Drug Index

Midazolam

 
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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 :

Sedation:

Oral: 500-750 mcg/kg once, 20-30 mins before procedure, diluted by juice. Max: 20 mg.

IM: 100-150 mcg/kg. Max: 10 mg.

IV: <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.

Anaesthesia:

Non-neonatal:

Loading dose: 50-150 mcg/kg IV over 2-3 minutes as and when needed. Continuous infusion: 1-2 mcg/kg/min IV infusion.

Neonatal:

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.

Buccal:

<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.


07/14/2019 01:44:52 Midazolam
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