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Midazolam Side Effects

Medically reviewed by Philip Thornton, DipPharm. Last updated on Jan 6, 2024.

Applies to midazolam: nasal spray. Other dosage forms:

Warning

Nasal route (Spray)

Warning: Risks from concomitant use with opioids; abuse, misuse, and addiction; dependence and withdrawal reactionsConcomitant use of benzodiazepines and opioids may result in profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs for patients for whom alternative treatment options are inadequate. Limit dosages and durations to the minimum required. Follow patients for signs and symptoms of respiratory depression and sedation.The use of benzodiazepines, including midazolam, exposes users to risks of abuse, misuse, and addiction, which can lead to overdose or death. Abuse and misuse of benzodiazepines commonly involve concomitant use of other medications, alcohol, and/or illicit substances, which is associated with an increased frequency of serious adverse outcomes. Before prescribing midazolam and throughout treatment, assess each patient's risk for abuse, misuse, and addiction.The continued use of benzodiazepines may lead to clinically significant physical dependence. The risks of dependence and withdrawal increase with longer treatment duration and higher daily dose. Although midazolam is indicated only for intermittent use, if used more frequently than recommended abrupt discontinuation or rapid dosage reduction of midazolam may precipitate acute withdrawal reactions, which can be life-threatening. For patients using midazolam more frequently than recommended, to reduce the risk of withdrawal reactions, use a gradual taper to discontinue midazolam.

Serious side effects of Midazolam

Along with its needed effects, midazolam may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking midazolam:

Incidence not known

Get emergency help immediately if any of the following symptoms of overdose occur while taking midazolam:

Symptoms of overdose

Other side effects of Midazolam

Some side effects of midazolam may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Less common

For Healthcare Professionals

Applies to midazolam: compounding powder, injectable solution, intramuscular solution, intravenous solution, nasal spray, oral syrup.

General

The most commonly reported side effects with oral formulations include emesis and nausea. Decreased tidal volume/respiratory rate and apnea were most commonly reported with parenteral formulations.[Ref]

Respiratory

Oral:

Very common (10% or more): Respiratory adverse events (up to 11%)

Common (1% to 10%): Respiratory depression, hypoxia, laryngospasm, upper airway obstruction, rhonchi, congestion

Uncommon (0.1% to 1%): Sneezing/rhinorrhea

Frequency not reported: Apnea, hypercarbia, desaturation, stridor, hiccough

Parenteral:

Very common (10% or more): Decreased tidal volume/respiratory rate (up to 23.3%), apnea (up to 15.4%)

Common (1% to 10%): Hiccoughs, coughing, desaturation

Very rare (less than 0.01%): Dyspnea, hiccup, laryngospasm, respiratory arrest

Frequency not reported: Respiratory depression

Postmarketing reports: Bronchospasm, hyperventilation, wheezing, shallow respirations, airway obstruction, tachypnea, dysphonia, yawning, continued phonation[Ref]

Respiratory adverse events included hypoxia, laryngospasm, rhonchi, coughing, respiratory depression, airway obstruction, upper airway congestion, and shallow respirations; these side effects occurred more frequently at higher doses.

Decreased tidal volume/respiratory rate occurred in 23.3% of patients given IV formulations and in 10.8% of patients given IM formulations.

Apnea occurred in 15.4% of patients given IV formulations.[Ref]

Gastrointestinal

Oral:

Very common (10% or more): Emesis/vomiting (up to 11%)

Common (1% to 10%): Nausea

Frequency not reported: Gagging, salivation

Parenteral:

Common (1% to 10%): Nausea, vomiting

Very rare (less than 0.01%): Constipation, dry mouth

Postmarketing reports: Acid taste, excessive salivation, retching, toothache[Ref]

Nervous system

Oral:

Common (1% to 10%): Sedation/prolonged sedation, somnolence, depressed levels of consciousness

Frequency not reported: Drooling, dizziness, ataxia, vertigo, dysarthria, loss of balance

Parenteral:

Common (1% to 10%): Headache, oversedation, drowsiness, seizure-like activity

Very rare (less than 0.01%): Movement disorder, ataxia, dizziness, seizure, anterograde amnesia

