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.
10/27/2020 01:21:06 Midazolam
Disclaimer: The information given by www.pediatriconcall.com is provided by medical and paramedical & Health providers voluntarily for display & is meant only for informational purpose. The site does not guarantee the accuracy or authenticity of the information. Use of any information is solely at the user's own risk. The appearance of advertisement or product information in the various section in the website does not constitute an endorsement or approval by Pediatric Oncall of the quality or value of the said product or of claims made by its manufacturer.
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0