MIDAZOLam
Classification
high alert medication
Controlled and targeted substance
Short-acting benzodiazepine
Indications
ACP: Sedation of agitated patients
ACP: Control of seizures
ACP: Maintenance of anesthesia in intubated patients
Contraindications
- Hypersensitivity to MIDAZOLam or other benzodiazepines
- Acute narrow-angle glaucoma
- Shock
- Decreased level of consciousness
- Hypotension
Adult dosages
ACP: All indications
- 2-5 mg IV/IO in increments to effect
- 5-10 mg IM
- May repeat as required in small increments
- Maximum dose from all sources is 30 mg
- CliniCall consultation required if higher doses or additional sedation is required.
Pediatric Considerations And Dosing
ACP: All indications
- 0.2 mg/kg IN, OR
- Maximum dose 10 mg
- Intranasal drug administration is recommended over intramuscular because of a more consistent absorption
- Administer half the dose in each nare
- Consult PR11: Intranasal Medication Administration for additional information on the use of mucosal atomizer devices
- 0.1 mg/kg IV/IO, OR
- Maximum dose 5 mg
- 0.2 mg/kg IM
Mechanism Of Action
Like other benzodiazepines, MIDAZOLam intensifies the activity of gamma aminobutyric acid, the major inhibitory neurotransmitter in the central nervous system. This action is believed to result in hyperpolarization of neuronal cells, which then take longer to reach threshold and depolarize.
Pharmacokinetics
- Onset: 3-5 minutes (IM); 1-3 minutes (IV)
- Peak: 15 minutes (IM); 10 minutes (IV)
- Duration: 30 minutes (IM); 20 minutes (IV)
Adverse Effects
- Sedation, headache, blurred vision
- Hypotension
- Nausea and vomiting
- Pain and tenderness if given IM
- Respiratory depression
Overdose
Benzodiazepine overdoses should be managed supportively, with oxygenation and ventilation supported as necessary, and fluids given to maintain an adequate blood pressure. Reversal agents are available in-hospital.
Warning And Precautions
Use with caution when administering other central nervous system depressants or narcotic analgesics.
Drug Interactions
- Erythromycin, diltiazem, verapamil, ketoconazole, fluconazole, and itraconazole can significantly increase the bioavailability of MIDAZOLam and may produce prolonged sedation.
- Ritonavir and nelfinavir may cause deep and prolonged sedation that may progress to respiratory depression.
- Rifampin, carbamazepine, and phenytoin may markedly reduce the effectiveness of MIDAZOLam.