Midazolam

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.

Indications by Condition

The following table is automatically generated from disease/condition pages across WikEM.

	Indication	Dose	Context	Route	Population
Agitated or combative patient#Midazolam Benzodiazepine for agitation Adult	Agitated or combative patient	5 mg IM	Benzodiazepine for agitation	IM	Adult
Excited delirium#Midazolam Benzodiazepine sedation Adult	Excited delirium	5 mg	Benzodiazepine sedation	IM	Adult
Procedural sedation#Midazolam Procedural sedation (with fentanyl) Adult	Procedural sedation	1-2 mg	Procedural sedation (with fentanyl)	IV	Adult
Rapid sequence intubation#Midazolam Induction Adult	Rapid sequence intubation	0.2-0.3 mg/kg	Induction	IV	Adult
Status epilepticus (peds)#Midazolam Prehospital first-line for pediatric status epilepticus Pediatric	Status epilepticus (peds)	0.2mg/kg IM/intranasal (max 10mg/dose)	Prehospital first-line for pediatric status epilepticus	IM/IN	Pediatric

See Also

• Intranasal sedation

References

Micromedex