Midazolam
GENERIC NAME
Midazolam
TRADE NAME
Versed
DESCRIPTION
Midazolam is a short-acting, water-soluble benzodiazepine that depresses the central nervous system (CNS), producing sedation and decreased responsiveness to commands.
HOW SUPPLIED
1 mg/ml (5 ml vial)
INDICATIONS
- Active seizures
- Sedation prior to cardioversion
- Sedation for administering CPAP
- Violent patients with extreme agitation
- Post resuscitation – sedation for agitation after intubation
CONTRAINDICATIONS
- Allergy or hypersensitivity to Midazolam
PRECAUTIONS
- Respiratory depression
- Hypotension
MECHANISM OF ACTION
Midazolam produces CNS depression, causing drowsiness and decreased responsiveness to commands.
SIDE EFFECTS
- Respiratory depression
- Hypotension
HOW ADMINISTERED
- IV/IO: Administer no faster than 5 mg over 2 minutes. For seizures, give in 2 mg increments, titrating to effect. Allow at least 10 minutes between doses.
- IM: Allow at least 10 minutes between doses. Total dosage may require two injections if volume exceeds the maximum single IM volume.
- IN: Deliver half of each dose per nostril. Allow at least 10 minutes between doses. Use the intranasal route only if IV/IO access is unavailable.
AUTHORIZATION
Paramedic: Standing order and Medical Control
DOSAGE
| Indication | Route | Adult Dosage | Pediatric Dosage |
|---|---|---|---|
| Seizure / Agitation / Violent Patient | IV/IO/IM | 2–5 mg, may repeat every 5 min, max 10 mg total | ≥ 13 years: 2–5 mg, may repeat every 5 min, max 10 mg total < 13 years: 0.1 mg/kg, max 10 mg total |
| Seizure / Agitation / Violent Patient | IN | 5 mg (½ dose per nostril), may repeat every 5 min, max 10 mg total | ≥ 13 years: 5 mg (½ dose per nostril), may repeat every 5 min, max 10 mg total < 13 years: 0.2 mg/kg, max 10 mg total |
| Bradycardia (prior to pacing) / Tachycardia (prior to cardioversion) | IV/IO | 2–5 mg, do not repeat | 0.1 mg/kg, max 5 mg |
| CPAP Sedation (Respiratory Distress) | IV/IO/IM | 0.5 mg, may repeat every 5 min, max 2 mg total | No pediatric protocol |
| Post Resuscitation (Sedation for agitation after intubation) | IV/IO/IM/IN | 2–5 mg, may repeat up to a total of 10 mg | 1 mg IV/IO, may repeat up to a total of 5 mg |
Notes:
- For all IV/IO administrations, administer no faster than 5 mg over 2 minutes.
- For IM administrations, total volume may require two injections if exceeding the maximum single IM volume.
- For IN administrations, deliver half of each dose per nostril. Use this route only if IV/IO access is not established.