DORMICUM
MIDAZOLAM · by MARTIN DOW
Composition
InjPer ml: Midazolam (as HCI) 1 mg/5 mg. Tab 7.5 mg/15 mg: Midazolam (as maleate) 7.5 mg/15 mg.
Indications & Dosage
Conscious sedation for procedures: BY SLOW IV INJ: Adult: Initially 2-2.5 mg, 5-10 minutes before procedure at a rate ofapproximately 2 mg/minute, increased in steps of 1 mgif required, usual total dose is 3.5-5 mg; max.7.5 mg per course. Elderly: Initially 0.5-1 mg,5-10 minutes before procedure at a rate of approximately 2 mg/minute, increased in steps of0.5-1 mg if required; max. 3.5 mg per course. Children 1 month-6yrs: Initially 25-50 mcg/kg, increased if necessary in small steps, max total dose 6 mg; over 2-3 minutes 5-10 minutes before procedure; 6-12 yr: Initially 25-50 mcg/kg, increased if necessary in small steps, was total dose 10 mg; over 2-3 minutes 5-10 minutes before procedure;12-18 yr: initially 25-50 mcg/kg, increased if necessary in small steps, max total dose 7.5 mg;over 2-3 minutes 5-10 minutes before procedure. Sedative in combined anaesthesia: BY IV INJECTION: Adult: 30-100 mcg/kg, repeated if necessary, alternatively (by continuous IV INF)30-100 mcg/kg/hour. Elderly: Lower doses needed. Premedication: BY DEEP IM INJ: Adult: 70-100 mcg/kg, 20-60 minutes before induction, for debilitated patients, use elderly dose Elderly: 25-50 mcg/kg, 20-60 minutes before induction. BY IV INJ: Adult: 1-2 mg, repeated if necessary, 5-30 minutes before procedure, for debilitated patients, use elderly dose Elderly: 0.5 mg, repeated if necessary, initial dose 5-30 minutes before procedure, repeatdose slowly as required Children 1 month-18 yrs: 500 mcg-1 mg, repeated if necessary, 15-30 minutes before the procedure. Induction of anaesthesia for minor surgical procedures: BY SLOW IV INJ: Adult: 150-200 mcg/kg daily in divided doses (max. per dose 5 mg), at intervals of2 minutes, max. total dose 600 mcg/kg, for debilitated patients, use elderly dose. Elderly: 50-150 mcg/kg daily in divided doses (max. per dose 5 mg), at intervals of 2 minutes, max. total dose 600 mcg/kg. Children 7-18 yr: Initially 150 mcg/kg, max 7.5 mg, given in steps of 50 mcg/kg, was 2.5 mg, over 2-5 minutes; wait for 2-5 minutes then give additional doses of 50 mcg/kg, max 2.5 mg, every 2 minutes if necessary, max total dose 500 mcg/kg (not exceeding 25 mg). Sedation of patient receiving intensive care: BY SLOW IV INJ: Adult: Initially 30-300 mcg/kg, in steps of 1-2.5mg every 2 minutes, then (by slow IV injection or by continuous IV INF) 30-200 mcg/kg/hour, reduce dose (or reduce or omit initial dose) in hypovolaemia, vasoconstriction, or hypothermia, lower doses may be adequate if opioid analgesic also used. BY IV INJ OR CONTINUOUS IV INF: Neonate: 60 mcg/kg/hr by continuous IV INF, reduced after 24 hr to 30 mcg/kg/hr; adjusted according to response, max treatment duration 4 days; 1-6 months: 60 mcg/kg/hr by continuous IV INF adjusted according to response; 6 months-12 yr: Initially 50-200 mcg/kg by slow IV injection over at least 3 minutes followed by 30-120 mcg/kg/hr by continuous IV INF adjusted ac-cording to response; 12-18 yr: Initially 30-300 mcg/kg by slow IV injection given in steps of 1-2.5 mg every 2 minutes followed by 30-200 mcg/kg/hr by continuous IV INF adjusted according to response. Confusion and restlessness in palliative care (adjunct to antipsychotic): BY SC INF: Adult: Initially 10-20 mg/24 hours, adjusted according to response; usual dose 20-60 mg/24 hours. Convulsions in palliative care: BY CONTINUOUS SC INF: Adult: Initially 20-40 mg/24 hours.
Administration
Administer by deep IM injection into large muscle or administer by slow IV injection over at least 2-5 min at a concentration of 1-5 mg/ml or by IV infusion. Continuous infusions should be administered via an infusion pump.
Compatibility
Stable in D5NS, D5W, NS. Incompatible with LR.Y-site administration:
Stability
: Reconstituted solution at a final concentration of 0.5 mg/ml is stable for up to 24 hours when diluted with D5W or NS.
Contraindications
Acute pulmonary insufficiency, CNS depression, compromised airway, severe respiratory depression
Precautions
Renal, hepatic or cardiac impairment, cardiac disease, children (particularly if cardiovascular impairment), concentration of midazolamin children under 15 kg not to exceed 1 mg/ml, debilitated patients (reduce dose), hypothermia, hypovolaemia (risk of severe hypotension), neonates, risk of airways obstruction and hypoventilation in children under 6 months (monitor respiratory rate and oxygen saturation), vasoconstriction paediatrics patients with cardiovascular instability, congestive heart failure; use lower doses, administer slowly and monitor vital functions, history of alcohol or drugs abuse, myasthenia gravis, elderly. Withdraw gradually.
Interactions
Antipsychotics, hypnotics, anxiolytics, antidepressants, narcotic analgesics, anticonvulsants,anaesthetics, antihistamines, alcohol, erythromycin, cimetidine, diltiazem, verapamil, ketoconazole, fluconazole, itracozole, other CYP3A4 inhibitors, cyclosporin, nifedipine.
Pregnancy
Avoid unless potential benefit outweighs risk
Lactation
Contraindicated, avoid
Side Effects
Anaphylaxis, ataxia, amnesia, bronchospasm, cardiac arrest, blood disorders, confusion, convulsions, depression of consciousness, dizziness, drowsiness, dry mouth, dysarthria, euphoria, fatigue, GI disturbances, hallucinations, headache, hiccups, hypotension, incontinence, increased appetite, involuntary movements, jaundice, laryngospasm, muscle weakness, paradoxical aggression and excitement, respiratory arrest, respiratory depression, restlessness, salivation changes, severe disinhibition, skin reactions, thrombosis, urinary retention, vertigo, visual disturbances