Home Drug Guide Remimazolam Besylate

Drug Guide

Generic Name

Remimazolam Besylate

Brand Names Byfavo

Classification

Therapeutic: Sedative, Anesthetic adjunct

Pharmacological: Benzodiazepine

FDA Approved Indications

  • Induction and maintenance of procedural sedation in adults

Mechanism of Action

Remimazolam enhances the effect of gamma-aminobutyric acid (GABA) at the GABA-A receptor, resulting in sedative, anxiolytic, amnestic, and hypnotic effects.

Dosage and Administration

Adult: Initial dose of 5 mg IV, may be repeated or titrated based on response; infusion rate up to 1 mg/min for maintenance.

Pediatric: Not approved for pediatric use.

Geriatric: Starting dose of 2.5 mg IV recommended due to increased sensitivity.

Renal Impairment: Adjustments not specifically required, but careful titration advised.

Hepatic Impairment: Use with caution, dosage adjustments may be necessary.

Pharmacokinetics

Absorption: Administered via IV; absorption is not applicable.

Distribution: Widely distributed; volume of distribution approximately 70 L.

Metabolism: Metabolized rapidly by tissue esterases to an inactive metabolite.

Excretion: Excreted primarily via urine; very little unchanged drug recovered.

Half Life: Approximately 0.75 hours, allowing for rapid recovery after infusion cessation.

Contraindications

  • Known hypersensitivity to remimazolam or benzodiazepines.

Precautions

  • Use with caution in patients with respiratory depression, elevated intracranial pressure, or hepatic impairment. Monitor vital signs closely.

Adverse Reactions - Common

  • Hypotension (Uncommon)
  • Respiratory depression (Uncommon)
  • Nausea (Common)

Adverse Reactions - Serious

  • Hypoxia, Respiratory arrest (Rare)
  • Anaphylaxis (Very rare)

Drug-Drug Interactions

  • Other CNS depressants, opioids, CYP3A4 inhibitors or inducers.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor sedation levels, respiratory and cardiovascular status.

Diagnoses:

  • Risk for respiratory depression
  • Altered mental status

Implementation: Administer slowly, titrate carefully, and monitor patient continuously.

Evaluation: Ensure patient maintains airway, stable vital signs, and appropriate sedation level.

Patient/Family Teaching

  • Inform patient about possible drowsiness and respiratory effects.
  • Advise against operating heavy machinery post-administration.

Special Considerations

Black Box Warnings:

  • Potential for respiratory depression, especially when combined with other CNS depressants.

Genetic Factors: None specific.

Lab Test Interference: Minimal; does not interfere with typical lab results.

Overdose Management

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

Treatment: Supportive care, airway management, and ventilatory support if needed. Flumazenil may be considered for benzodiazepine reversal under careful monitoring.

Storage and Handling

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

Stability: Stable until expiration date on packaging.

🛡️ 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.