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 | 5 mg IM | Benzodiazepine for agitation | IM | Adult |
| Excited delirium | 5 mg | Benzodiazepine sedation | IM | Adult |
| Procedural sedation | 1-2 mg | Procedural sedation (with fentanyl) | IV | Adult |
| Rapid sequence intubation | 0.2-0.3 mg/kg | Induction | IV | Adult |
| Status epilepticus (peds) | 0.2mg/kg IM/intranasal (max 10mg/dose) | Prehospital first-line for pediatric status epilepticus | IM/IN | Pediatric |
See Also
References
Micromedex