Midazolam

Aliases: Versed 

Indications: Procedural/maintenance sedation, Anticonvulsant, Rapid Sequence Induction, Acute behavioral emergencies, EtOH withdrawal, Uncontrolled Anxiety/Panic Attack     

Contraindications: Allergy, Shock, Coma, Closed Angle Glaucoma 

Concentrations: 

Injection: 5mg/mL

Dosing

Adult:

Indication Dose Route Note 
-Seizure
-ETOH Withdrawal
10 mgIM/INRepeat every 5 minutes PRN 
-Seizure
-ETOH Withdrawal		5 mgIVRepeat every 5 minutes PRN 
-Agitation/Anxiety
-Procedural Sedation 		5 mgIM/IN/IV-Repeat every 5 minutes PRN
-Trend RASS Score every
5 minutes

Pediatric:

Indication Dose Route Note 
Seizure
0.2 mg/kg
(Max: 10 mg)		IM/INRepeat every 5 minutes PRN 
Seizure0.1 mg/kg
(Max: 5 mg)		IVRepeat every 5 minutes PRN 
-Agitation/Anxiety
-Procedural Sedation 		0.1 mg/kg
(Max: 5 mg)		IM/IN/IV-Repeat every 5 minutes PRN
-Trend RASS Score every
5 minutes
Use Handtevy or Approved Pediatric Reference Guide for Amount to Administer

Precautions: 

Pregnancy Category D. 

Premedication with an opiate may potentiate midazolam and lead to apnea. 

Reducing the dose to 50% is suggested in elderly and patients under the influence of other CNS depressants 

Adverse/Side Effects:

Minor: N/V, Headache, Drowsiness, Lethargy, Cough, Hiccups. 

Major: Respiratory Depression, Apnea, Hypotension, Cardiac Arrest, Paradoxical CNS stimulation. 

Class: Short-acting benzodiazepine central nervous system (CNS) depressant. .   

Mechanism of Action: Acts at the level of the limbic, thalamic, and hypothalamic regions of the CNS through potentiation of GABA (inhibitory neurotransmitter). Decreases neural cell activity in all regions of CNS. Anxiety is decreased by inhibiting cortical and limbic arousal. Promotes relaxation through inhibition of spinal motor reflex pathway, also depresses muscle & motor nerve function directly. As an anticonvulsant, augments presynaptic inhibitions of neurons, limiting the spread of electrical activity. However, it does not alter the electrical activity of the seizure’s focus. Midazolam has twice the affinity for benzodiazepine receptors than diazepam and has more potent amnesic effects. It is short acting and roughly 3-4 times more powerful than diazepam. 

Onset of ActionPeak EffectDuration of Action 
IV: 3 – 5 mins  
IN: ~ 10 mins 
IM: 5 – 15 mins		IV: 3 – 5 mins  
IN: ~ 15 mins 
IM: 15 – 30 mins  		IV: < 2 hours (single dose)  
IN: ~ 30 mins 
IM: ~ 2 hours