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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:

Usual Geriatric Dose for:

Additional dosage information:

Usual Adult Dose for Light Sedation

Oral:
10 to 20 mg one time before procedure (IM or IV is preferred).

IV:
1 to 2.5 mg IV over 2 to 3 minutes before procedure. Wait an additional 2 or more minutes to fully evaluate the sedative effect. If additional titration is necessary, it should be given at a rate of no more than 1 mg over 2 minutes, waiting an additional 2 or more minutes each time to fully evaluate the sedative effect. Total doses greater than 5 mg are not usually necessary.

IM:
0.07 to 0.08 mg/kg 30 to 60 minutes prior to surgery. Reduce dose in patients with COPD, high risk patients, and when narcotics or other CNS depressants are used. Maximum dose 10 mg.

Usual Adult Dose for Light Anesthesia

Initial dose: 2 mg IV once at a rate not to exceed 1 mg/min immediately before the procedure. Additional doses of 0.5 to 2 mg may be administered after 2 minutes to achieve desired level of sedation. Most patients achieve adequate sedation with a total dose less than 5 mg.
Maintenance dose: Generally does not exceed 25% of the dose initially required to achieve sedation.

Usual Adult Dose for ICU Agitation

Initial dose: 0.01 to 0.08 mg/kg (usually 1 to 5 mg) IV over 2 to 3 minutes, every 5 to 15 minutes to control acute agitation.
Maintenance dose: 0.02 to 0.2 mg/kg/hour by continuous infusion. The patient should be assessed regularly and the infusion rate adjusted to maintain the desired level of sedation. The minimum effective rate is recommended. Lower infusion rates are required in patients also receiving opioid analgesics.

Usual Geriatric Dose for Light Sedation

IV:
1 to 1.5 mg IV over 2 to 3 minutes before procedure. Wait an additional 2 or more minutes to fully evaluate the sedative effect. If additional titration is necessary, it should be given at a rate of no more than 1 mg over 2 minutes, waiting an additional 2 or more minutes each time to fully evaluate the sedative effect. Total doses greater than 3.5 mg are not usually necessary.

IM:
0.02 to 0.05 mg/kg IM 30 to 60 minutes prior to surgery.
Usual doses are 1 to 3 mg. Some patients may respond to as little as 1 mg.

If concomitant CNS depressant premedications are used in these patients, they will require at least 50% less midazolam than healthy young unpremedicated patients.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Dose Adjustments

The dose of midazolam must be individualized and reduced in debilitated patients, high risk surgical patients, COPD patients, and patients receiving concomitant narcotics or depressants.

In obese pediatric patients, the dose should be calculated based on ideal body weight.

Oral: A pediatric dose of 0.25 mg/kg is recommended for higher risk surgical patients, those with cardiac or respiratory compromise, or those who have received narcotics or other CNS depressants.

Patients over 70 years of age require a lower plasma concentration of midazolam to produce the same level of sedation achieved in patients less than 60 years of age.

Precautions

BOXED WARNINGS:
-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.

Consult WARNINGS section for additional precautions

US Controlled Substance: Schedule IV

Dialysis

Data not available

Other Comments

Midazolam can be administered concomitantly with atropine sulfate or scopolamine hydrochloride and reduced doses of narcotics.

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