Dangerous Drug: Midazolam Hydrochloride(mid ay’ zoh lam)
Apo-Midazolam (CAN)
PREGNANCY CATEGORY D
CONTROLLED SUBSTANCE C-IV
Drug Classes
Anxiolytic
Benzodiazepine (short-acting)
CNS depressant
Sedative/hypnotic
Therapeutic Actions
Indications
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IV or IM: Sedation, anxiolysis, and amnesia prior to diagnostic, therapeutic, or endoscopic procedures or surgery
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Induction of general anesthesia
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Continuous sedation of intubated and mechanically ventilated patients as a component of anesthesia or during treatment in the critical care setting
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Unlabeled use: Treatment of epileptic seizure or refractory status epilepticus
Contraindications and Cautions
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Contraindicated with hypersensitivity to benzodiazepines, allergy to cherries (syrup), psychoses, acute narrow-angle glaucoma, shock, coma, acute alcoholic intoxication; for intrathecal or epidural administration; pregnancy (cleft lip or palate, inguinal hernia, cardiac defects, microcephaly, pyloric stenosis have been reported when used in first trimester; neonatal withdrawal syndrome reported in infants) and in neonates.
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Use cautiously in elderly or debilitated patients; in patients being treated for open-angle glaucoma; with impaired liver or renal function, lactation.
Available Forms
Injection—5 mg/mL, 1 mg/mL; syrup—2 mg/mL
Dosages
Black box warning Midazolam should only be administered by a person trained in general anesthesia and with equipment for maintaining airway and resuscitation on hand; respiratory depression and respiratory arrest can occur. Administer IV with continuous monitoring of respiratory and CV function. Individualize dosage; use lower dosage in the elderly and debilitated patients. Adjust dosage according to use of other premedication. Midazolam syrup has been associated with respiratory depression and respiratory arrest.
Warning Rapid injection should be avoided in neonates, especially when given with fentanyl.
Warning Midazolam syrup has been associated with respiratory depression and arrest, especially when given with opioids.Adults
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Preoperative sedation, anxiety, amnesia: Younger than 60 yr: 70–80 mcg/kg IM 1 hr before surgery (usual dose, 5 mg).Older than 60 yr or debilitated: 20–50 mcg/kg IM 1 hr before surgery (usual dose, 1–3 mg).
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Conscious sedation for short procedures: Younger than 60 yr: 1–2.5 mg IV initially, maintenance dose of 25% of initial dose; total dose, 5 mg.Older than 60 yr: 1–1.5 mg IV initially, maintenance dose of 25% initial dose; total dose, 3.5 mg.
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Induction of anesthesia: Younger than 55 yr: 300–350 mcg/kg IV (up to a total of 600 mcg/kg).Older than 55 yr: 150–300 mcg/kg IV as initial dose.Debilitated adults: 200–250 mcg/kg IV as initial dose.
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Sedation in critical care areas: 10–50 mcg/kg (0.5–4 mg usual dose) IV as a loading dose; may repeat every 10–15 min until desired effect is seen; continuous infusion of 20–100 mcg/kg/hr to sustain effect.
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