7/23/2019 Versed (Midazolam) Dosing, Indications, Interactions, Adverse Effects, And More

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midazolam (Rx)Brand and Other Names:Versed

Classes: Antianxiety Agents;

 Anxiolytics, Benzodiazepines

Dosing & Uses AdultPediatric

Dosage Forms & Strengths

Preoperative Sedation/Anx iolys is With Anterogr ade Amnesia

IM

70-80 mcg/kg (dose range ~5 mg) 30-60 minutes before surgery (reduce 50% for chronically ill or geriatric

patients)

IV

Initial: Usually 0.5-1 mg given over 2 minutes (not to exceed 2.5 mg/dose); wait 2-3 minutes to evaluate

sedative effect after each dose adjustment; total dose >5 mg usually not necessary to reach desired sedation;

use 30% less midazolam if patient premedicated with narcotics or other CNS depressants

Debilitated or chronically ill patients: 1.5 mg IV initially; may repeat with 1 mg/dose IV q2-3 min PRN; not toexceed cumulative dose of 3.5 mg; peak effect may be delayed in elderly, so increments should be smaller 

and rate of injection slower 

Maintenance: 25% of initial effective dose PRN by slow titration; reduce 30% if premedicated with opiate

(50% in elderly/chronically ill)

 Anesthesia

Induction

<55 years without premedication: 300-350 mcg/kg IV injection over 20-30 seconds; wait 2-3 minutes to

evaluate sedative effect after each dose adjustment; may use increments of 25% of initial dose PRN to

complete induction; may use up to 0.6 mg/kg total dose in resistant cases, but such dosing may prolong

recovery

>55 years without premedication and with no systemic disease, in a patient who is not weak: 300 mcg/kg over 

20-30 seconds initially; wait 2-3 minutes to evaluate sedative effect after each dose adjustment

>55 years without premedication but presence of systemic disease or weak patient: 200-250 mcg/kg over 

20-30 seconds usually enough; 0.15 mg/kg enough in some cases; wait 2-3 minutes to evaluate sedative

effect after each dose adjustment>55 years with premedication: 150-350 mcg/kg IV injection over 20-30 seconds; wait 2-3 minutes to evaluate

sedative effect after each dose adjustment; a dose of 250 mcg/kg usually enough to achieve desired effect

Maintenance

May administer increments of 25% of induction dose PRN when there are signs that anesthetic effects are

lightening

Sedation of Intubated/Ventilated Patients

Load: 10-50 mcg/kg (dose range 0.5-4 mg) slow IV injection or infusion over several minutes; repeat q10-15min

PRN

Maintenance: Initial, 20-100 mcg/kg/hr infusion; titrate up or down 25-50% PRN

Refractory Status Epilepticus (Off-label)

150-300 mcg/kg IV; may repeat q10-15min PRN

 Alternatively, 0.2 mg/kg bolus followed by continuous infusion of 50-600 mcg/kg/hr 

Seizure Clusters (Orphan)

Rescue treatment of seizures in patients on stable AED regimens who require control of intermittent bouts of 

increased seizure activity (eg, acute repetitive seizures, seizure clusters)

 Administered by intranasal route

Orphan indication sponsors

Upsher-Smith Laboratories, Inc. 6701 Evenstad Drive Maple Grove, MN 55369-6026

Schwarz Biosciences, Inc. 8010 Arco Corporate Drive Raleigh, NC 27617

Dosing Considerations

Because it is water soluble, takes approximately 3 times longer than diazepam to peak EEG effects; thus, clinician

must wait 2-3 minutes to fully evaluate sedative effects before initiating procedure or repeating dose

Has twice the affinity for benzodiazepine receptors that diazepam has

May be administered IM if unable to obtain vascular access

 Anesthesia: Typical adult induction and maintenance doses may need to be decreased in some elderly patients by

20-50%, because the elderly overall are more susceptible to CNS depressants than is the general population

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Geriatric Dosing

Preoperative sedation/anxiolysis with anterograde amnesia

IM: 1-3 mg (~35-40 mcg/kg) 30-60 minutes before surgery; some elderly patients may respond to as little as 1

mg; onset is 15 minutes (peaking at 30-60 min)

IV (>60 years): 1.5 mg initially; may repeat with 1 mg/dose q2-3min PRN; not to exceed cumulative dose of 

3.5 mg; peak effect may be delayed in elderly, so increments should be smaller and rate of injection slower 

IV maintenance: 10-15% of initial effective dose PRN by slow titration

Dosing considerations

 Anesthesia : Typical adult induction and maintenance doses may need to be decreased in some elder ly

patients by 20-50%, because the elderly overall are more susceptible to CNS depressants than is the generalpopulation

Dosage Forms & Strengths

Sedation

500-750 mcg/kg PO once diluted by juice 20-30 minutes prior to procedure; not to exceed 20 mg

100-150 mcg/kg IM; up to 500 mcg/kg used; not to exceed 10 mg

IV

<6 months: Initial, 50 mcg/kg IV over 2-3 minutes; titrate with small increments to clinical effect; monitor 

closely

6 months-6 years: Initial, 50-100 mcg/kg IV over 2-3 minutes; repeat q2-3min PRN; may require up to 600

mcg/kg total dose; not to exceed 6 mg total dose

6-12 years: Initial, 25-50 mcg/kg IV over 2-3 minutes; repeat q2-3min PRN; may require up to 400 mcg/kg;

not to exceed 10 mg total dose

 Anesthesia (Non-neonatal)

Loading dose: 50-150 mcg/kg IV over 2-3 minutes PRN to achieve desired effect

Continuous infusion: 1-2 mcg/kg/min IV infusion

 Anesthesia (Neonatal )

IV loading dose should not be used in neonates

Continuous infusion: 0.5 mcg/kg/min IV infusion

sed (midazolam) dosing, indications, interactions, adverse effects, a... http://reference.medscape.com/drug/versed-midazolam-342907

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