Midazolam: Difference between revisions
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''See [[critical care quick reference]] for drug doses by weight.'' | ''See [[critical care quick reference]] for drug doses by weight.'' | ||
==General== | ==General== | ||
*Type: [[Benzodiazepines]] | *Type: [[Is DrugClass::Benzodiazepines]] | ||
*Dosage Forms: | *Dosage Forms: IV | ||
*Common Trade Names: | *Common Trade Names: [[BrandName::Versed]] | ||
==Adult Dosing== | ==Adult Dosing== | ||
*2mg IV | *[[Has Indication::Anxiolysis]]/[[Has Indication::sedation]]: | ||
**1-2mg IV push | |||
**0.07 to 0.08 mg/kg IM, usual dose 5 mg for 60 kg pt | |||
*[[Seizure]]: | |||
**[[SeizureDose::10mg IM/IV]] | |||
*ICU Sedation: | |||
**Load: 10-50mcg/kg IV infusion | |||
**Maintenance: 20-100 mcg/kg/hr infusion | |||
**Use with standardized sedation protocol for titration | |||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
''See [[critical care quick reference]] for drug doses by weight.'' | ''See [[critical care quick reference]] for drug doses by weight.'' | ||
*Anxiolysis/sedation: | |||
**6mo-5yr: 0.05-0.1 mg/kg IV push | |||
**6-12yr: 0.025-0.05 mg/kg IV push | |||
*Intranasal | |||
**[[Has Indication::Seizure]]: 0.2 mg/kg IN divided between nostrils | |||
**Procedural sedation: 0.2-0.6 mg/kg IN divided between nostrils | |||
**Anxiolysis: 0.5 mg/kg IN (max dose 10 mg) | |||
==Special Populations== | ==Special Populations== | ||
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: | *[[Drug Ratings in Pregnancy|Pregnancy Rating]]: D | ||
*Lactation: | **Maternal use shortly before delivery associated with floppy infant syndrome | ||
*Renal Dosing | *Lactation: Distributed in breast milk, use with caution | ||
**Adult | *Renal Dosing: | ||
**Adult: Decrease by 50% for severe renal failure | |||
**Pediatric | **Pediatric | ||
*Hepatic Dosing | *Hepatic Dosing: | ||
**Adult | **Adult: Prolonged clearance in cirrhosis | ||
**Pediatric | **Pediatric | ||
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==Adverse Reactions== | ==Adverse Reactions== | ||
===Serious=== | ===Serious=== | ||
*Apnea | |||
*Hypopnea | |||
*Hypotension | |||
*[[Delirium]], when used for prolonged periods in ICU setting | |||
===Common=== | ===Common=== | ||
*Drowsiness | |||
*[[Nausea/vomiting]] | |||
==Pharmacology== | ==Pharmacology== | ||
*Half-life: | *Peak effect: | ||
*Metabolism: | **IM: Children: 15 to 30 minutes; Adults: 30 to 60 minutes | ||
*Excretion: | **IV: 5 to 7 minutes | ||
*Mechanism of Action: | **Intranasal: 10 minutes | ||
*Duration | |||
**IV: Single dose: <2 hours (dose-dependent),up to 6 hours with cirrhosis | |||
**IM: Up to 6 hours; Mean: 2 hours | |||
**Intranasal: Children: 18 to 41 minutes | |||
*Half-life: 1.8-6.4 hr | |||
*Metabolism: Metabolized in liver by CYP3A4 to active metabolite α<sub>1</sub>-hydroxymidazolam | |||
*Excretion: Renal | |||
*Mechanism of Action: CNS depressant. Acts at GABA receptor to increase frequency of chloride channel opening, causing hyperpolarization and stabilization of neuronal membrane. | |||
==See Also== | ==See Also== | ||
*[[Intranasal sedation]] | |||
== | ==References== | ||
Micromedex | |||
<references/> | <references/> | ||
[[Category: | [[Category:Pharmacology]] | ||
Latest revision as of 10:05, 15 July 2025
See critical care quick reference for drug doses by weight.
General
- Type: Benzodiazepines
- Dosage Forms: IV
- Common Trade Names: Versed
Adult Dosing
- Anxiolysis/sedation:
- 1-2mg IV push
- 0.07 to 0.08 mg/kg IM, usual dose 5 mg for 60 kg pt
- Seizure:
- 10mg IM/IV
- ICU Sedation:
- Load: 10-50mcg/kg IV infusion
- Maintenance: 20-100 mcg/kg/hr infusion
- Use with standardized sedation protocol for titration
Pediatric Dosing
See critical care quick reference for drug doses by weight.
- Anxiolysis/sedation:
- 6mo-5yr: 0.05-0.1 mg/kg IV push
- 6-12yr: 0.025-0.05 mg/kg IV push
- Intranasal
- Seizure: 0.2 mg/kg IN divided between nostrils
- Procedural sedation: 0.2-0.6 mg/kg IN divided between nostrils
- Anxiolysis: 0.5 mg/kg IN (max dose 10 mg)
Special Populations
- Pregnancy Rating: D
- Maternal use shortly before delivery associated with floppy infant syndrome
- Lactation: Distributed in breast milk, use with caution
- Renal Dosing:
- Adult: Decrease by 50% for severe renal failure
- Pediatric
- Hepatic Dosing:
- Adult: Prolonged clearance in cirrhosis
- Pediatric
Contraindications
- Allergy to class/drug
Adverse Reactions
Serious
- Apnea
- Hypopnea
- Hypotension
- Delirium, when used for prolonged periods in ICU setting
Common
- Drowsiness
- Nausea/vomiting
Pharmacology
- Peak effect:
- IM: Children: 15 to 30 minutes; Adults: 30 to 60 minutes
- IV: 5 to 7 minutes
- Intranasal: 10 minutes
- Duration
- IV: Single dose: <2 hours (dose-dependent),up to 6 hours with cirrhosis
- IM: Up to 6 hours; Mean: 2 hours
- Intranasal: Children: 18 to 41 minutes
- Half-life: 1.8-6.4 hr
- Metabolism: Metabolized in liver by CYP3A4 to active metabolite α1-hydroxymidazolam
- Excretion: Renal
- Mechanism of Action: CNS depressant. Acts at GABA receptor to increase frequency of chloride channel opening, causing hyperpolarization and stabilization of neuronal membrane.
See Also
References
Micromedex