be limited to healthcare providers who are capable of monitoring and treating respiratory/cardiovascular adverse events, including respiratory and cardiac resuscitation. Chronic and/or home use should be avoided.
-The dose of this drug should be determined by patient response, the type/duration of the procedure, and the type/dose of concomitant medications.

Monitoring:
-Sedation
-Heart rate and blood pressure
-Respiratory rate and oxygen saturation

Patient advice:
-Advise patients to speak to their healthcare provider if they become pregnant, intend to become pregnant, or are breastfeeding.
-Inform patients that this drug may cause drowsiness, and they should avoid driving or operating machinery until the full effects of the drug are seen.
-Patients and their caregivers should be told to report any signs/symptoms of respiratory depression or profound sedation.
-Patients should be advised to report alcohol consumption and all concurrent prescription and nonprescription medications or herbal products they are taking.

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