Drug Summary

Midazolam (Versed®)

Pharmacologic properties:

Midazolam is a short-acting sedative hypnotic of the benzodiazepine family that increases the action of gamma-aminobutyric acid (GABA), the major inhibitory neurotransmitter in the central nervous system. Midazolam depresses the limbic system, thalamus, and hypothalamus resulting in profound sedation and muscle relaxation. The inhibitory nature of the drug also provides anti-epileptic activity that terminates and prevents seizures.

Indications:

  • Status epilepticus
  • Cocaine (sympathomimetic) toxicity
  • Behavioral emergencies in patients with severe agitation or aggressive behavior resulting in interference with patient care or patient/crew safety
  • May be adjunctive treatment with antipsychotics

Contraindications:

  • Acute alcohol intoxication
  • Do not administer to neonatal patients
  • Respiratory insufficiency
  • Hypotension (SBP < 90 mmHg)
  • Known hypersensitivity to benzodiazepines

Precautions:

  • Use extreme caution with intravenous administration - rapid IV bolus may cause hypotension and respiratory depression/arrest
  • Effects are exacerbated in the elderly, and when administered to patients who have already ingested another CNS depressant (ETOH, barbiturates, GHB)

Adverse Reactions:

  • Confusion
  • Drowsiness
  • Respiratory depression/arrest
  • Hypotension
  • Nausea
  • Vomiting

Dosage and administration:

  • Adult
    • Seizures
      • 5 mg IM or intranasal via MAD
      • 2.5 mg IV (slow IVP)
    • Behavioral Agitation (may be combined in same syringe as Haloperidol)
      • 5 mg IM or intranasal via MAD
      • 2.5 mg IV (slow IVP)
  • Pediatric
    • Seizures
      • 0.2 mg/kg IM or intranasal via MAD (maximum dose 5 mg)
      • 0.1 mg/kg IV (slow IVP) (maximum dose 2.5 mg)