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MIDAZOLAM is a brand name for Midazolam. The medicine, its uses, side effects and dosage are the same regardless of brand.
Used for: As intravenous sedative cover before and during minor medical, dental and surgical procedures such as gastroscopy, endoscopy, cytoscopy, bronchoscopy and cardiac catheterisation. For sedation by intravenous injection (either continuous infusion or intermittent bolus injection) in critically ill patients in intensive…
Verbatim from this product's MHRA label. Tap a section to expand.
One or more intravenous injections over a single operating session.
Adults:
An assessment should be made of the degree of sedation necessary for the planned procedure. The dose should be titrated against the response of the patient. The desired titration end point will depend upon the procedure. Full sedation will be evident by drowsiness, slurred speech but response to commands will be maintained.
As a guide it is recommended that initially 2mg be administered intravenously over 30 seconds. 5 - 1mg should be given. 07mg/kg body weight). 0mg are not usually necessary.
Elderly:
THE ELDERLY ARE MORE SENSITIVE TO THE EFFECTS OF BENZODIAZEPINES. 5ML).
Children:
Midazolam Injection has not been evaluated for use as an intravenous sedative in children.
Combination therapy:
Where analgesia is provided by a narcotic analgesic, the latter should be administered first, the dose of Midazolam should then be carefully titrated and low doses 1-2mg (1-2ml) may be adequate. 0ml) may be adequate.
Mode of administration:
For the administration of Midazolam the patient should be placed in a supine position and remain there throughout the procedure. Resuscitation facilities should always be available and a second person fully trained in the use of such equipment, should always be present.
It is recommended that patients should remain under medical supervision until at least 1 hour has elapsed from the time of injection. They should always be accompanied home by a responsible adult. Patients who have received only Midazolam IV sedation prior to minor procedures, should be warned not to drive or operate machinery for 12 hours.
g. potent analgesics) recovery may be prolonged. Patients should therefore be assessed carefully before being allowed to go home or resume normal activities.
Sedation in the critically ill patient:
Midazolam can be given intravenously by two methods for this purpose, either by continuous infusion or by intermittent bolus dose. Both have their own advantages and disadvantages and the appropriate method of giving Midazolam will need to be determined for each patient.
Midazolam can cause respiratory and cardiovascular depression, ventricular irritability and a change in the baroreflex control of heart rate. There is a wide variation in susceptibility to its effects, the elderly being particularly sensitive.
Respiratory depression, respiratory arrest, hypotension and even death have been reported following its use, usually during conscious sedation. Adverse effects following intravenous midazolam include agitation, involuntary movements, confusion, slurred speech, blurred vision, lethargy, and dizziness and occur in less than 1% of patients receiving midazolam parenterally.
Nausea and vomiting occur in 2-3% of patients following intravenous use. g. agitation, restlessness and disorientation have been reported, although this is rare. Hallucinations, some of a sexual nature, have been reported Pain on injection is rare following intravenous midazolam, while thrombosis and thrombophlebitis occur in less than 1% of cases and is less common than with diazepam with organic solvents.
Like other anaesthetics, midazolam is known to depress renal blood flow and renal function.
Midazolam is a potent sedative agent and there is a wide variation in susceptibility to its effects. Deaths have been reported to the UK Committee on Safety of Medicines associated with respiratory and cardiovascular depression. It is therefore essential that the drug is only used intravenously by those skilled in resuscitation and tracheal intubation.
A means of ventilating the lungs and full resuscitative apparatus must always be available when the drug is given intravenously. Flumazenil as an antidote should also be available. Patients with chronic respiratory disease may be particularly sensitive to the respiratory depressant effects of intravenous midazolam and exhibit a more marked and prolonged depression than healthy subjects.
In hypovolaemia, vasoconstriction or hypothermia, the dose should be reduced, or the initial dose omitted. Low doses may be adequate if an opioid analgesic is also used. After prolonged administration of Midazolam, abrupt discontinuation may be accompanied by withdrawal symptoms, therefore a gradual reduction of Midazolam is required.
Elderly patients tend to be particularly sensitive to midazolam. Liver disease may delay elimination of midazolam, thus prolonged sedation may result as this may be accompanied by withdrawal symptoms. Midazolam should be given with care with compounds that inhibit certain hepatic enzymes (particularly cytochrome P450 IIA) as these compounds influence the pharmacokinetics of Midazolam and may lead to prolonged sedation.
3. Contra-indications • Known Benzodiazepine sensitivity. • Pregnancy - unless the benefits outweigh the possible risks. • Hypersensitivity to the active substance, other benzodiazepines or any of the excipients. • Myasthenia Gravis • Severe respiratory insufficiency • Sleep apnoea syndrome • Severe liver failure • Acute intoxication with alcohol, hypnotics, neuroleptics, antidepressants or lithium • Acute narrow angle glaucoma
Not medical advice. Always read the patient information leaflet and follow your prescriber or pharmacist.
Other brands of Midazolam in United Kingdom.
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The dose of Midazolam needed to sedate critically ill patients varies considerably between patients. The dose of Midazolam should be titrated to the desired state of sedation. This will depend on the clinical need, physical status, age and concomitant medication.
Midazolam can also be given in combination with an opioid. The opioid may be used for its analgesic effects or as an antitussive agent to help the patient tolerate the tracheal tube and ventilatory support. Patients receiving Midazolam for sedation in the intensive care situation should receive ventilatory support.
Safety of the use of Midazolam for periods of over 14 days in duration has not been established in clinical trials. After prolonged iv administration of Midazolam, abrupt discontinuation may be accompanied by withdrawal symptoms, therefore a gradual reduction of Midazolam is recommended.
Potential drug interactions:
The critically ill patient is exposed to many drugs. Because of this, there is a potential for drug interactions. ) Sedation by intermittent bolus dose in intensive care Midazolam only: The exact dose of Midazolam needs to be titrated to the individual patient response.
0mg (1-2ml) can be given, and repeated, until the required degree of sedation is reached.
Midazolam and an opioid:
When Midazolam and an opioid are used together, the opioid should be given first. Both drugs need to be titrated to the individual patient’s response and to the level of sedation thought to be necessary. Small doses of Midazolam 1-2mg can be given, and repeated, until the required degree of sedation is reached.
0ml) may be adequate. The use of these two groups of drugs can increase the risk of respiratory depression. If the patient is being given ventilatory support, using a mode that depends upon some spontaneous effort by the patient, then the minute volume may decrease.
Sedation by continuous infusion in intensive care Midazolam only:
Adults and children: Loading dose: For patients already sedated or anaesthetised after an operation, a loading dose of midazolam is unnecessary. 3 mg/kg is recommended depending on the level of sedation required. This should be given over a five minute period.
The loading dose should be reduced or omitted in hypovolaemic, vasoconstricted or hypothermic patients. 2 mg/kg/hour is recommended, starting at the lower dose. The dose should be reduced in hypovolaemic, vasoconstricted or hypothermic patients.
Midazolam and an opioid:
When opioid analgesics are used, the rate of infusion of Midazolam should be titrated carefully to the sedative needs of the patient. 1mg/kg/hour may be used to start. The use of these two groups of drugs an increase the risk of respiratory depression.
If the patient is being given ventilatory support, using a mode that depends upon some spontaneous effort by the patient, then the minute volume may decrease. Whenever a continuous infusion of Midazolam is used (with or without an opioid analgesic), its need should be assessed on a daily basis in order to reduce the risk of accumulation and prolonged recovery.
Each day, the infusion of Midazolam should be stopped or […]