Midazolam

Therapeutic Group

Psycholeptics (Antipsychotic, Anxiolytic/Hypnotic)

Indication Dosage

Midazolam is a medication that doctors use to help people relax and feel less anxious before surgeries or medical procedures. It can also be used to treat seizures in emergencies and as a sedative for certain medical tests. So, in simple terms, Midazolam is used to calm nerves, control seizures, and make medical procedures more comfortable.

Conscious Sedation For Procedures: 

By Slow IV Inj: 

  • Adult: Initially 2-2.5 Mg, 5-10 Minutes Before Procedure At A Rate Of approximately 2 Mg/minute, Increased In Steps Of 1 Mgif Required, Usual Total Dose Is 3.5-5 Mg; Maximum7.5 Mg Per Course 
  • Elderly: Initially 0.5-1 Mg,5-10 Minutes Before Procedure At A Rate Of Approximately 2 Mg/minute, Increased In Steps Of0.5-1 Mg If Required; Maximum 3.5 Mg Per Course 
  • Children 1 Month - 6 yrs: Initially 25-50 Mcg/kg, Increased If Necessary In Small Steps, Max Total Dose 6 Mg; Over 2-3 Minutes 5-10 Minutes Before Procedure;
  • 6-12 Yr: Initially 25-50 Mcg/kg, Increased If Necessary In Small Steps, Was Total Dose 10 Mg; Over 2-3 Minutes 5-10 Minutes Before Procedure;
  • 12-18 Yr: Initially 25-50 Mcg/kg, Increased If Necessary In Small Steps, Max Total Dose 7.5 Mg; over 2-3 Minutes 5-10 Minutes Before Procedure 

Sedative In Combined Anaesthesia: 

By IV Injection: 

  • Adult: 30-100 Mcg/kg, Repeated If Necessary, Alternatively (by Continuous IV infusion)30-100 Mcg/kg/hour 
  • Elderly: Lower Doses Needed 

Premedication: 

By Deep IM Inj: 

  • Adult: 70-100 Mcg/kg, 20-60 Minutes Before Induction, For Debilitated Patients, Use Elderly Dose 
  • Elderly: 25-50 Mcg/kg, 20-60 Minutes Before Induction 

By IV Inj: 

  • Adult: 1-2 Mg, Repeated If Necessary, 5-30 Minutes Before Procedure, For Debilitated Patients, Use Elderly Dose 
  • Elderly: 0.5 Mg, Repeated If Necessary, Initial Dose 5-30 Minutes Before Procedure, Repeatdose Slowly As Required 
  • Children 1 Month-18 Yrs: 500 Mcg-1 Mg, Repeated If Necessary, 15-30 Minutes Before The Procedure 

Induction Of Anaesthesia For Minor Surgical Procedures: 

By Slow IV Inj: 

  • Adult: 150-200 Mcg/kg Daily In Divided Doses (max. Per Dose 5 Mg), At Intervals Of2 Minutes, Maximum Total Dose 600 Mcg/kg, For Debilitated Patients, Use Elderly Dose 
  • Elderly: 50-150 Mcg/kg Daily In Divided Doses (max. Per Dose 5 Mg), At Intervals Of 2 Minutes, Maximum Total Dose 600 Mcg/kg 
  • Children 7-18 Yr: Initially 150 Mcg/kg, Max 7.5 Mg, Given In Steps Of 50 Mcg/kg, Was 2.5 Mg, Over 2-5 Minutes; Wait For 2-5 Minutes Then Give Additional Doses Of 50 Mcg/kg, Max 2.5 Mg, Every 2 Minutes If Necessary, Max Total Dose 500 Mcg/kg (not Exceeding 25 Mg). 

Sedation Of Patient Receiving Intensive Care: 

By Slow IV Inj: 

  • Adult: Initially 30-300 Mcg/kg, In Steps Of 1-2.5mg Every 2 Minutes, Then (by Slow IV Injection Or By Continuous IV infusion) 30-200 Mcg/kg/hour, Reduce Dose (or Reduce Or Omit Initial Dose) In Hypovolaemia, Vasoconstriction, Or Hypothermia, Lower Doses May Be Adequate If Opioid Analgesic Also Used 

By IV Inj Or Continuous IV Infusion: 

  • Neonate: 60 Mcg/kg/hr By Continuous IV infusion, Reduced After 24 Hr To 30 Mcg/kg/hr; Adjusted According To Response, Max Treatment Duration 4 Days;
  • 1-6 Months: 60 Mcg/kg/hr By Continuous IV infusion Adjusted According To Response; 
  • 6 Months - 12 Yr: Initially 50-200 Mcg/kg By Slow IV Injection Over At Least 3 Minutes Followed By 30-120 Mcg/kg/hr By Continuous IV infusion Adjusted According To Response; 
  • 12-18 Yr: Initially 30-300 Mcg/kg By Slow IV Injection Given In Steps Of 1-2.5 Mg Every 2 Minutes Followed By 30-200 Mcg/kg/hr By Continuous IV infusion Adjusted According To Response. 

Confusion And Restlessness In Palliative Care (adjunct To Antipsychotic): 

By Sc Infusion: 

  • Adult: Initially 10-20 Mg/24 Hours, Adjusted According To Response; Usual Dose 20-60 Mg/24 Hours 

Convulsions In Palliative Care: 

By Continuous Sc Infusion: 

  • Adult: Initially 20-40 Mg/24 Hours

Content

  • Inj Per ml: Midazolam (as Hci) 1mg /5mg.
  • Tab 7.5mg /15mg: Midazolam (as Maleate) 7.5mg /15mg.

Pregnancy

Avoid Unless Potential Benefit Outweighs Risk

Stability

  • Benzodiazepine

Contra Indications

  • Acute Pulmonary Insufficiency, Cns Depression, Compromised Airway, Severe Respiratory Depression

Precautions

  • Acute Pulmonary Insufficiency, Cns Depression, Compromised Airway, Severe Respiratory Depression

Lactation

  • Contraindicated, Avoid

Side Effects

  • Anaphylaxis
  • Ataxia
  • Amnesia
  • Bronchospasm
  • Cardiac Arrest
  • Blood Disorders
  • Confusion
  • Convulsions
  • Depression Of Consciousness
  • Dizziness
  • Drowsiness
  • Dry Mouth
  • Dysarthria
  • Euphoria
  • Fatigue
  • Gi Disturbances
  • Hallucinations
  • Headache
  • Hiccups
  • Hypotension
  • Incontinence
  • Increased Appetite
  • Involuntary Movements
  • Jaundice
  • Laryngospasm
  • Muscle Weakness
  • Paradoxical Aggression And Excitement
  • Respiratory Arrest
  • Respiratory Depression
  • Restlessness
  • Salivation Changes
  • Severe Disinhibition
  • Skin Reactions
  • Thrombosis
  • Urinary Retention
  • Vertigo
  • Visual Disturbances