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MIDAZOLAM Lactation Yes(Caution) Trade Name: Versed
Class / Mechanism of Action
Benzodiazepine
Acts as an Anxiolytic/Hypnotic, anticonvulsant and sedative.
Onset of action: Sedation; IV: 1-5min, IM: 15min, Intranasal: 4-8min Duration: IV, less
than 2 hours. (20-30min per ECCN Nurse Protocols, May 2012)
Indications
Labeled Indications: Preoperative sedation, induction and maintenance of general anesthesia
Unlabeled: Anxiety / agitation, status epilepticus, conscious sedation (intranasal)
Contraindications
• Hypersensitivity to midazolam or any component of the formulation or other benzodiazepines
• Acute narrow angle glaucoma, Acute Alcohol Intoxication
• Respiratory Insufficiency/Depression (except during mechanical ventilation)
• (Overdose Reversal: FLUMAZENIL can be used, however it carries elevated risk.
Respiratory support until the medication is metabolized is traditionally the best care in
Benzodiazepine overdose)
• Should not be used in shock
• Neurologic Depression (Head Trauma) (unless having active seizure)
Adverse Reactions / Precautions
• No Analgesic properties (Narcotic pain control is needed for RSI’d/Intubated trauma patients)
• May Cause Respiratory depression: Do not give without stable IV line and BVM (airway control) ready
• Hypotension, vasodilation
• Amnesia, confusion, drowsiness, slurred speech (Paradoxical Reactions possible: aggressiveness,
agitation, anxiety, inappropriate behavior)
Dose and Administration: ADULT PEDIATRIC Always Reference BROSELOW Tape
Induction for RSI; Continued sedation; Procedural sedation; Transcutaneous Pacing;
Hyperthermia: Cardioversion:
IV: IV:
• Induction 0.1mg/kg IV/IO • 0.05-0.1mg/kg q15-30min prn
• Continued Sedation .05mg IV/IO Intranasal (unlabeled route):
• Infusion sedation 0.05mg/kg bolus • 0.2-0.5mg/kg (maximum total dose: 10mg or 5mg per
IV, then titrate 0.05-0.1mg/kg/hr IV nare
gtt
Induction/RSI (Not preferred drug)
Transcutaneous Pacing / IV:
Cardioversion, Anxiety, Agitation,: • 0.1-0.3mg/kg
IV
• 2.5-5mg q15-30min prn
Seizure
Seizure Dosage: IV, IM:
• If no IV/IO access, 5mg IN (repeat in • 0.2mg/kg q15-30min prn
10 minutes in opposite nostril if still Status epilepticus, prehospital treatment (unlabeled use):
seizing (preferred) or 10mg IM IV:
(alternate) • Infants: 1-2mg
• 5mg IV/IO, may repeat • 13-40 kg: 4mg once
After 3 doses should consider addition of another • >40 kg: Refer to adult dosing
agent.

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