midazolam

NATIONAL

CALIFORNIA

VENTURA

category

mechanism

Short-acting benzodiazepine binds to benzodiazepine receptors (GABA receptors) on neurons at several sites within the central nervous system.

indications

Treatment of seizures
Treatment of severe agitation in behavioral and intoxication (e.g. cocaine, methamphetamine)
Sedation, anxiolysis, and amnesia for a painful procedure (e.g. cardioversion)

contraindications

dosing

Adult:

IM: 0.1 mg/kg up to 5 mg

IV: 0.1 mg/kg up to 5 mg, repeat q 2 min as needed, maximum total dose 5 mg

Pediatric:

IM: 0.1 mg/kg up to 5 mg

IV: 0.1 mg/kg up to 2 mg, repeat q 2 minutes as needed, maximum total dose 5 mg

administration

IM: Administer undiluted deep IM into large muscle
IV: Administer by IV injection over 2 minutes

onset

IM: Children: Within 5 minutes
Adults: ~15 minutes

IV: 1 to 5 minutes

peak

IM: Children: 15 to 30 minutes
Adults: 30 to 60 minutes

IV: 3 to 5 minutes

duration

IM: 20 to 120 minutes

IV: 7 to 75 minutes

notes

Monitoring: Monitor blood pressure, pulse and respiration continuously during administration. Oxygen and resuscitative equipment should be readily available.
Oversedation: Midazolam has been associated with profound sedation, respiratory depression, and respiratory arrest. Airway obstruction, desaturation, hypoxia, and apnea have also been reported, most often when used concomitantly with other CNS depressants (eg, opioids).
Kidney disease: Use with caution in kidney dysfunction and those on dialysis. The duration is prolonged in patients with kidney injury.
Paradoxical reactions: Paradoxical reactions, including hyperactive or aggressive behavior, have been reported with benzodiazepines.

dosage form

IV solution: 2 mg/2 mL (2 mL)
5 mg/5 mL (5 mL)

brand name

Versed

adverse reactions

structure