• 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
  • Injection:
    • 5mg/mL
    • 1mg/mL
  • Tablet:
    • 15mg
  • Give IV slowly over at least 2 min and wait at least 2 min when adjusting doses to desired effect
  • Excessive dose or too rapid infusion may cause respiratory arrest
  • Pediatric patients generally require higher IV dosages of midazolam (mg/kg) than do adults
  • IM given deep into large muscle mass

Short-acting benzodiazepine

It causes increase in neuronal membrane permeability to chloride ions which enhances the inhibitory effects of GABA. The shift in chloride ions causes hyperpolarization (less excitability) and stabilization of the neuronal membrane

  • Sedation
  • Nausea
  • Vomiting
  • Injection site pain
  • Hiccups
  • Hypotension
  • Agitation
  • Dystonia
  • Amnesia
  • Diplopia
  • Disinhibition
  • Confusion
  • Ataxia
  • Weakness
  • Dysarthria
  • Euphoria
  • Rash
  • Documented hypersensitivity
  • Acute alcohol intoxication
  • Acute narrow angle glaucoma
  • Intrathecal/epidural use (formulations containing preservatives, such as, benzyl alcohol)

WARNING

  • Respiratory depression/arrest has been associated with use, especially when used for sedation in noncritical care settings
  • Should be used only in settings that can provide continuous monitoring of respiratory and cardiac function
  • Concomitant benzodiazepine use with opioids may result in profound sedation, respiratory depression, coma and death
    • Reserve concomitant use for patients with inadequate alternative treatment options
  • Amifampridine
  • Atazanavir
  • Bupropion
  • Cobicistat
  • Dalfampridine
  • Darunavir
  • Fosamprenavir
  • Itraconazole
  • Ketoconazole
  • Lonafarnib
  • Lopinavir/ritonavir
  • Metoclopramide
  • Nelfinavir
  • Ritonavir
  • Saquinavir
  • Tipranavir

                          Drug Status

Availability Prescription only
Pregnancy Category D
Breastfeeding Contraindicated
Schedule Controlled
BRAND NAME STRENGTH FORMULATION PACK SIZE MANUFACTURER DISTRIBUTOR
Benzosed 1mg/mL Injection 5mL Troikaa Harley’s Ltd
Benzosed 5mg/mL Injection 3mL Troikaa Harley’s Ltd
Dormicum 15mg Tablet 10’s F. Hoffman-La Roche Laborex Kenya
Dormicum 5mg/5mL Injection 10’s F. Hoffman-La Roche Laborex Kenya
Dormicum 15mg/3mL Injection 5’s F. Hoffman-La Roche Laborex Kenya
Dormicum 50mg/10mL Injection 5’s F. Hoffman-La Roche Laborex Kenya
Milam 15mg Tablet 20’s Pharma Jordan Generics Africa
Milam 7.5mg Tablet 40’s Pharma Jordan Generics Africa
Milam 15mg Injection 1’s Pharma Jordan Generics Africa
Sedalam 5mg/mL Injection 15mg/3ml Pharma Jordan Generics Africa
Sedalam 1mg/mL Injection 5mg/5mL Pharma Jordan Generics Africa
Tasnovel 5mg/5mL Injection 10’s Tasa Pharma Sai Pharma
Tasnovel 15mg/3mL Injection 10’s Tasa Pharma Sai Pharma