Midazolam is a sedative commonly used before surgery. This drug can reduce anxiety, make the patient feel relaxed, and sleepy so that he falls asleep during the operation. In addition, midazolam can also be used to relieve seizures in status epilepticus.
Midazolam has a calming effect by increasing the activity of a natural chemical in the body called gamma-aminobutyric acid (GABA). Apart from being a sedative before surgery, midazolam can also be given to ICU patients who require the installation of a breathing apparatus or ventilator.
Injectable midazolam should only be given in a hospital by a doctor or medical personnel under the supervision of a doctor.
Midazolam trademark:Anesfar, Dormicum, Fortanest, Hypnoz, Midanest-15, Midazolam-Hameln, Midazolam Hydrochloride, Miloz, Sedacum
What is Midazolam
|Sedation before surgery and for patients in intensive care requiring a ventilator
|Adults and children
|Midazolam for pregnant and lactating women
|Category D:There is positive evidence of risks to the human fetus, but the benefits may outweigh the risks, for example in dealing with life-threatening situations.
Midazolam may be absorbed into breast milk. If you are breastfeeding, do not use this medicine without consulting your doctor first.
Precautions Before Using Midazolam
There are several things to consider before using this drug, including:
- Tell your doctor about any allergies you have. Midazolam should not be used in patients allergic to this drug or to other benzodiazepine drugs.
- Tell your doctor if you are taking medication with an opioid class of drugs, such as codeine. Midazolam should not be given in this condition.
- Tell your doctor if you have or have had glaucoma, kidney disease, liver disease, chronic obstructive pulmonary disease (COPD), sleep apnea, heart disease, ormyasthenia gravis.
- Tell your doctor if you have ever had drug abuse or alcohol addiction. Midazolam should not be given to patients who regularly consume alcoholic beverages.
- Do not drive a vehicle or perform activities that require alertness while you are taking midazolam, as this medicine may cause dizziness and drowsiness.
- Tell your doctor if you are pregnant, breastfeeding, or planning a pregnancy.
- Tell your doctor if you are taking any other medicines, including supplements, or herbal products.
- Tell your doctor right away if you have an overdose, allergic reaction to a drug, or a more serious side effect after using midazolam.
Dose and Rules for Use Midazolam
The dose of midazolam varies in each patient. Midazolam is given by injection into a vein (intravenous/IV) or into a muscle (intramuscular/IM) by a doctor or medical officer under the supervision of a doctor.
The following is a division of midazolam dosage based on its intended use:
Purpose: Sedation before minor surgery or dental surgery
- Mature: The initial dose is 2–2.5 mg per day, given 5–10 minutes before surgery. The dose may be increased by 0.5–1 mg until the desired therapeutic response is achieved.
- Children aged 6 months until 5 years: The initial dose is 0.05–0.1 mg/kg per day, given 5–10 minutes before surgery. The dose can be increased up to 0.6 mg/kg body weight per day. The maximum dose is 6 mg per day.
- Children ages 6–12 years: The initial dose is 0.025–0.05 mg/kg body weight per day. The dose can be increased up to 0.4 mg/kg body weight per day. The maximum dose is 10 mg per day.
- seniors: The initial dose is 0.5–1 mg per day, given 5–10 minutes before surgery. The maximum dose is 3.5 mg or until the desired therapeutic response is achieved.
Purpose: Sedatives for patients undergoing intensive care
- Mature: The initial dose is 0.03–0.3 mg/kg body weight per day. The dose may be increased up to 1–2.5 mg per day, injected slowly over 20–30 seconds. Maintenance dose 0.03–0.2 mg/kg per hour.
- Children <32 weeks old until 6 months: 0.06 mg/kg per hour, given by continuous infusion.
- Children >6 months old: 0.05–0.2 mg/kgBW, given by slow injection over at least 2–3 minutes to get the desired effect. Maintenance dose 0.06–0.12 mg/kg per hour.
Purpose: Premedication in surgery
- Mature: 0.07–0.1 mg/kgBW injected IM, given 20–60 minutes before surgery. An alternative dose of 1–2 mg is injected IV, given 5–30 before surgery.
- Children aged 1–15 years: 0.08–0.2 mg/kg by IM injection, given 15–30 minutes before surgery.
- seniors: 0.025–0.05 mg/kgBW by IM injection, given 20–60 minutes before surgery or surgery.
Purpose:Relieves seizures due to status epilepticus
- Adult: 10 mg by injection IM.
How to use Midazolam correctly
Midazolam injection will be given directly by a doctor or medical officer under the supervision of a doctor. Injections will be given IM (intramuscularly / into the muscle) or IV (intravenous / into a vein) or through an IV. This medicine should only be used in a hospital or in a health facility.
While the patient is undergoing treatment with midazolam, close monitoring will be carried out to assess the response to therapy and prevent unwanted side effects.
Midazolam Interactions with Other Drugs
The following are some of the effects of drug interactions that may occur if midazolam is taken at the same time as other drugs:
- Increased effectiveness of midazolam when used with ketoconazole, itraconazole, voriconazole, calcium channel blockers, macrolide antibiotics, or antiviral drugs, such as ritonavir
- Increased risk of fatal side effects, such as coma and respiratory distress when used with opioid drugs, such as morphine or codeine
- Decreased effectiveness of midazolam when used with rifampicin, carbamazepine, or phenytoin
- Increased effectiveness of antipsychotic drugs, anesthetics, antidepressants, antihistamines, antihypertensive drugs, or barbiturate anticonvulsants, such as phenobarbital
Side Effects and Dangers Midazolam
During treatment with midazolam, the doctor will monitor closely to prevent unwanted side effects. Some of the side effects that can occur after using midazolam are:
- Nausea or vomiting
- Temporary amnesia
- Pain, redness, or swelling, at the injection site
Report and tell the doctor if the side effects mentioned above do not subside or get worse. Get help right away if you have an allergic reaction to a drug or experience more serious side effects, such as:
- Breath sounds (wheezing) or difficulty breathing
- Slow heart rate
- Feeling so dizzy that you want to pass out
- Uncontrolled eye and muscle movements