Midazolam

Midazolam

[1 vial 15mg/3ml $2.47]

ADMINISTRATION ROUTES:

  • IV, IM, PO

ALTERNATIVE NAMES:

  • Hypnovel

ICU INDICATIONS:

  1. sedation
  2. treatment of seizures

PRESENTATION AND ADMINISTRATION:

  • IV:
    15mg/3ml ampoules and 5mg/5ml ampoules
    For direct IV injection, usually diluted to a concentration of 1mg/ml using compatible IV fluid and injected slowly.
    For continuous infusion dilute 60mg up to a total of 60ml with compatible IV fluid
    Compatible with the following IV fluids:
    Normal saline, 5% dextrose, 10% dextrose, Hartmanns
    Any solutions not used within 24 hours should be discarded
    Store at room temperature. Do not freeze.
  • IM:
    Inject undiluted into a large muscle mass

DOSAGE:

  • IM:
    Sedation: 1-5mg
  • IV:
    Sedation: 1-10mg
    Infusion: 0-20mg/hr
  • PO:
    Premed: 7.5-15mg

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

  • Dose in renal impairment [GFR (ml/min)]
    <10: 50% of normal dose
    10-20: dose as in normal renal function
    >20-50: dose as in normal renal function
  • Dose in renal replacement therapy
    CAPD: 50% of normal dose
    HD: 50% of normal dose
    CVVHDF: dose as in normal renal function

DOSAGE IN PAEDIATRICS:

  • IM:
    Sedation: usually 0.1-0.5mg/kg.
  • IV:
    Sedation: usually 0.1-0.5mg/kg.
    Infusion (ventilated): Dilute 3mg/kg in 50ml 5% dextrose and run at 0-5ml/hr (0-5mcg/ kg/min)
  • Intranasal:
    Sedation: 0.2mg/kg nasal (repeated in 10 minutes if required)
  • PO:
    Sedation: 0.5mg/kg (max 20mg)

CLINICAL PHARMACOLOGY:

  • Midazolam is a benzodiazepine. The precise mechanism by which midazolam exerts its antiseizure effect is unknown, although it is believed to be related to its ability to enhance the activity of gamma aminobutyric acid (GABA), the major inhibitory neurotransmitter in the central nervous system.

CONTRAINDICATIONS:

  1. hypersensitivity to benzodiazepines

WARNINGS

  • Withdrawal Symptoms
    Withdrawal symptoms of the barbiturate type have occurred after the discontinuation of benzodiazepines including midazolam

PRECAUTIONS

  • General:
    Hypoventilation, airway obstruction, and apnoea can lead to hypoxia and/or cardiac arrest unless effective countermeasures are taken immediately.
  • Laboratory Tests:
    No tests in addition to routine ICU tests are indicated
  • Drug/Laboratory Test Interactions:
    None noted

IMPORTANT DRUG INTERACTIONS FOR THE ICU

  • The CNS-depressant action of the benzodiazepine class of drugs may be potentiated by alcohol, narcotics, barbiturates, nonbarbiturate hypnotics, anti-anxiety agents, the phenothiazines, thioxanthene and butyrophenone classes of antipsychotic agents, monoamine oxidase inhibitors and the tricyclic antidepressants, and by other anticonvulsant drugs.

ADVERSE REACTIONS

  • Neurologic:
    Abnormal eye movements, aphonia, choreiform movements, coma, diplopia, dysarthria, dysdiadochokinesis, ‘glassy-eyed’ appearance, headache, hypotonia, nystagmus, respiratory depression, slurred speech, tremor, vertigo.
  • Psychiatric:
    Confusion, depression, amnesia, hallucinations, hysteria, increased libido, insomnia, psychosis, suicidal attempt. The following paradoxical reactions have been observed: Excitability, irritability, aggressive behavior, agitation, nervousness, hostility, anxiety, sleep disturbances, nightmares and vivid dreams.
  • Respiratory:
    Apnoea, hypoventilation
  • Cardiovascular:
    Palpitations, hypotension.
  • Hematopoietic:
    Anemia, leukopenia, thrombocytopenia, eosinophilia.
  • Hepatic:
    Hepatomegaly, transient elevations of serum transaminases and alkaline phosphatase.

Critical Care Drug Manual

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