Midazolam

See critical care quick reference for drug doses by weight.

General

Adult Dosing

  • Anxiolysis/sedation:
    • 1-2mg IV push
    • 0.07 to 0.08 mg/kg IM, usual dose 5 mg for 60 kg pt
  • 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

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