# 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**

**EMT:** Not authorized

**AEMT:** Not authorized

**Paramedic:** Standing order and Medical Control

#### **DOSAGE**

<table border="1" id="bkmrk-indication-route-adu" style="width: 100%;"><tbody><tr><th style="width: 28.7247%;">Indication</th><th style="width: 8.69942%;">Route</th><th style="width: 28.3685%;">Adult Dosage</th><th style="width: 34.2074%;">Pediatric Dosage</th></tr><tr><td style="width: 28.7247%;">Seizure / Agitation / Violent Patient</td><td style="width: 8.69942%;">IV/IO/IM</td><td style="width: 28.3685%;">2–5 mg, may repeat every 5 min, max 10 mg total</td><td style="width: 34.2074%;">≥ 13 years: 2–5 mg, may repeat every 5 min, max 10 mg total  
&lt; 13 years: 0.1 mg/kg, max 10 mg total</td></tr><tr><td style="width: 28.7247%;">Seizure / Agitation / Violent Patient</td><td style="width: 8.69942%;">IN</td><td style="width: 28.3685%;">5 mg (½ dose per nostril), may repeat every 5 min, max 10 mg total</td><td style="width: 34.2074%;">≥ 13 years: 5 mg (½ dose per nostril), may repeat every 5 min, max 10 mg total  
&lt; 13 years: 0.2 mg/kg, max 10 mg total</td></tr><tr><td style="width: 28.7247%;">Bradycardia (prior to pacing) / Tachycardia (prior to cardioversion)</td><td style="width: 8.69942%;">IV/IO</td><td style="width: 28.3685%;">2–5 mg, do not repeat</td><td style="width: 34.2074%;">0.1 mg/kg, max 5 mg</td></tr><tr><td style="width: 28.7247%;">CPAP Sedation (Respiratory Distress)</td><td style="width: 8.69942%;">IV/IO/IM</td><td style="width: 28.3685%;">0.5 mg, may repeat every 5 min, max 2 mg total</td><td style="width: 34.2074%;">No pediatric protocol</td></tr><tr><td style="width: 28.7247%;">Post Resuscitation (Sedation for agitation after intubation)</td><td style="width: 8.69942%;">IV/IO/IM/IN</td><td style="width: 28.3685%;">2–5 mg, may repeat up to a total of 10 mg</td><td style="width: 34.2074%;">1 mg IV/IO, may repeat up to a total of 5 mg</td></tr></tbody></table>

##### **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.