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midazolam

Generic Name: midazolam (oral) (mye DAZ oh lam)
Brand Name: Versed

What is midazolam?

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

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

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

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

Midazolam can slow or stop your breathing, especially if you have recently used a narcotic (opioid) medication. Midazolam is given in a hospital, dentist office, or other clinic setting where your vital signs can be watched closely.

You should not take midazolam if you have narrow-angle glaucoma, if you are allergic to cherries, or if you are allergic to midazolam or similar medicines (Valium, Xanax, Ativan, and others).

Do not drink alcohol for at least 24 hours after taking midazolam.

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

You should not take this medicine if:

  • you have narrow-angle glaucoma;

  • you are allergic to cherries; or

  • you are allergic to midazolam or to other benzodiazepines, such as alprazolam (Xanax), chlordiazepoxide (Librium), clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan), or oxazepam (Serax).

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

  • open-angle glaucoma;

  • asthma, emphysema, bronchitis, chronic obstructive pulmonary disorder (COPD), or other breathing problems;

  • kidney or liver disease;

  • congestive heart failure; or

  • if you also 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.

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

How should I take midazolam?

Midazolam can slow or stop your breathing, especially if you have recently used a narcotic (opioid) medication. Midazolam should be used only in a hospital, dentist office, or other clinic setting where any serious side effects can be quickly treated.

Midazolam is usually given as a single dose just before your surgery or procedure.

After you take midazolam, you will be watched closely to make sure the medicine 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.

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?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of midazolam can be fatal.

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

What should I avoid while taking midazolam?

Do not drink alcohol for at least 24 hours after taking midazolam. This medication can increase the effects of alcohol, which could be dangerous.

Grapefruit and grapefruit juice may interact with midazolam and lead to potentially dangerous effects. Avoid the use of grapefruit products while taking midazolam.

Midazolam injection can cause extreme drowsiness that may last for 24 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; difficult breathing; swelling of your face, lips, tongue, or throat.

Tell your caregivers right away if you have:

  • cough, wheezing, trouble breathing, weak or shallow breathing;

  • slow heart rate;

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

  • agitation, hostility, tremors; or

  • confusion, hallucinations, unusual thoughts or behavior.

The sedative effects of midazolam may last longer in older adults. Accidental falls are common in elderly patients who take benzodiazepines. Use caution to avoid falling or accidental injury while you are taking midazolam.

Common side effects may include:

  • amnesia or forgetfulness after your procedure;

  • drowsiness, dizziness;

  • nausea, vomiting;

  • runny nose, sneezing; or

  • blurred vision.

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.

Side Effects (complete list)

Midazolam dosing information

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

What other drugs will affect midazolam?

Shortly after you take midazolam, 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.

Many drugs can interact with midazolam. Not all possible interactions are listed here. Tell your doctor about all your current medicines, especially:

  • antifungal medicine;

  • an antibiotic;

  • an antidepressant;

  • heart or blood pressure medicine;

  • antiviral medicine to treat hepatitis C or HIV/AIDS;

  • seizure medication; or

  • tuberculosis medication.

This list is not complete and many other drugs can interact with midazolam. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Give a list of all your medicines to any healthcare provider who treats you.

Where can I get more information?

  • Your pharmacist can provide more information about midazolam.
  • 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: 3.01.

Last reviewed: November 29, 2016
Date modified: December 03, 2017

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