Home Drug Guide Midazolam

Drug Guide

Generic Name

Midazolam

Brand Names Nayzilam, Midazolam in 0.9% Sodium Chloride, Midazolam in 0.8% Sodium Chloride

Classification

Therapeutic: Sedative, Anxiolytic, Amnesic, Hypnotic, Sedative-Hypnotic

Pharmacological: Benzodiazepine

FDA Approved Indications

Acute treatment of intermittent, stereotypic episodes of partial seizures with or without generalization in patients aged 12 years and older.

Mechanism of Action

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

Dosage and Administration

Adult: For seizures, the typical dose is 2.5 mg administered intranasally. Doses may be repeated after 10 minutes if seizures persist. Maximum dose per episode is 5 mg.

Pediatric: Dosing varies by weight and age; typically 0.2 mg/kg (up to 5 mg) intranasally or buccally, repeated after 10 minutes if needed.

Geriatric: Lower initial doses due to increased sensitivity; close monitoring recommended.

Renal Impairment: Use with caution; dose adjustments not well established.

Hepatic Impairment: Use with caution; may prolong sedation.

Pharmacokinetics

Absorption: Rapid via intranasal or buccal routes.

Distribution: Widely distributed, crosses blood-brain barrier.

Metabolism: Hepatic CYP3A4 metabolism.

Excretion: Metabolites excreted primarily in urine.

Half Life: Approximately 2 hours in healthy adults, may be prolonged in certain populations.

Contraindications

Hypersensitivity to midazolam or benzodiazepines.
Severe respiratory insufficiency.
Sleep apnea syndrome.
Acute narrow-angle glaucoma.

Precautions

Use with caution in elderly, debilitated, or patients with compromised respiratory or hepatic function.
Risk of respiratory depression, especially when combined with other CNS depressants.

Adverse Reactions - Common

Drowsiness (Common)
Dizziness (Common)
Respiratory depression (Uncommon)

Adverse Reactions - Serious

Respiratory arrest (Rare)
Hypotension (Uncommon)
Prolonged sedation (Uncommon)

Drug-Drug Interactions

CNS depressants (opioids, alcohol)
Other benzodiazepines
Cimetidine (may increase plasma levels)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor respiratory status (rate, depth), sedation level, and blood pressure.

Diagnoses:

Risk for respiratory depression
Impaired spontaneous ventilation

Implementation: Administer in healthcare setting with resuscitation equipment available. Adjust dosing based on patient response.

Evaluation: Ensure patient remains stable with adequate airway and breathing; assess for adverse reactions.

Patient/Family Teaching

Do not operate heavy machinery or drive after administration.
Report excessive sedation, difficulty breathing, or other concerning symptoms.
Inform about the potential for drowsiness and impairment.

Special Considerations

Black Box Warnings:

Respiratory depression and respiratory arrest

Genetic Factors: CYP3A4 polymorphisms may affect metabolism.

Lab Test Interference: None.

Overdose Management

Signs/Symptoms: Extreme drowsiness, respiratory depression, hypotension, coma.

Treatment: Supportive care, maintain airway, oxygen, IV fluids, and ventilatory support if needed. Flumazenil as an antagonist may be considered, with caution.

Storage and Handling

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

Stability: Stable under recommended storage conditions.