Midazolam

• Procedural sedation:
  • < 60 years: IV 1mg every 2-3min
    • Max:2.5mg/dose

• • Elderly, debilitated or chronically ill patients:
    • IV 1mg every 2-3min. Max: 1.5mg/dose

• • ≥6 months: PO 0.25-0.5mg/kg/dose *1
    • Started 20-30min before procedure
    • Max: 20mg
    • Children <6 years may require up to 1mg/kg/dose

• • ≥6 months: IM 0.1-0.15mg/kg/dose *1
    • Initially 15-30min before procedure
    • Max: 0.5mg/kg total
    • Cumulative dose >10mg rarely needed

• • 6 months-5 years: IV 0.5-0.1mg/kg/dose *1, repeated every 2-3min PRN
    • Started 5min before procedure
    • Max: 0.6mg/kg total

• • 6-12 years: IV 0.025-0.05mg/kg/dose *1, repeated every 2-3min PRN
    • Started 5min before procedure
    • Max: 0.4mg/kg total

• • > 12 years: IV 0.5-2mg *1, repeated every 2-3min PRN
    • Started 5min before procedure

• Preoperative sedation/anxiolysis with anterograde amnesia:
  • IM 70-80mcg/kg (dose range ~5 mg) 30-60 minutes before surgery
    • Reduce 50% for chronically ill or geriatric patients
    • Use 30% less midazolam if patient premedicated with narcotics or other CNS depressants

OR

• • Initially IV 0.5-1mg given over 2 minutes
    • Max 2.5mg/dose

• • Debilitated or chronically ill patients: IV 1.5mg IV initially
    • May repeat with IV 1mg/dose every 2-3 min PRN
    • Max cumulative dose: 3.5 mg

• General anesthesia induction:
  • <55 years: IV 0.3-0.35mg/kg/dose *1
    • May give incremental doses of 25% of initial dose PRN to achieve complete induction, up to 0.6mg/kg total dose in resistant patients
    • Consider decreasing dose to IV 0.25mg/kg/dose *1 if premedicated OR to 0.15mg/kg/dose *1 if severe systemic disease or debilitated

• • ≥55 years: IV 0.3mg/kg/dose *1
    • Consider decreasing dose to IV 0.2mg/kg/dose *1 if premedicated OR 0.15mg/kg/dose *1 if severe systemic dz or debilitated

• • Children: Loading dose: IV 50-150mcg/kg over 2-3 minutes PRN to achieve desired effect
    • Continuous infusion: 1-2mcg/kg/min IV infusion

• General anesthesia maintenance:
  • IV 25% of induction dose PRN
    

• Sedation of intubated/ventilated patients:
  • LD: 10-50mcg/kg (dose range 0.5-4mg) slow IV injection or infusion over several minutes
  • Repeat every 5-15min PRN
  • Maintenance: Initially 20-100mcg/kg/hour infusion; titrate up or down 25-50% PRN
    

• Acute repetitive seizures (Off-label):
  • 5mg intranasally *1
    • Max: 2 doses/single episode
    • 1 episode every 3 days up to 5 episodes/month
    • May repeat dose *1 after 10min *1

OR

• • 10mg buccally *1
    

• Status epilepticus (Off-label):
  • IM 10mg *1

OR

• • 5mg intranasally *1
    • Max: 2 doses/single episode
    • 1 episode every 3 days up to 5 episodes/month
    • May repeat dose *1 after 10min *1

OR

• • 10mg buccally *1
    

• Refractory status epilepticus (Off-label):
  • Initially IV 0.2mg/kg/dose *1
  • May repeat 0.1-0.2mg/kg/dose *1, then increase by 0.05-0.1mg/kg/hour every 3-4 hours PRN