Home Drug Guide Midazolam Hydrochloride

Drug Guide

Generic Name

Midazolam Hydrochloride

Brand Names Versed, Midazolam Hydrochloride Preservative Free, Midozalam Hydrochloride, Seizalam, Midazolam Hydrochloride (autoinjector)

Classification

Therapeutic: Sedative, Anxiolytic, Amnestic, Sedative-Hypnotic

Pharmacological: Benzodiazepine

FDA Approved Indications

  • Preoperative sedation, anxiolysis, and amnesia
  • Induction of anesthesia
  • Sedation of mechanically ventilated patients
  • Status epilepticus (injectable form)

Mechanism of Action

Midazolam enhances the effects of gamma-aminobutyric acid (GABA) at the GABA-A receptor, resulting in sedative, anxiolytic, muscle relaxant, and anticonvulsant properties.

Dosage and Administration

Adult: Dosage varies based on indication and route; for preoperative sedation, 1-2.5 mg IV over 2 minutes, repeated as needed; for status epilepticus, 5 mg IV every 10-15 minutes up to 30 mg total.

Pediatric: Typically, 0.05-0.1 mg/kg IV; oral doses are 0.25-0.5 mg/kg.

Geriatric: Lower initial doses recommended; e.g., 0.5-1 mg IV slow administration.

Renal Impairment: Use caution; dosage may need adjustment based on response.

Hepatic Impairment: Reduce dosage; clearance may be decreased.

Pharmacokinetics

Absorption: Rapid IV absorption with quick onset of action, peaks in 1-5 minutes.

Distribution: Widely distributed; high affinity for brain tissue. Protein binding approximately 94%.

Metabolism: Extensively metabolized in the liver via CYP3A4 to inactive metabolites.

Excretion: Primarily excreted in urine; minimal in feces.

Half Life: Approx. 1.5-2.5 hours in healthy adults.

Contraindications

  • Hypersensitivity to benzodiazepines or any component of the formulation.
  • Acute narrow-angle glaucoma.

Precautions

  • Use with caution in patients with respiratory insufficiency, sleep apnea, hepatic impairment, or myasthenia gravis.
  • Risk of respiratory depression; closely monitor airway and respiration.
  • Use in pregnancy only if clearly needed; category D.
  • Lactation: can be excreted in breast milk; caution advised.

Adverse Reactions - Common

  • Respiratory depression (Common)
  • Hypotension (Common)
  • Amnesia (Common)
  • Drowsiness (Common)

Adverse Reactions - Serious

  • Cardiorespiratory depression (Serious)
  • Anaphylaxis (Rare)
  • Seizures (paradoxical reaction in some cases) (Rare)

Drug-Drug Interactions

  • CNS depressants (opioids, alcohol)
  • Cimetidine and other CYP3A4 inhibitors increasing midazolam levels.
  • Rifampin decreases midazolam levels.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor vital signs, especially respiratory and cardiovascular status. Observe for excessive sedation.

Diagnoses:

  • Risk for respiratory depression
  • Altered mental status

Implementation: Administer IV slowly; continuous monitoring during and after administration.

Evaluation: Assess effectiveness of sedation, monitor for adverse effects.

Patient/Family Teaching

  • Do not operate heavy machinery or drive after use.
  • Inform about potential side effects such as drowsiness, dizziness.
  • Caution about alcohol and other CNS depressants.
  • Report any respiratory issues or severe side effects.

Special Considerations

Black Box Warnings:

  • Respiratory depression leading to hypoxia, respiratory arrest, or death—use only where resuscitation equipment and trained personnel are available.

Genetic Factors: CYP3A4 genetic variants may affect metabolism.

Lab Test Interference: None known.

Overdose Management

Signs/Symptoms: Excessive sedation, respiratory depression, hypotension.

Treatment: Supportive care, airway management, intravenous flumazenil as an antidote (if appropriate), caution due to risk of seizures from flumazenil in benzodiazepine-dependent seizures.

Storage and Handling

Storage: Store at room temperature, away from moisture, heat, and light.

Stability: Stable for the duration of the shelf life specified by the manufacturer.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.