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Midazolam is a short-acting benzodiazepine that acts as a central nervous system (CNS) depressant. Depending on the dose, midazolam is used to treat insomnia and anxiety, induce sedation prior to minor surgical and dental procedures, and inducing anesthesia.
Midazolam is usually available as an oral tablet or an IM/IV injection. The oral tablets should be swallowed whole without crushing or chewing. It is preferably taken on an empty stomach for optimal absorption and effect. You can take it 1-2 hours before a meal or 2-3 hours after a meal.
The IM/IV injection is typically prepared and administered by a licensed healthcare worker in the hospital or clinic. Do not self-administer IM/IV injections.
Midazolam is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store midazolam in the bathroom or the freezer. There may be different brands of midazolam that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.
You should not flush midazolam down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.
Before using this medication, inform your doctor if:
As a benzodiazepine, additional precautions should be taken:
There is positive evidence that shows there is an increased risk of congenital malformations associated with the use of benzodiazepines. Midazolam is excreted in breastmilk and should be used with caution in breastfeeding mothers.
Please always consult with your doctor to weigh the potential benefits and risks before taking this medication. This medication is pregnancy risk category D, according to the US Food and Drug Administration (FDA).
FDA pregnancy risk category reference below:
Midazolam is excreted in breast milk. If you are or will be breastfeeding while you are using midazolam, check with your doctor or pharmacist to discuss the risks to your baby.
Common expected side effects include irritability, coughing, hiccups, insomnia, nightmares, drowsiness, headache, nausea, vomiting, restlessness, and speech difficulty.
Uncommon side effects include mental confusion, hypotension, coma, dizziness, impaired balance, reflexes and coordination, seizures, skin rash, and palpitations. These should be reported immediately to a doctor.
Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side effect, please consult your doctor or pharmacist.
Midazolam may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects.
To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs, and herbal products) and share it with your doctor and pharmacist.
For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.
Products may interact with this drug, including:
Midazolam may be less absorbed when taken together with food. It is best to take this medication on an empty stomach for maximum absorption and effect.
Do not take this drug with alcohol as it may increase the CNS depressive effects which include symptoms ranging from drowsiness to coma to death.
Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.
Midazolam may interact with your current health conditions. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have.
These health conditions are:
The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using midazolam.
Initial dose: 2-2.5 mg at a rate of 2 mg/min 5-10 min before procedure, with increments of 0.5-1 mg at intervals of at least 2 min. Total dose: 2.5-7.5 mg.
Loading dose: 0.03-0.3 mg/kg, may be given in increments of 1-2.5 mg at 2 min between each dose.
Maintenance: 0.02-0.2 mg/kg/hr. Patients w/ hypothermia, hypovolaemia or vasoconstriction: Reduce or omit loading dose, and reduce maintenance dose.
Total dose: 150-250 mcg/kg in premedicated patients and 300-350 mcg/kg for those without premedication. Sedation in combined anaesth: 30-100 mcg/kg by inj or 30-100 mcg/kg/hr by infusion.
70-100 mcg/kg 20-60 min before surgery by deep IM injection or 1-2 mg, 5-30 min before surgery by IV injection, repeat dose if necessary.
Ages 6 months to 16 years old: 0.25-1 mg/kg, as a single dose 20-30 minutes before the procedure. Maximum dose of 20 mg.
Ages 3-12 months: 2.5 mg; 1-5 years: 5 mg; 5-10 years: 7.5 mg; 10-18 years: 10 mg. Doses are to be given as a single dose.
Age 1-15 years: 50-150 mcg/kg. Maximum dose of 10 mg.
*Note: IM route should not be used routinely.
Age 1-15 years: 80-200 mcg/kg given 15-30 mins before surgery by deep IM injection.
Age 6 months to 5 years: 500-100 mcg/kg, maximum dose of 6 mg.
Age 6-12 years: 25-50 mcg/kg, maximum dose of 10 mg.
Initial doses are given over 2-3 minutes with an additional interval of 2-5 minutes.
Age 0-32 weeks: 60 mcg/kg/hr via continuous IV infusion, reduce the dose after 24 hours to 30 mcg/kg/hr. The maximum duration of treatment is 4 days.
Age 32 weeks to 6 months: 60 mcg/kg/hr. The maximum duration of treatment is 4 days for neonates.
Age 6 months to 12 years:
Loading dose: 50-200 mcg/kg given via slow injection over 3 minutes or more.
Maintenence dose: 30-120 mcg/kg/hr given as continuous infusion.
Age over 7 years: 150 mcg/kg by slow injection.
Midazolam is available in the following brands, dosage forms, and strengths:
In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room. You may be given flumazenil as an antidote.
Symptoms of overdose may include:
Life-threatening symptoms of overdose include:
In most cases, your dose will be administered by a licensed health professional so missing a dose will be unlikely. In case a dose was missed, do not administer double the dose.
Hello Health Group does not provide medical advice, diagnosis or treatment.
Midazolam. https://www.mims.com/philippines/drug/info/midazolam. Accessed July 13, 2020
Midazolam – Injection, USP. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/208878Orig1s000lbl.pdf. Accessed July 13, 2020.