Midazolam

PHARMACOLOGY

Benzodiazepines have GABA-potentiating actions in the CNS (spinal cord, hippocampus, cerebellum, cerebrum) thereby reducing neuronal activity

Onset of action: 5-10 minutes SC; 2-3 min IV; 15 minutes sublingual
Time to peak: 30 min SC; 60 minutes PO
Duration of action: 4 h
Plasma ½ life: 2-5 h

DOSING

  • 2.5-5 mg stat and prn PO/SC
  • Infusional rate: 10-60 mg/24h
  • Anti-epileptic: 10 mg SC
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  • 100 mcg/kg SC over one minute, then if necessary 300-700 mcg/kg over 24 h by continuous SC infusion

UNWANTED EFFECTS

  • Sedation
  • Fatigue
  • Decreased co-ordination
  • Blurred vision
  • Memory impairment
  • Hypotension
  • Anxiety
  • Decreased libido
  • Depression
  • Headaches
  • Insomnia

PITFALLS/CONCERNS

  • Benzodiazepines used alone in delirium will likely exacerbate the condition
  • There are some drug-drug interactions with benzodiazepines
  • Abrupt cessation of long-term benzodiazepine therapy can cause withdrawal symptoms
  • May cause hypotension
  • Use with caution in severe hepatic disease

NOTE

This information is drawn from a number of sources (see below). The reader is encouraged to access these and other relevant literature for more detail. As always, sound clinical judgment should be used in individual clinical cases. In particular, it should be remembered that there may be significant variation in the pharmokinetics of a drug resulting from a number of factors, including the individual patient’s metabolism/disease status and how the medication has been formulated.

SOURCES/REFERENCES

  1. Brunton LL, Lazo JS, Parker KL, editors. Goodman and Gilman’s: the pharmacological basis of therapeutics. 11th ed. McGraw-Hill Professional; 2006.
  2. Twycross R, Wilcock A. Palliative care formulary. 3rd ed. Radcliffe Medical Press Ltd; 2008.
  3. Repchinsky C, editor. Compendium of pharmaceuticals and specialties (CPS): the Canadian drug reference for health professionals. 44th ed. Canadian Pharmacists Association; 2009.
  4. Goldman A, Hain R, Liben S. Oxford textbook of palliative care for children. 1st ed. Oxford University Press; 2006.

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