Indications
Remimazolam is a short-acting sedative used in hospitals to make patients calm and sleepy (procedural sedation) during short procedures such as endoscopy or bronchoscopy. In some countries it is also used to start and maintain general anaesthesia.
How It Works
Remimazolam is a benzodiazepine. It boosts the effect of GABA, the brain’s main calming chemical messenger, which quickly causes relaxation, sleepiness and loss of memory for the procedure. It is broken down rapidly by enzymes in the blood and tissues, so patients usually wake up quickly once it is stopped.
Dosage and Administration
It is given only by a doctor trained in sedation or anaesthesia, as an injection or infusion into a vein, with continuous monitoring of breathing, oxygen level, heart rate and blood pressure. The dose is adjusted for each patient’s age, weight, health and response, so it is always as prescribed. Breathing support equipment must be ready during use.
Interactions
- Opioid pain relievers (such as Fentanyl), Propofol, other sedatives and alcohol greatly increase sleepiness and the risk of slowed breathing and low blood pressure.
- Flumazenil reverses its effect and may be used by the doctor if needed.
- Tell the team about all medicines, including sleeping tablets, antidepressants and antiepileptics.
Contraindications
- Allergy to Remimazolam, other benzodiazepines, or dextran 40 (an ingredient of some preparations).
- Severe breathing failure or untreated sleep apnoea, unless the airway is managed.
- Acute narrow-angle glaucoma.
Side Effects
Common effects include low blood pressure, slowed or shallow breathing, low oxygen levels, slow or fast heartbeat, headache, nausea and drowsiness after the procedure. Some people feel confused or have hiccups.
After going home, get urgent medical help if you have trouble breathing, extreme sleepiness or difficulty waking, chest pain, fainting, or swelling of the face, lips or throat.
Pregnancy and Lactation
Benzodiazepines can affect the unborn baby, especially near delivery, so it is used in pregnancy only if clearly needed. Small amounts may pass into breast milk; the doctor may advise pausing breastfeeding for a short time after the procedure.
Precautions and Warnings
- Do not drive, operate machinery, drink alcohol or make important decisions for at least 24 hours afterwards.
- A responsible adult should take you home and stay with you.
- Older people and those with heart, lung or liver disease need lower doses and close monitoring.
Overdose
Too much causes deep sedation, slowed breathing and low blood pressure. The team supports breathing and may give Flumazenil.
Therapeutic Class
Benzodiazepine sedative and anaesthetic agent.
Storage
Store as directed on the pack, usually below 30°C and protected from light. For hospital use only; keep out of the reach of children.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.