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midazolam (injection)

Generic Name: midazolam (injection) (mi DAZ oh lam)
Brand Name:

What is midazolam?

Midazolam is a benzodiazepine (ben-zoe-dye-AZE-eh-peen) sedative.

Midazolam injection is used to sedate a person who is having a minor surgery, dental work, or other medical procedure.

Midazolam injection is also used to sedate a patient who is under critical care and needs a mechanical ventilator (breathing machine).

Midazolam injection may also be used for purposes not listed in this medication guide.

What is the most important information I should know about midazolam?

Before you are treated with midazolam injection, tell your doctor about all your medical conditions or allergies, and all the medicines you are using. Also make sure your doctor knows if you are pregnant or breast-feeding. In some cases, you may not be able to receive midazolam, or you may need a dose adjustment or special precautions.

You should not receive this medication if you have narrow-angle glaucoma.

Using midazolam with other drugs that make you sleepy or slow your breathing can cause dangerous or life-threatening side effects. Ask your doctor before taking a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.

Do not drink alcohol shortly after receiving midazolam. This medication can increase the effects of alcohol, which could be dangerous.

What should I discuss with my healthcare provider before receiving midazolam?

You should not be treated with midazolam injection if you are allergic to it, or if you have:

  • narrow-angle glaucoma.

To make sure midazolam is safe for you, tell your doctor if you have:

  • open-angle glaucoma;

  • asthma or other breathing disorder;

  • kidney or liver disease;

  • congestive heart failure;

  • an electrolyte imbalance (such as low levels of potassium or magnesium in your blood);

  • if you have recently used alcohol, sedatives, tranquilizers, or narcotic (opioid) medications;

  • if you are dehydrated; or

  • if you use a narcotic (opioid) medication.

Midazolam can cause birth defects in an unborn baby, and generally should not be used during pregnancy. Tell your doctor if you are pregnant or plan to become pregnant.

Midazolam can pass into breast milk and may harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

The sedative effects of midazolam may last longer in older adults. Accidental falls are common in elderly patients who use benzodiazepines. Use caution to avoid falling or accidental injury shortly after receiving midazolam injection.

How is midazolam injection given?

Midazolam is injected into a muscle, or into a vein through an IV. You will receive this injection in a medical, dental, or surgical setting.

Midazolam is usually given as a single dose just before a surgery or medical procedure. For mechanical ventilation, midazolam is given using a continuous infusion that keeps the patient sedated around the clock.

After treatment with midazolam injection, you will be watched to make sure the medication is working and does not cause harmful side effects.

Your breathing, blood pressure, oxygen levels, and other vital signs will be watched closely while you are in surgery.

Midazolam can make you very drowsy, dizzy, or light-headed. These effects may last longer in older adults. Use caution to avoid falling or accidental injury after you have received midazolam injection. You may need help getting out of bed for at least the first 8 hours.

When midazolam is discontinued after long-term use, you may have withdrawal symptoms. The most common withdrawal symptoms are hallucinations, tremors, sweating, muscle cramps, stomach pain, and vomiting. You may also have a seizure (convulsions).

What happens if I miss a dose?

Because you will receive midazolam in a clinical setting, you are not likely to miss a dose.

What happens if I overdose?

Since this medication is given by a healthcare professional in a medical setting, an overdose is unlikely to occur.

What should I avoid after receiving midazolam?

Do not drink alcohol shortly after receiving midazolam. This medication can increase the effects of alcohol, which could be dangerous.

Midazolam injection can cause extreme drowsiness that may last for several hours after you have received the medication. Older adults may feel sleepy for even longer.

Avoid driving or doing anything that requires you to be awake and alert until the effects of this medicine have worn off completely.

Midazolam side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Tell your caregivers right away if you have:

  • wheezing, trouble breathing, weak or shallow breathing;

  • slow heart rate;

  • a light-headed feeling, like you might pass out;

  • tremors, uncontrolled muscle movements;

  • restlessness, feeling agitated;

  • a seizure (convulsions); or

  • confusion, hallucinations, loss of coordination, muscle weakness.

Common side effects may include:

  • drowsiness, dizziness, confusion;

  • pain, redness, or swelling where the medicine was injected;

  • headache, blurred vision;

  • cough, hiccups;

  • nausea, vomiting; or

  • amnesia or forgetfulness after your procedure.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Midazolam dosing 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.

What other drugs will affect midazolam?

Shortly after you are treated with this medicine, taking other drugs that make you sleepy or slow your breathing can cause dangerous side effects. Tell your doctor if you regularly use a sleeping pill, narcotic pain medicine, prescription cough medicine, a muscle relaxer, or medicine for anxiety, depression, or seizures.

Tell your doctor about all your current medicines, especially:

  • any other benzodiazepines (such as alprazolam, diazepam, Valium, Xanax, and others);

  • antibiotic or antifungal medicine;

  • heart or blood pressure medicine; or

  • HIV or AIDS medication.

This list is not complete. Other drugs may interact with midazolam, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Where can I get more information?

  • Your doctor or pharmacist can provide more information about midazolam injection.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 1.01.

Last reviewed: June 04, 2013
Date modified: November 30, 2016

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