Drug Index


Mechanism :

Midazolam is a short-acting benzodiazepine central nervous system (CNS) depressant. Benzodiazepines presumably exert their effects by binding at stereo specific receptors at several sites within the central nervous system. All benzodiazepines cause a dose-related central nervous system depressant activity.

Indication :

  • Premedication
  • Sedation for procedures
  • Febrile seizure
  • Epilepsy
  • Anxiety

Contraindications :

Contraindicated in patients with a known hypersensitivity to the drug, in patients with acute narrow-angle glaucoma. Midazolam Injection is not intended for intrathecal or epidural administration due to the presence of the preservative benzyl alcohol in the dosage form.

Dosing :

500-750 mcg/kg once, 20-30 mins before procedure, diluted by juice. Max: 20 mg.
100-150 mcg/kg. Max: 10 mg.
<6 months: 50 mcg/kg IV over 2-3 minutes. Titrate with small increments till clinical effect is attained.
6 months to 6 years:
50-100 mcg/kg IV over 2-3 minutes. Repeat every 2-3 mins as and when needed. Max: 6 mg.
6-12 years:
25-50 mcg/kg IV over 2-3 minutes. Repeat every 2-3 mins as and when needed. Max: 10 mg.
Loading dose: 50-150 mcg/kg IV over 2-3 minutes as and when needed. Continuous infusion: 1-2 mcg/kg/min IV infusion.
Continuous infusion: 0.5 mcg/kg/min IV infusion
Status epilepticus:
IV initial bolus of 0.15-0.2 mg/kg followed by 1 mcg/kg/min and increase by 1 mcg/kg/min every 15 min until seizures stop. Max: 5 mcg/kg/min.
<6 month: 300 mcg/kg
6 month-1 year: 2.5 mg
1-4 years: 5 gm
5-9 years: 7.5 mg
>10 years: 10 mg

Adverse Effect :

Decreased respiratory rate and apnea, drowsiness, seizure like activity, nausea/vomiting, cough, pain at injection site, ataxia, irritability, light-headedness, dysarthria, disinhibition, confusion, hangover, headache, dizziness, blurred vision, depression and hallucinations. Withdrawal symptoms on long term usage: muscle cramps, tremor, irritability, convulsions and perceptual distortions.

Interaction :

Erythromycin and other Macrolide Antibiotics, Quinupristin/Dalfopristin and Cimetidine: Inhibit the metabolism of midazolam resulting in reduced clearance, prolonged half-life, and increased volume of distribution producing raised and prolonged plasma midazolam concentrations resulting in profound sedation.
Itraconazole, Ketoconazole, Efavirenz, Nelfinavir, Saquinavir. Indinavir, and . ritonavir: Markedly raise the plasma concentration of midazolam thereby increasing the sedative and amnesic effects.
Diltiazem and Verapamil: Markedly increase the plasma levels and the effects of midazolam.
Grapefruit juice: Can increase the bioavailability of oral midazolam.
Theophylline, Carbamazepine and Phenytoin: May antagonize the sedative effects of benzodiazepines.
Opiates, Anticonvulsants, Sedative Antihistamines, Antipsychotics, Antidepressants and other Anxiolytic/Sedative agents: Enhancement of central depressive effect may occur.

Renal Dose :

Dose in Renal Impairment GFR (mL/min)
20-50Dose as in normal renal function
10-20Dose as in normal renal function
<10Use sparingly and titrate according to response. Only bolus doses, not continuous infusion

Dose in Patients undergoing Renal Replacement Therapies
CAPDUnlikely to be dialysed. Dose as in GFR<10 mL/min
HDNot dialysed. Dose as in GFR<10 mL/min
HDF/High fluxUnknown dialysability. Dose as in GFR<10 mL/min
CAV/VVHDUnknown dialysability. Dose as in normal renal function

Hepatic Dose :

Single dose (eg, induction): No dosage adjustment recommended; patients with hepatic impairment may be more sensitive compared to patients without hepatic impairment; anticipate longer duration of action.
Multiple dosing or continuous infusion: Expect longer duration of action and accumulation; based on patient response, dosage reduction likely to be necessary.
02/22/2024 18:43:31 Midazolam
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