Midazolam

Question 1

Midazolam

Presentation

Answer 1

15mg in 3mls (5mg/ml).

Question 2

Midazolam

Use

Answer 2

• Prolonged seizure activity - generalised seizure lasting ≥ 5 minutes OR recurrent / status seizure activity as per CPG
• Focal seizure activity which is prolonged (≥ 5 minutes) and is associated with a GCS ≤ 12 as per CPG
• Disturbed and/or abnormal behaviour that poses a threat to others or themselves as per CPG
.

Question 3

Midazolam

Type

Answer 3

water-soluble benzodiazepine that has anxiolytic, sedative and anticonvulsive characteristics..

Question 4

Midazolam

Dose

Answer 4

Seizures / Sedation (Non-TBI)
Adult <70 years:
• IM
o 5mg, repeat once after 10 min if needed and no IV access.
• IV/IO
o 2.5 - 5mg, repeat dose 2.5mg every 5 min as needed to 15mg max.
Adult ≥70 years or frail:
• IM
o 2.5mg, repeat once after 10 min if required and no IV access.
• IV/IO
o 2.5mg, repeat dose 1mg every 5 min as needed to 15mg max.
Paediatric:
• IM
o 0.2mg/kg max single bolus 5mg, repeat once after 10 min if needed and no IV access.
• IV/IO
o 0.1mg/kg to a max single bolus dose of 2.5mg, repeat as needed every 5 min to a 10mg max.
The use of Midazolam in both adults and paediatric patients for other seizure types outside of CPG requires ASMA authority.
Drug Induced Psychosis
• IM
o 10 mg (half doses for the paediatric, small, or frail patient
.

Question 5

Midazolam

Actions

Answer 5

This is due to its bonding with receptors in the CNS; its action to increase the inhibitory effect of the g-aminobutyric acid (GABA) neurotransmitter on the GABA receptors and subsequent membrane threshold.
• Midazolam is lipid-soluble in physiological pH and it reaches the CNS quickly
.

Question 6

Midazolam

Contraindications

Answer 6

• Hypersensitivity

Question 7

Midazolam

Adverse effects

Answer 7

•	Respiratory depression
•	Hypotension
•	Anterograde and retrograde amnesia
•	Myasthenia Gravis
.

Question 8

Midazolam

Precautions

Answer 8

• Early monitoring where practicable is required when administering midazolam; ideally this would include SpO2, respiratory rate, pulse and blood pressure
• Psychostimulants, in toxic levels can produce severe agitation and psychotic behaviou
.