Midazolam HCl Injection CIV
Generic Name and Formulations:
Midazolam HCl 1mg/mL or 5mg/mL; soln for IV or IM inj; contains benzyl alcohol.
Various generic manufacturers
Indications for Midazolam HCl Injection:
Preoperative sedation/anxiolysis/amnesia (IV or IM). Sedation/anxiolysis/amnesia prior to or during diagnostic, therapeutic or endoscopic procedures either alone or in combination with other CNS depressants (IV). Induction of general anesthesia before administration of other anesthetics, or as a component of IV supplementation of nitrous oxide and oxygen (balanced anesthesia). Continuous IV infusion for sedation of intubated and mechanically ventilated patients as a component of anesthesia or during treatment in a critical care setting.
Individualize, titrate slowly. Preoperative sedation/anxiolysis/amnesia: <60yrs: 0.07-0.08mg/kg deep IM inj dosed up to 1 hour before surgery. Sedation/anxiolysis/amnesia for procedures: <60yrs: initially 1–2.5mg IV; administer over 2 minutes, allow additional 2 minutes to evaluate sedation, may increase dose in small increments (max 2.5mg) to total max 5mg in ≥2 minute increments. ≥60yrs or other risk factors: reduce dose and slow inj or infusion rate, see literature. Induction of anesthesia: Administer IV over 20–30 seconds; allow 2 minutes for effect. Unpremedicated: <55yrs: initially 0.3–0.35mg/kg; if needed to complete induction, increments of approx. 25% of initial dose may be used; resistant cases: up to 0.6mg/kg total dose may be used; >55yrs: initially 0.3mg/kg; severe systemic disease, debilitated: initially 0.15–0.25mg/kg. Premedicated: usual range: 0.15–0.35mg/kg: see literature. Continuous IV infusion: loading dose: 0.01–0.05mg/kg; may repeat dose at 10–15 minute intervals until adequate sedation achieved. Maintenance of sedation: initially 0.02–0.1mg/kg/hr; adjust to find minimum effective infusion rate.
Individualize, titrate slowly, see literature. Sedation/anxiolysis/amnesia (IM): 0.1–0.15mg/kg; more anxious may use up to 0.5mg/kg; max total dose 10mg. Sedation/anxiolysis/amnesia (IV); administer initial dose over 2–3 minutes: 6months–5yrs: initially 0.05–0.1mg/kg; max total dose 6mg. 6–12yrs: initially 0.025–0.05mg/kg; max total dose 10mg. 12–16yrs: use adult dose. Continuous IV infusion (non-neonatal): loading dose: 0.05–0.2mg/kg administered over 2–3 minutes; adjust to minimum effective infusion rate; Neonatal: <32weeks: 0.03mg/kg/hr; >32weeks: 0.06mg/kg/hr.
Acute narrow-angle glaucoma. Intrathecal or epidural use.
Risk of respiratory depression/arrest: only use in hospital or ambulatory care settings that provide continuous monitoring of respiratory and cardiac function. To be administered under the supervision of experienced clinicians. Have intubation, artificial respiration, oxygen therapy and reversal agents available. Shock, coma, acute alcohol intoxication: not recommended. Uncompensated acute illness (eg, severe fluid or electrolyte disturbances). COPD. Procedures involving the upper airway (eg, endoscopy, dental care). Chronic renal failure. CHF. Avoid extravasation. Neonates: avoid rapid inj. Pre-term infants. Debilitated. Elderly. Labor & delivery: not recommended. Pregnancy (Cat.D). Nursing mothers.
Severe hypotension in neonates with concomitant fentanyl. Potentiated by CNS depressants, CYP3A4 inhibitors (eg, cimetidine, erythromycin, diltiazem, verapamil, ketoconazole, itraconazole). Potentiates thiopental, halothane.
Inj site reactions, headache, hiccoughs, GI upset, cough, oversedation, drowsiness; cardiorespiratory events (eg, respiratory depression, apnea, respiratory arrest and/or cardiac arrest, airway obstruction, oxygen desaturation; may be fatal). Also children: hypotension, paradoxical reactions, seizure-like activity, nystagmus.
Formerly known under the brand name Versed.