Know the basics
What is midazolam used for?
Midazolam is used in children before a procedure or anesthesia to cause drowsiness, decrease anxiety, and cause forgetfulness of the surgery or procedure. It should be used while the child is under the care of a health professional. It is not for home or long-term use.
Midazolam belongs to a class of medications called benzodiazepines, which produce a calming effect on the brain and nerves (central nervous system). It is thought to work by increasing the effect of a certain natural chemical (GABA) in the brain.
This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional.
This drug may also be used short-term for sleep problems (for example, trouble sleeping, “night terrors”).
How should I take midazolam?
A healthcare professional will prepare and measure your dose. Take midazolam by mouth as directed by your doctor. It is usually given as a single dose before a procedure or anesthesia.
The dosage is based on your medical condition, response to therapy, weight, and other medications you may be taking.
Midazolam may cause withdrawal reactions, especially if it has been used regularly for a long time or in high doses. In such cases, withdrawal symptoms (such as shaking, sweating, vomiting, abdominal/muscle cramps, seizures) may occur if you suddenly stop using midazolam. To prevent withdrawal reactions, your doctor may reduce your dose gradually. Consult your doctor or pharmacist for more details, and report any withdrawal reactions immediately.
Though very unlikely, abnormal drug-seeking behavior (addiction) is possible with midazolam. To lessen the risk of becoming addicted, do not increase the dose, take it more frequently, or take it for a longer time than prescribed. Talk with the doctor if midazolam stops working well. Properly stop the midazolam when so directed.
Avoid eating grapefruit or drinking grapefruit juice while being treated with midazolam unless the doctor instructs you otherwise. Grapefruit can increase the amount of certain medications in the bloodstream. Consult the doctor or pharmacist for more details.
How do I store midazolam?
Midazolam is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store midazolam in the bathroom or the freezer. There may be different brands of midazolam that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.
You should not flush midazolam down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.
Know the precautions & warnings
What should I know before using midazolam?
Before your child receives midazolam,
- Tell your child’s doctor and pharmacist if he or she is allergic to midazolam, any other medications, or cherries.
- Tell your child’s doctor if your child is taking certain medications for human immunodeficiency virus (hiv) including amprenavir (agenerase), atazanavir (reyataz), darunavir (prezista), delavirdine (rescriptor), efavirenz (sustiva, in atripla), fosamprenavir (lexiva), indinavir (crixivan),lopinavir (in kaletra), nelfinavir (viracept), ritonavir (norvir, in kaletra), saquinavir (invirase), and tipranavir (aptivus). Your child’s doctor may decide not to give midazolam to your child if he or she is taking one or more of these medications.
- Tell your child’s doctor and pharmacist what other prescription and nonprescription medications, vitamins, and nutritional supplements your child is taking or plans to take. Be sure to mention these medications following: amiodarone (cordarone, pacerone); aminophylline (truphylline); antifungals such as fluconazole (diflucan), itraconazole (sporanox), and ketoconazole (nizoral); certain calcium channel blockers such as diltiazem (cartia, cardizem, tiazac, others) and verapamil (calan, isoptin, verelan, others); cimetidine (tagamet); clarithromycin (biaxin); dalfopristin-quinupristin (synercid); erythromycin (e-mycin, e.e.s.); fluvoxamine (luvox); certain medications for seizures such as carbamazepine (tegretol), phenobarbital, and phenytoin (dilantin); methylphenidate (concerta, metadate, ritalin, others); nefazodone; ranitidine (zantac); rifabutin (mycobutin); and rifampin (rifadin, rimactane). Your child’s doctor may need to change the doses of your child’s medications or monitor your child carefully for side effects. Many other medications may also interact with midazolam, so be sure to tell your child’s doctor about all the medications your child is taking, even those that do not appear on this list.
- Tell your child’s doctor what herbal products your child is taking, especially st. John’s wort.
- Tell your child’s doctor if your child has glaucoma. Your child’s doctor may decide not to give your child midazolam.
- Tell your child’s doctor if your child has or has ever had kidney or liver disease.
- Tell your child’s doctor if your child is or may be pregnant, or is breast-feeding.
- You should know that midazolam may make your child very drowsy and may affect his or her memory, thinking, and movements. Do not allow your child to ride a bicycle, drive a car, or do other activities that require him or her to be fully alert for at least 24 hours after receiving midazolam and until the effects of the midazolam have worn off. Watch your child carefully to be sure that he or she does not fall while walking during this time.
- You should know that alcohol can make the side effects of midazolam worse.
Is it safe to take midazolam during pregnancy or breast-feeding?
There are no adequate studies in women for determining risk when using midazolam during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking midazolam. Midazolam is pregnancy risk category D according to the US Food and Drug Administration (FDA).
