Midazolam
Tranquilizer, Sedative/Hypnotic · Benzodiazepine
Indications
Inj: Sedative before and during minor surgical procedures. Sedation by IV infusion in intensive care. Induction of anaesthesia. Tab: Disturbances of sleep rhythm and all forms of insomnia; difficulty in falling sleep either initially or after premature awakening. Sedation in pre-medication before surgical or diagnostic procedures.
Dosage
Adults: The dose needs to be individualized based on the patient's age, underlying diseases and concurrent medications. Consider reducing dose by 20% to 50% in elderly, chronically ill, or debilitated patients and those receiving opioids or other CNS depressants. Preoperative/preprocedural sedation: Healthy adults < 60 yr: IM: 0.07-0.08 mg/kg 30-60 minutes prior to surgery/procedure, usual dose 5 mg. IV: 0.02-0.04 mg/kg, repeat every 5 minutes as needed to desired effect or up to 0.1-0.2 mg/kg. Conscious sedation: IV: Healthy adults < 60 yr: Initial 1 mg; no more than 2.5 mg over a period of 2 minutes. Additional doses after 2 minutes if necessary. Total dose above 5 mg is generally not needed. Maintenance 25% of dose used to reach sedative effect. Above 60 yr age, consider dose reduction as for elderly as mentioned below. Anaesthesia: IV: Induction: Adults < 55 yr: Patients without…
Administration
IM: Give deep IM into large muscle. IV: Administer by slow IV injection over at least 2-5 min at a concentration of 1-5 mg/mL or by IV infusion. Continuous infusions should be administered via an infusion pump. Compatibility: Stable in D5NS, D5W, NS. Incompatible with LR. Y-site administration: Drug to Drug IV Compatibility: Amikacin, amiodarone, aztreonam, calcium gluconate, cephazolin, ceftriaxone, cimetidine, ciprofloxacin, cisatracurium, digoxin, diltiazem, diphenhydramine, dopamine, enalapril, epinephrine, esmolol, famotidine, fentanyl, fluconazole, gentamicin, heparin, hydromorphone, labetalol, levofloxacin, linezolid, lorazepam, magnesium sulphate, methylprednisolone, metoclopramide, metronidazole, milrinone, morphine, nitroglycerin, nitroprusside, norepinephrine, ondansetron, phenylephrine, ranitidine, tobramycin, vancomycin, vasopressin, vecuronium. Drug to Drug IV…
Adverse Effects
Confusion, euphoria, hallucinations, headache, somnolence, impaired consciousness, dizziness, ataxia, anterograde amnesia, paradoxical reactions, convulsions, GI upset, cardiorespiratory depression, hypotension, rash, slight tachycardia, vasodilation, dyspnoea, erythema, thrombophlebitis, thrombosis, pain at injection site. Paradoxical reactions, anterograde amnesia. Tolerance and dependence may develop during long-term sedation. Judgement and dexterity may be impaired; warn patient. Reports of anterograde amnesia.
Risk Factor (Pregnancy/Lactation)
Pregnancy: Positive evidence of risk: Use only when no safer alternative exists for a serious problem. Lactation: Caution advised or effect undetermined. Contraindications: Acute pulmonary insufficiency. Respiratory depression. Sleep apnoea, myasthenia gravis. Severe hepatic impairment. History of alcohol or drug abuse. Precautions: Cardiopulmonary resuscitation facilities must be available. Chronic respiratory insufficiency, renal, hepatic or cardiac impairment, paediatrics patients with cardiovascular instability, congestive heart failure; use lower doses, administer slowly and monitor vital functions. History of alcohol or drugs abuse. Myasthaenia gravis. Outpatients; ensure accompanied by responsible adult. Elderly, debilitated patients, withdraw gradually.
Interactions
Antipsychotics, hypnotics, anxiolytics, antidepressants, narcotic analgesics, anticonvulsants, anaesthetics, antihistamines, alcohol, erythromycin, cimetidine, diltiazem, verapamil, ketoconazole, fluconazole, itraconazole, other CYP3A4 inhibitors or inducers, cyclosporin, nifedipine, nabilone, muscle relaxants, ulcer-healing drugs, xanthines, macrolides, protease inhibitors, atorvastatin, calcium-channel blockers, rifampicin, St John's wort, grapefruit juice, levodopa, disulfiram.
Advice to Patient
Do not take prescription medications, OTC sedatives or hypnotics for atleast 24 hours after administration. Avoid alcohol during therapy. Be cautious while driving or doing tasks that require alertness until drowsiness or dizziness has completely gone.
Pharmacokinetics
Onset of action: IM: Sedation: Children: Within 5 mins; Adults: Approx. 15 mins; IV: 3-5 mins; Oral: 10-20 mins; Intranasal: Children: 5.55 ± 2.22 mins. Adults: Within 5 mins. Peak effect: IM: Children: 15-30 mins; Adults: 30-60 mins; IV: 3-5 mins; Intranasal: Children: 10 mins. Duration: IM: Up to 6 hrs; Mean: 2 hrs; Intranasal: Children: 23.1 mins; IV: Single dose: <2 hrs (dose-dependent). Absorption: IM: Rapid, complete; Oral, Intranasal: Rapid. Metabolism: Extensively hepatic. Bioavailability: Oral: 40%-50%, approx. 36% (children); IM: >90%; Intranasal: Children: Approx. 60%; Rectal: Children: Approx. 40%-65%. Half-life elimination: Prolonged in cirrhosis, congestive heart failure, obesity, renal failure, and elderly. Note: In patients with renal failure, reduced elimination of active hydroxylated metabolites leads to drug accumulation and prolonged sedation. Preterm infants (n=24;…
Brands with this active ingredient
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