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Midazolam
From WikEM
See critical care quick reference for drug doses by weight.
Contents
General
- Type: Benzodiazepines
- Dosage Forms: IV
- Common Trade Names: Versed
Adult Dosing
- Anxiolysis/sedation:
- 1-2mg IV push
- 0.07 to 0.08 mg/kg IM, usual dose 5 mg for 60 kg pt
- ICU Sedation:
- Load: 10-50mcg/kg IV infusion
- Maintenance: 20-100 mcg/kg/hr infusion
- Use with standardized sedation protocol for titration
Pediatric Dosing
See critical care quick reference for drug doses by weight.
- Anxiolysis/sedation:
- 6mo-5yr: 0.05-0.1 mg/kg IV push
- 6-12yr: 0.025-0.05 mg/kg IV push
- Intranasal
- Seizure: 0.2 mg/kg IN divided between nostrils
- Procedural sedation: 0.2-0.6 mg/kg IN divided between nostrils
Special Populations
- Pregnancy Rating: D
- Maternal use shortly before delivery associated with floppy infant syndrome
- Lactation: Distributed in breast milk, use with caution
- Renal Dosing:
- Adult: Decrease by 50% for severe renal failure
- Pediatric
- Hepatic Dosing:
- Adult: Prolonged clearance in cirrhosis
- Pediatric
Contraindications
- Allergy to class/drug
Adverse Reactions
Serious
- Apnea
- Hypopnea
- Hypotension
- Delirium, when used for prolonged periods in ICU setting
Common
- Drowsiness
- Nausea/vomiting
Pharmacology
- Peak effect:
- IM: Children: 15 to 30 minutes; Adults: 30 to 60 minutes
- IV: 5 to 7 minutes
- Intranasal: 10 minutes
- Duration
- IV: Single dose: <2 hours (dose-dependent),up to 6 hours w/ cirrhosis
- IM: Up to 6 hours; Mean: 2 hours
- Intranasal: Children: 18 to 41 minutes
- Half-life: 1.8-6.4 hr
- Metabolism: Metabolized in liver by CYP3A4 to active metabolite alpha1-hydroxymidazolam
- Excretion: Renal
- Mechanism of Action: CNS depressant. Acts at GABA receptor to increase frequency of chloride channel opening, causing hyperpolarization and stabilization of neuronal membrane.
See Also
References
Micromedex
