Midazolam Intravenous for Adults

Who can administer

Administration RESTRICTED - see Appendix 1

Flumazenil injection must be available at all times when administering midazolam by the intravenous route
Midazolam should only be administered by experienced physicians in a setting fully equipped for the monitoring and support of respiratory and cardiovascular function
Not to be used for conscious sedation in patients with severe respiratory failure or acute respiratory depression
Acute respiratory depression, respiratory arrest and cardiac arrest may occur especially when used for sedation in non-critical care settings
The need for a continuous infusion should be reassessed daily to reduce the risk of accumulation and prolonged recovery (particularly in patients with renal and hepatic impairment)
For Y-site compatibility see below

Hypnovel 10mg per 2mL ampoule

Hypnovel 10mg per 5mL ampoule

Already in solution

Draw up using a 5 micron filter needle

Sodium chloride 0.9% or Glucose 5%

Slow intravenous injection

Consider using the 10mg per 5mL strength to allow for more accurate dose measurement and titration
Administer required dose at a rate of 2mg per minute

Continuous intravenous infusion (critical care areas only). Administer using an electronically controlled infusion device

Use 12ml of 10mg/2mL strength, and add 48ml infusion fluid to produce a 60mg in 60mL (1mg/1mL) infusion

Conscious sedation for procedures

Adults less than 60 years: Initial dose: 2 to 2.5mg, given five to ten minutes before the beginning of the procedure. Further doses of 1mg may be given, as necessary, to a total dose of 3.5 to 7.5mg
Adults 60 years or more, debilitated or chronically ill: Initial dose: 0.5 to 1mg, given five to ten minutes before the beginning of the procedure. Further doses of 0.5 to 1mg may be given, as necessary to a total dose of 3.5mg
Consider using the 10mg per 5mL strength to allow for easier dose measurement and titration

Anaesthesia

Sedation in intensive care units

In hypovolemic, vasoconstricted, or hypothermic patients, both the loading and maintenance doses should be reduced
Escalate in increments of 1 to 2.5mg every two minutes
Infusion maintenance doses vary but are in the range of 2.1 to 14mg/hr for a 70kg patient (30 to 200 microgram/kg/hour)
Abrupt discontinuation after prolonged intravenous administration may lead to withdrawal symptoms
Consider reducing slowly when stopping drug

Renal impairment

In patients with renal impairment (CrCl < 30ml/min), midazolam may be accompanied by more pronounced and prolonged sedation, including clinically relevant respiratory and cardiovascular depression
Such patients should be dosed carefully and dose titrated for the desired effect

Hepatic impairment

In patients with hepatic impairment, the clinical effects of midazolam may be prolonged
The required dose of midazolam may have to be reduced

Adults over 60 years of age:

Monitor respiratory and cardiovascular parameters
Monitor blood pressure - hypotension is more common in patients also on opioids ^{(ref 1)}

Special caution should be excercised in the following patients

Adults over 60 years of age
Chronically ill or debilitated patients
Chronic respiratory insufficiency - respiratory arrest is more common with high doses/rapid administration
Chronic renal failure, impaired hepatic or cardiac function

The elimination half life may be prolonged up to six times in critically ill patients

Store below 25⁰C

Hypnovel 10mg/2mL SPC October 2019

Hypnovel 10mg/5mL SPC October 2019

(1) Uptodate, accessed online 19/10/2021

Benzodiazepine