Midazolam

Midazolam is a prescription medication used to treat the symptoms of Status Epilepticus, sedation of intubated or ventilated patients, anesthesia and preoperative sedation or Anxiolysis with Anterograde Amnesia. 

• Midazolam is available under the following different brand names: Seizalam, Versed (DSC)

Adult and Pediatric dosage

Oral syrup: Schedule IV

Adult dosage

• 2mg/mL (generic)
• Injectable solution: Schedule IV
  • 1mg/mL (generic)
  • 5mg/mL (generic, Seizalam)

Preoperative Sedation/Anxiolysis with Anterograde Amnesia

Adult dosage

IM

• 70-80 mcg/kg (dose range ~5 mg) 30-60 minutes before surgery (reduce 50% for chronically ill or geriatric patients)

IV

• Initial: Usually 0.5-1 mg given over 2 minutes (not to exceed 2.5 mg/dose); wait 2-3 minutes to evaluate sedative effect after each dose adjustment; total dose over 5 mg usually not necessary to reach desired sedation; use 30% less midazolam if patient premedicated with narcotics or other CNS depressants
• Debilitated or chronically ill patients: 1.5 mg IV initially; may repeat with 1 mg/dose IV every 2-3 minutes as needed; not to exceed cumulative dose of 3.5 mg; peak effect may be delayed in elderly, so increments should be smaller and rate of injection slower
• Maintenance: 25% of initial effective dose as needed by slow titration; reduce 30% if premedicated with opiate (50% in elderly/chronically ill)

Anesthesia

Adult dosage

Induction

• Younger than 55 years of age without premedication: 300-350 mcg/kg IV injection over 20-30 seconds; wait 2-3 minutes to evaluate sedative effect after each dose adjustment; may use increments of 25% of initial dose as needed to complete induction; may use up to 0.6 mg/kg total dose in resistant cases, but such dosing may prolong recovery. 
• Older than 55 years without premedication and with no systemic disease, in a patient who is not weak: 300 mcg/kg over 20-30 second initially; wait 2-3 minutes to evaluate sedative effect after each dose adjustment
• Older than 55 years without premedication but presence of system disease or weak patient: 200-250 mcg/kg over 20-30 seconds usually enough; 0.15 mg/kg enough in some cases; wait 2-3 minutes to evaluate sedative effect after each dose adjustment
• Older than 55 years with premedication: 150-350 mcg/kg IV injection over 20-30 seconds; wait 2-3 minutes to evaluate sedative effect after each dose adjustment; a dose of 250 mcg/kg usually enough to achieve desired effect

Maintenance

• May administer increments of 25% of induction dose as needed when there are signs that anesthetic effects are lightening

Pediatric dosage

Non-neonatal

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

Neonatal

• IV loading dose should not be used in neonates
• Continuous infusion: 0.5 mcg/kg/min IV infusion
• Sedation of Intubated/Ventilated Patients

Adult dosage

• Load: 10-50 mcg/kg (dose range 0.5-4 mg) slow IV injection or infusion over several minutes; repeat every 5-15 min as needed
• Maintenance: Initial, 20-100 mcg/kg/hr infusion: titrate up or down 25-50% as needed

Pediatric dosage

• 500-750 mcg/kg orally once diluted by juice 20-30 minutes prior to procedure; not to exceed 20 mg
• 100-150 mcg/kg IM; up to 500 mcg/kg used; not to exceed 10 mg
• IV
  • Younger than 6 months: Initial, 50 mcg/kg IV over 2-3 minutes; titrate with small increments to clinical effect; monitor closely; data are limited in non-intubated infants
  • 6 months-6 years: Initial, 50-100 mcg/kg IV over 2-3 minutes; repeat every 2-3 minutes as needed; may require up to 600 mcg/kg total dose; not to exceed 6 mg total dose
  • 6-12 years: Initial, 25-50 mcg/kg IV over 2-3 minutes; repeat every 2-3 minutes as needed; may require up to 400 mcg/kg; not to exceed 10 mg total dose

Status Epilepticus

Adult dosage

• Seizalam: Indicated for treatment of status epilepticus in adults
• 10 mg IM

Dosage Considerations – Should be Given as Follows: 

• See “Dosages.”