MIDAZOLAM
Background and Date of Approval
Midazolam is an anaesthetic medication approved by the U.S. Food and Drug Administration. It was initially approved on 8 October 1985 for the treatment of status epilepticus.
Uses
Midazolam helps to treat certain conditions like status epilepticus (which is a prolonged and continuous seizure activity or recurrent seizures without a return to baseline neurological function between seizures), preoperative sedation (aims to help relax patients and reduce anxiety before surgery), and amnesia (memory loss).
How is it administered?
Midazolam will be administered to you by a healthcare professional in a hospital setting. It is usually administered orally, intravenously, intramuscularly, or as a nasal spray. Your doctor will decide the dose, route of administration, and frequency based on your disease condition and other factors.
Side Effects
The side effects known to occur commonly during the treatment with Midazolam are injection site reactions (redness, pain, swelling), nausea, vomiting, drowsiness, cough, headache, hiccup, dry mouth and feeling confused.
Warnings
This drug is contraindicated for patients with known hypersensitivity or allergy to the drug, and it is not advised to administer the drug to them. Also, this drug is contraindicated in patients with acute narrow-angle glaucoma (Narrow-angle glaucoma is a specific type of glaucoma that can cause a sudden increase in eye pressure). Benzodiazepines should be avoided in patients with this condition because they may further increase intraocular pressure, which can be harmful. Suppose you have severe breathing problems, such as chronic obstructive pulmonary disease (COPD) or asthma. In that case, informing your doctor or nurse before being administered Midazolam for conscious sedation is important. This drug can cause respiratory depression, which means it can slow down or decrease your respiratory function.
Precautions
Report to your physician if you suspect pregnancy, breastfeeding, or planning to have a baby. This drug during breastfeeding is unsafe because it tends to get excreted in human milk. Consult your doctor for more advice. Midazolam is not intended for epidural or intrathecal administration due to the preservative benzyl alcohol in the dosage form. Benzyl alcohol has been linked with serious adverse effects resulting in neurological toxicity.
Word of Advice
Concurrent use of alcohol or other sedative agents with midazolam may potentiate sedative effects and result in excessive drowsiness. Alcohol and other sedatives should be avoided during midazolam treatment. Clarification regarding the medicine should be sought from your physician or pharmacist if uncertainties arise. Midazolam should be stored away from excessive moisture and heat, which may compromise medication stability. Storage should be maintained in a cool, dry location.
References
Hameln Pharma Ltd, Electronic medicines compendium (EMC), [ Revised on April 2020] [ Accessed on 31st May 2023], https://www.medicines.org.uk/emc/files/pil.6420.pdf Fresenius kabi, US Food and Drug Administration, [ Revised on March 2017] [Accessed on 31st May 2023], https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/208878Orig1s000lbl.pdf Goodman & Gilmanâs, The Pharmacological Basis of Therapeutics, General anaesthetics and therapeutic gases, 12th edition, 2011, 548. KD Tripathi, Essentials of Medical Pharmacology, General anaesthetics, 7th edition, 2013, 383.
Frequently Asked Questions
What are the common side effects of Midazolam?
Common side effects of Midazolam may include drowsiness, dizziness, confusion, headache, changes in coordination, and nausea. These side effects are usually temporary and set back to normal as the medication is eliminated.
How is Midazolam administered?
Midazolam can be administered orally, intravenously, intramuscularly, or as a nasal spray. The route of administration varies on the specific medical indication and the healthcare provider's judgement.
How quickly does Midazolam take effect?
The onset of action of this drug can vary depending on the route of administration. When given intravenously, its effects are usually felt within 1 to 5 minutes. Orally administered Midazolam generally takes longer to take effect, typically within 15 to 60 minutes.
Is Midazolam safe during pregnancy and breastfeeding?
Midazolam is generally not recommended during pregnancy, especially during the first trimester, due to potential risks to the developing fetus. It may also pass into breast milk, so discussing it with a physician before using this drug while breastfeeding is highly advisable.
How long does the soothing effect of Midazolam last?
The duration of the soothing effect of Midazolam depends on various factors such as dosage, individual metabolism, and other medications being used. Generally, the sedative effects of this drug can last between 2 and 6 hours.
Whether Midazolam can be used in children?
Midazolam can be used in children, but a paediatrician should carefully determine the dosage and administration. It is commonly used to provide sedation and reduce anxiety in paediatric patients undergoing medical procedures.
Are there any contraindications for Midazolam?
Midazolam is contraindicated in individuals with a known hypersensitivity to benzodiazepines. Caution is required in patients with severe respiratory insufficiency, acute narrow-angle glaucoma, or a history of substance abuse.