Midazolam
Procedural sedation, Seizures, Anxiolysis, RSI premedication
Indications
- Procedural sedation
- Seizures
- Anxiolysis
- RSI premedication
Adult dosing
- sedation: dose: 0.02; maxDose: 10; maxDoseAbsolute: true; unit: mg/kg; route: IV; weightBased: true; seizure: dose: 0.2; unit: mg/kg; maxDose: 10; maxDoseAbsolute: true; route: IM; weightBased: true; anxiolysis: dose: 1; unit: mg; route: IV; interval: titrate q2-3min; fixed: true
Pediatric dosing
- sedation: dose: 0.05; maxDose: 5; maxDoseAbsolute: true; unit: mg/kg; route: IV; weightBased: true; seizure im: dose: 0.2; unit: mg/kg; maxDose: 10; maxDoseAbsolute: true; route: IM; weightBased: true; intranasal: dose: 0.2; unit: mg/kg; maxDose: 10; maxDoseAbsolute: true; route: IN; weightBased: true; seizure in: dose: 0.2; unit: mg/kg; maxDose: 10; maxDoseAbsolute: true; route: IN; weightBased: true; pedNote: Status epilepticus when IV unavailable
Contraindications
- Acute narrow-angle glaucoma
- Severe respiratory depression (without ventilatory support)
Clinical pearls
- IM midazolam is first-line for status epilepticus when IV access unavailable (RAMPART trial)
- Intranasal route effective in pediatric seizures — 0.2 mg/kg
- Reversal agent: flumazenil 0.2mg IV — use cautiously (may precipitate seizures in chronic benzo users)
Source and review
- Tintinalli's Emergency Medicine, 9th ed.. Last reviewed: 2024-10-01