Midzo

Indications

Midazolam is a short-acting sedative. It is used to make people calm and sleepy before and during medical procedures such as endoscopy, minor surgery and dental work, as part of general anaesthesia, and for sedation of patients on a breathing machine in intensive care. Tablets are sometimes used for short-term treatment of severe sleeplessness, and a mouth (buccal) form is used to stop prolonged seizures.

How It Works

Midazolam belongs to the benzodiazepine group. It boosts the effect of GABA, a natural calming chemical in the brain, which reduces anxiety, causes sleepiness, relaxes muscles and stops seizures. People often do not remember what happened while it was working.

Dosage and Administration

Injections are given only by a doctor or nurse in a hospital or clinic, where breathing and blood pressure can be watched. The dose depends on age, weight, health and the procedure, and is given as prescribed. Tablets and the buccal form are used only as prescribed, for the shortest time possible. Do not take more than prescribed or share it with others.

Interactions

• Alcohol, opioid painkillers (such as Morphine and Tramadol), other sedatives, sleeping pills and sedating antihistamines can cause dangerous drowsiness and slow breathing.
• Ketoconazole, Itraconazole, Clarithromycin, Erythromycin, Diltiazem, Verapamil, some HIV medicines and grapefruit juice raise midazolam levels and make sedation stronger and longer.
• Rifampicin, Carbamazepine and Phenytoin lower its effect.

Tell the doctor about every medicine you take.

Contraindications

Allergy to midazolam or other benzodiazepines, severe breathing problems, severe untreated sleep apnoea, myasthenia gravis (a muscle-weakness disease), acute narrow-angle glaucoma and severe liver failure, unless the doctor decides otherwise in a monitored setting.

Side Effects

Common: drowsiness, memory gaps around the procedure, dizziness, headache, nausea, hiccups and low blood pressure. Some people, especially children and older adults, become restless or agitated instead of calm. Using the tablets for a long time can lead to dependence.

Get urgent medical help if the person has slow or shallow breathing, blue lips, cannot be woken, has a very slow heartbeat, or shows signs of a serious allergic reaction such as swelling of the face or throat.

Pregnancy and Lactation

Used in pregnancy only when the doctor feels it is needed. Use late in pregnancy or during labour can make the newborn floppy, sleepy and slow to breathe. Small amounts pass into breast milk; after a single dose, ask the doctor how long to wait before breastfeeding.

Precautions and Warnings

• Do not drive, operate machines, sign important papers or drink alcohol for at least 24 hours after receiving it. A responsible adult should take you home.
• Extra care is needed in older adults, very ill people, and those with lung, heart, liver or kidney disease.
• After regular use, do not stop suddenly; the doctor will reduce the dose slowly.

Overdose

Overdose causes deep sleep, confusion, poor coordination, low blood pressure and slowed breathing, which can be life-threatening, especially with alcohol or opioids. Call for emergency help at once. In hospital, the antidote Flumazenil may be given along with breathing support.

Therapeutic Class

Benzodiazepine sedative (short-acting hypnotic and anticonvulsant).

Storage

Store below 30°C, away from light and out of the reach of children. Injections are stored and handled by hospital staff.