FDA pregnancy risk category reference below:
- A=No risk,
- B=No risk in some studies,
- C=There may be some risk,
- D=Positive evidence of risk,
Know the side effects
What are the side effects of midazolam?
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.
Tell your caregivers at once if you have:
- Cough, wheezing, trouble breathing, weak or shallow breathing;
- Slow heart rate;
- A light-headed feeling, like you might pass out;
- Agitation, hostility;
- Confusion, hallucinations, unusual thoughts or behavior.
Common side effects may include:
- Nausea, vomiting;
- Drowsiness, dizziness;
- Blurred vision;
- Runny nose, sneezing; or
- Amnesia or forgetfulness after your procedure.
Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.
Know the interactions
What drugs may interact with midazolam?
Midazolam may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.
Taking midazolam with other drugs that make you sleepy or slow your breathing can cause dangerous or life-threatening side effects. Ask your doctor before taking midazolam with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.
Many drugs can interact with midazolam. Not all possible interactions are listed here. Tell your doctor about all your medications and any you start or stop using during treatment with midazolam, especially:
- John’s wort;
- An antibiotic–clarithromycin, erythromycin, telithromycin;
- Antifungal midazolam–itraconazole, ketoconazole, posaconazole, voriconazole;
- Heart midazolam–nicardipine, quinidine;
- Hepatitis c medications–boceprevir, telaprevir;
- Hiv/aids midazolam–atazanavir, delavirdine, efavirenz, fosamprenavir, indinavir, nelfinavir, nevirapine, ritonavir, saquinavir;
- Seizure midazolam–carbamazepine, fosphenytoin, oxcarbazepine, phenobarbital, phenytoin, primidone; or
- Tuberculosis midazolam–isoniazid, rifabutin, rifampin, rifapentine.
Does food or alcohol interact with midazolam?
Midazolam may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.
- Grapefruit Juice.
What health conditions may interact with midazolam?
Midazolam may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have, especially:
- Apnea (temporary stopping of breathing);
- Heart disease;
- Hypoventilation (slow breathing);
- Lung disease, severe;
- Lung or airway blockage—Use with caution. May increase risks for more serious side effects.
- Congestive heart failure;
- Kidney disease;
- Liver disease—Use with caution. The effects may be increased because of slower removal of the medicine from the body.
- Glaucoma, acute narrow-angle—Should not be used in patients with this condition.
Understand the dosage
The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using midazolam.
What is the dose of midazolam for an adult?
Usual Adult Dose for Light Sedation
- Oral: 10 to 20 mg one time before procedure (IM or IV is preferred).
- Intravenous injection: 1 to 2.5 mg IV over 2 to 3 minutes before procedure. Wait an additional 2 or more minutes to fully evaluate the sedative effect. If additional titration is necessary, it should be given at a rate of no more than 1 mg over 2 minutes, waiting an additional 2 or more minutes each time to fully evaluate the sedative effect. Total doses greater than 5 mg are not usually necessary.
- Intramuscular injection: 0.07 to 0.08 mg/kg 30 to 60 minutes prior to surgery. Reduce dose in patients with COPD, high risk patients, and when narcotics or other CNS depressants are used. Maximum dose 10 mg.
Usual Adult Dose for Light Anesthesia
- Initial dose: 2 mg Intravenous once at a rate not to exceed 1 mg/min immediately before the procedure.
- Additional doses of 0.5 to 2 mg may be administered after 2 minutes to achieve desired level of sedation.
- Most patients achieve adequate sedation with a total dose less than 5 mg.
Usual Adult Dose for ICU Agitation
- Initial dose: 0.01 to 0.08 mg/kg (usually 1 to 5 mg) Intravenous over 2 to 3 minutes, every 5 to 15 minutes to control acute agitation.
- Maintenance dose: 0.02 to 0.2 mg/kg/hour by continuous infusion. The patient should be assessed regularly and the infusion rate adjusted to maintain the desired level of sedation.
What is the dose of midazolam for a child?
The dosage has not been established in pediatric patients. It may be unsafe for your child. It is always important to fully understand the safety of the drug before using. Please consult with your doctor or pharmacist for more information.
How is midazolam available?
Midazolam is available in the following dosage forms and strengths:
- Solution, Injection: 2 mg/mL, 5 mg/mL, 10 mg/2 mL.
What should I do in case of an emergency or overdose?
In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.
What should I do if I miss a dose?
If you miss a dose of midazolam, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.
Hello Health Group does not provide medical advice, diagnosis or treatment.
Midazolam. https://www.drugs.com/mtm/midazolam.html. Accessed June, 30, 2016.
Midazolam. http://www.everydayhealth.com/info/v1ss/midazolam. Accessed June, 30, 2016.
Midazolam. http://www.mayoclinic.org/drugs-supplements/midazolam-injection-route/description/drg-20064813. Accessed June, 30, 2016.
Review Date: May 30, 2016 | Last Modified: January 4, 2017