Midazolam is used as: • Hypnotic & hence it is used for short term management of insomnia. • Sedative & hence it relieves anxiety, tension & fear • Pre-anaesthetics• Anticonvulsants
The actions of benzodiazepines such as midazolam are mediated through the inhibitory neurotransmitter gamma-aminobutyric acid (GABA), which is one of the major inhibitory neurotransmitters in the central nervous system. Benzodiazepines increase the activity of GABA, thereby producing a sedating effect, relaxing skeletal muscles, and inducing sleep, anesthesia, and amnesia. Benzodiazepines bind to the benzodiazepine site on GABA-A receptors, which potentiates the effects of GABA by increasing the frequency of chloride channel opening. These receptors have been identified in different body tissues including the heart and skeletal muscle, although mainly appear to be present in the central nervous system.
The duration of treatment with oral midazolam should not be more than of 2 weeks. In certain cases extension beyond the maximum treatment period may be necessary. Insomnia: Adults: -7.5 mg to 15 mg daily. Elderly: -7.5 mg daily. Premedication: 7.5 mg to 15 mg, should be given 30-60 minutes before the procedure. Endoscopic or Cardiovascular procedures: Adult: Initial dose is 2.5 mg (IV). Elderly & debilitated patients: 1-1.5 mg (IV). Induction of Anesthesia: Adult: 10-15 mg (IV) or 0.07-0.1 mg/Kg body weight, usually 5 mg (IM). Children: 0.15-0.20 mg/Kg (IM).
Midazolam can enhance the central sedative effect of neuroleptics, tranquillizers, antidepressants, sleep-inducing drugs, analgesics, anaesthetics, antipsychotics, anxiolytics, antiepileptic drugs and sedative antihistamines.
Known hypersensitivity to Midazolam or other benzodiazepines, severe respiratory, insufficiency, severe hepatic insufficiency, sleep apnea syndrome, myasthenia gravis, patients with a history of alcohol or drug abuse & children. CNS depressants, erythromycin, azole type animycotics & cimetidine may interfere the metabolism of Midazolam. So caution should be taken during the concomitant treatment with these drugs along with Midazolam. Long time use of Midazolam may increase dependency. As Midazolam is a strong sedative, it should not be taken before driving or other performance skilled tasks.
Drowsiness is the most common side Effect. Less common side Effects are CNS depression, ataxia, confusion, tiredness, muscle weakness, fatigue, headache, dizziness & double vision. These Effects occur predominantly at the start of treatment & usually disappear with dose adjustment or continuation of therapy.
Pregnancy category D . Breastfeeding is not recommended during treatment
Extreme overdosage may lead to coma, areflexia, cardiorespiratory depression and apnea. The effects of overdosage can be controlled with benzodiazepine antagonist flumazenil.
Protect from light and moisture, store in cool and dry place. Keep out of the reach of children.
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