Skip to Content

Remimazolam Dosage

Usual Adult Dose for Light Sedation

INDUCTION: 5 mg via IV injection (over 1 minute) ONCE
-American Society of Anesthesiologists-Physical Status (ASA-PS) III and IV patients: 2.5 to 5 mg via IV injection (over 1 minute) ONCE

MAINTENANCE OF PROCEDURAL SEDATION: 2.5 mg via-IV injection (over 15 seconds)
-ASA-PS III-IV: 1.25 to 2.5 mg via IV injection (over 15 seconds)

Comments:
-Vital signs should be monitored, an unobstructed airway should be maintained, and artificial ventilation equipment should be available.
-A benzodiazepine reversal agent should be immediately available.
-Fentanyl, used in 25 to 75 mcg doses (for anesthesia), should be administered before this drug; additional fentanyl doses may be given as needed for analgesia.
-At least 2 minutes should elapse between maintenance doses (if needed).

Use: Induction and maintenance of procedural sedation in patients undergoing procedures lasting 30 minutes or less

Usual Adult Dose for Sedation

INDUCTION: 5 mg via IV injection (over 1 minute) ONCE
-American Society of Anesthesiologists-Physical Status (ASA-PS) III and IV patients: 2.5 to 5 mg via IV injection (over 1 minute) ONCE

MAINTENANCE OF PROCEDURAL SEDATION: 2.5 mg via-IV injection (over 15 seconds)
-ASA-PS III-IV: 1.25 to 2.5 mg via IV injection (over 15 seconds)

Comments:
-Vital signs should be monitored, an unobstructed airway should be maintained, and artificial ventilation equipment should be available.
-A benzodiazepine reversal agent should be immediately available.
-Fentanyl, used in 25 to 75 mcg doses (for anesthesia), should be administered before this drug; additional fentanyl doses may be given as needed for analgesia.
-At least 2 minutes should elapse between maintenance doses (if needed).

Use: Induction and maintenance of procedural sedation in patients undergoing procedures lasting 30 minutes or less

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Mild to moderate liver dysfunction: Data not available
Severe liver dysfunction: Doses should be carefully titrated; patients may require less frequent supplemental doses to achieve sedation. Frequent monitoring for cardiorespiratory adverse events is recommended.

Precautions

CONTRAINDICATIONS:
-Patients with a history of a severe hypersensitivity reaction to dextran 40 and/or any product containing dextran 40

US BOXED WARNINGS:
PERSONNEL AND EQUIPMENT FOR MONITORING AND RESUSCITATION:
-This drug has been associated with bradycardia, hypotension, and hypoxia.
Recommendations:
-This drug should only be administered by personnel trained in the administration of procedural sedation and not involved in the conduct of the diagnostic or therapeutic procedure.
-Vital signs should be continuously monitored during sedation and through the recovery period.
-Administering personnel should 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.
-Resuscitative drugs and age-/size-appropriate equipment for bag/valve/mask-assisted ventilation must be immediately available during administration of this drug.

RISKS FROM CONCOMITANT USE WITH OPIOID ANALGESICS AND OTHER SEDATIVE-HYPNOTICS
-Concomitant use of benzodiazepines (including this drug) and opioid analgesics may result in profound sedation, respiratory depression, coma, and/or death.
-The sedative effect of IV formulations can be accentuated by concomitantly administered central nervous system (CNS) depressant medications, including other benzodiazepines and propofol.
Recommendation:
-Patients should be continuously monitored for respiratory depression and depth of sedation.

Safety and efficacy have not been established in pediatric patients this drug is not recommended for use in these patients.

Consult WARNINGS section for additional precautions.

US Controlled Substance: Schedule IV

Dialysis

Data not available

Other Comments

Administration advice:
-Prepared IV solutions should be administered immediately.

Storage requirements:
-Vials should be protected from light.
-Reconstituted solution: Vials may be stored at 20 to 25C for up to 8 hours.

Reconstitution/preparation techniques:
-The manufacturer product information should be consulted.

IV compatibility:
-Compatible: 20% dextrose injection, 5% dextrose injection, 5% dextrose and 0.45% sodium chloride-0.9% sodium chloride
-Incompatible: Other drugs or fluids

General:
-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:
-CARDIORESPIRATORY: Frequent monitoring for sedation-related adverse events

Patient advice:
-Patients should be advised to report alcohol consumption and all concurrent prescription and nonprescription medications or herbal products they are taking.
-Advise patients to speak to their healthcare provider if they become pregnant, intend to become pregnant, or are breastfeeding.

Further information

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