Frequency not reported: Involuntary movements, hyperactivity, decreased alertness, somnolence, prolonged/postoperative sedation, convulsions/drug withdrawal convulsions, feeling faint, tonic/clonic movements and muscle tremor

Postmarketing reports: Vasovagal episode, retrograde amnesia, grogginess, athetoid movements, lethargy, slurred speech, paresthesia, loss of balance, lightheadedness, feeling of burning, emergence delirium or agitation[Ref]

Cardiovascular

Oral:

Common (1% to 10%): Bradycardia, bigeminy

Frequency not reported: Increased heart rate, cardiac arrest, heart failure, decreased systolic and diastolic blood pressure

Parenteral:

Common (1% to 10%): Hypotension

Very rare (less than 0.01%): Bradycardia, cardiac arrest, vasodilation

Frequency not reported: Thrombophlebitis, thrombosis, variations in blood pressure and pulse rate

Postmarketing reports: Bigeminy, premature ventricular contractions, tachycardia, nodal rhythm, hematoma, cardiovascular collapse, cardiovascular reactions, severe cardiorespiratory adverse events[Ref]

Local

Parenteral:

Common (1% to 10%): IM injection site pain, IV site tenderness/pain during injection/redness/induration

Uncommon (0.1% to 1%): IM injection site induration/redness/muscle stiffness, IV site phlebitis

Frequency not reported: Injection site erythema, injection site pain

Postmarketing reports: Hive-like elevation at injection site, warmth or coldness at injection site[Ref]

Psychiatric

Oral:

Common (1% to 10%): Agitation

Frequency not reported: Dysphoria, disinhibition, excitation, aggression, mood swings, hallucinations, confusion, inappropriate/adverse behavior, behavioral/emotional disorders, euphonia, libido disorders, restlessness, irritability, delusions, anger eruptions, nightmares, psychosis, physical dependency, withdrawal symptoms, abuse, depression (existing, unobserved depression)

Parenteral:

Very rare (less than 0.01%): Aggression/aggressiveness, agitation, anger, hallucination, hostility, confusion/confusional state, euphoric mood/euphoria

Frequency not reported: Rage, excitement/paroxysmal excitement, abuse, physical drug dependence and withdrawal syndrome

Postmarketing reports: Argumentativeness, nervousness, anxiety, restlessness, sleep disturbance, insomnia, nightmares, dysphoria, irritability, tension, mood changes, dreaming during sleep[Ref]

Dermatologic

Oral:

Common (1% to 10%): Rash

Uncommon (0.1% to 1%): Pruritus and urticaria

Parenteral:

Frequency not reported: Angioedema

Postmarketing reports: Hives, rash, pruritus, skin reactions[Ref]

Ocular

Oral:

Frequency not reported: Diplopia, strabismus, blurred vision

Parenteral:

Common (1% to 10%): Nystagmus

Postmarketing reports: Blurred vision, diplopia, pinpoint pupils, visual disturbance, difficulty focusing eyes, cyclic movement of the eyelids[Ref]

Other

Oral:

Frequency not reported: Fatigue, falls

Parenteral:

Common (1% to 10%): Paradoxical reaction

Very rare (less than 0.01%): Fatigue, falls, assault/physical assault

Postmarketing reports: Prolonged emergence from anesthesia, blocked ears, chills, weakness, swelling, dreaming during emergence[Ref]

Hypersensitivity

Oral:

Frequency not reported: Hypersensitivity

Parenteral:

Frequency not reported: Hypersensitivity, anaphylactic shock

Postmarketing reports: Allergic reaction, anaphylactoid reactions[Ref]

Musculoskeletal

Oral:

Frequency not reported: Muscle weakness, fractures

Parenteral:

Frequency not reported: Fractures[Ref]

Frequently asked questions

References

1. Product Information. Versed (midazolam). Roche Laboratories. 2001;PROD.

2. Cerner Multum, Inc. UK Summary of Product Characteristics.

3. Cerner Multum, Inc. Australian Product Information.

Further information

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

Some side effects may not be reported. You may report them to the FDA.

Medical Disclaimer