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Midazolam Hydrochloride (Versed)
Health Professionals Version
Carol Kline
--------------------------------------------------------------------------------
Every attempt has been made to insure the accuracy of this material, however, medical science is constantly changing. If the information on this page differs from what you have been told by a nurse, pharmacist or physician, consult the person who told you differently or the manufacturer.
Actions: Short acting benzodiazepine. CNS depressant with sedative, muscle relaxant, anticonvulsant, and amnesiac effects. Estimated to be 3-4 times as potent as diazepam. Intensifies activity of gamma-aminobenzoic acid (GABA), a major inhibitory neurotransmitter of the brain. This acts to calm the patient, relaxes skeletal muscles, blocks memory, prevents feeling pain, but enables them to follow commands.
Indications: Sedation before general anesthesia, to impair memory of perioperative events, for conscious sedation prior to short diagnostic or endoscopic procedures, and as a supplement for short surgical procedure
Onset: IV 1 to 5 minutes; IM-5-15 minutes, PO/Rectal-less than 10 minutes, Intranasal-less than 5 minutes.
Peak Plasma Concentrations: IV-3-5 minutes, IM-15-30 minutes, PO-30 minutes, Intranasal-10 minutes, Rectal-20-30 minutes. In the body Midazolam becomes highly lipid soluble and readily passes the blood-brain barrier and the placenta.
Steady State: This drug does not reach steady state as it is not given on an on-going basis, but a peak concentration is achieved.
Duration of Action: IV-less than 2 hours; IM-1-4 hours; PO/Rectal-2-6 hours
Metabolism: Metabolized in the liver and excreted in the urine.
Half-life: 1-4 hours
Contraindications: Patients with intolerance to benzodiazepines, acute narrow-angle glaucoma, shock, coma, acute alcohol intoxication, and intraarterial injection. Safe use of this medication in pregnancy, labor and delivery, or by nursing mothers has not been established.
Should be used with caution in patients with COPD, chronic renal failure, CFH, and the elderly.
Warning: Intravenous midazolam has been associated with severe respiratory depression and arrest, especially when given with an opioid analgesic or when administered too rapidly. It should be administered only in a hospital or ambulatory care setting that has continuous respiratory and cardiac monitoring and resuscitative drugs and equipment available.
Drug interactions:
Alcohol and Narcotics: CNS and circulatory depressant effects will be potentiated.
Cimetidine: increases midazolam plasma levels, increasing it's toxicity
Levodopa: will decrease the antiparkinsonism effects
Phenytonin: may increase levels of this drug
Smoking: decreases sedative and antianxiety effects
Method of Administration: Midazolam is given primarily by IV injection by a Registered Nurse or Physician prior to a procedure or surgery in an ambulatory care (clinic) or hospital setting. It is not intended for home use. It is a scheduled IV controlled substance.
Dosing: PO-20-40mg (0.5-0.75mg/Kg) Give 5mg/m1 solution diluted in 3-5ml of apple juice or carbonated cola; atropine 0.03mg/Kg po may be added to reduce secretions.
Intranasal-0.2-0.3mg/Kg; use a high potency injectate solution of 5mg/ml.
IV-0.5-5mg (0,025-0.lmg/Kg); titrate slowly to the desired effect. Continuous monitoring of respiratory and cardiac functioning should occur.
IM-3.5-10mg (0.05-0.2mg/Kg)
Rectal-15-20mg (0.3-0.35mg/Kg); dilute in 5ml NS
Anticonvulsant: IV/IM 2-5mg (0.025-0.lmg/Kg) every 10-15 minutes as needed
The range between therapeutic dosage and unconsciousness and disorientation is narrow, necessitating close monitoring of the patient.
Toxicity: Not routinely monitored
Overdose symptoms: Somnolence, confusion, sedation, coma, increased pulse, and low blood pressure
Antidote: Flumazenil IV, 0.2-2mg
Management of overdosage: Discontinue or reduce the medication; support ventilation and circulation (maintain a patent airway, give oxygen IV fluids, and vasopressors), administer the antidote.
Routes: Midazolam is available intranasal, PO, rectal, IM, and IV. The most common method of administration by far is IV.
Side effects:
CNS-amnesia, headache, lightheadedness, euphoria, confusion, agitation, anxiety, delirium, prolonged dreaming with emergence from anesthesia, insomnia, muscle tremor, ataxia, dizziness, dysphoria, slurred speech, and paresthesia.
Cardiovascular-hypotension, PVC's, tachycardia, vasovagal episode
Eye-blurred vision, diplopia, nystagmus, pinpoint pupils
Gastrointestinal-(low incidence) nausea, vomiting, acid taste, retching, excessive salivation
Respiratory-coughing, bronchospasm, laryngospasm, apnea, hypoventilation, respiratory arrest, wheezing, airway obstruction, tachypnea
Skin-swelling, burning, pain, and induration at the site of injection
Patient education: Provide written instructions along with verbal teaching to ensure understanding and compliance during the amnesiac period.
Caution: Use of this medication with alcohol or CNS depressing drugs may result in hypotension, respiratory depression, and possible respiratory and cardiac arrest. Debilitated patients and those 55 years and older require a smaller dose than normal and administered at a slower rate.
How do you know if it works: The patient will be calm, pain free, but able to follow directions. Speech will be slurred, patient will be drowsy, motor movements will be sluggish. Memory of the procedure will be blocked.
References:
McKenry, L. & Salerno, E. (1998). Mosby's Pharmacology in Nursing 20th Edition. -St. Louis: C.V. Mosby. p. 283 and 309.
Omoigui, Sota. (1995). The Pain Drugs Handbook.
Shannon, M.T., Wilsom, B.A., & Stana, C.L. (1995) Eighth Edition Govoni & Hgyes Drugs and Nursing implications. Norwalk, Connecticut: Appleton and Lange. p. 780-78 1.
Fonz
Midazolam Hydrochloride (Versed)
Health Professionals Version
Carol Kline
--------------------------------------------------------------------------------
Every attempt has been made to insure the accuracy of this material, however, medical science is constantly changing. If the information on this page differs from what you have been told by a nurse, pharmacist or physician, consult the person who told you differently or the manufacturer.
Actions: Short acting benzodiazepine. CNS depressant with sedative, muscle relaxant, anticonvulsant, and amnesiac effects. Estimated to be 3-4 times as potent as diazepam. Intensifies activity of gamma-aminobenzoic acid (GABA), a major inhibitory neurotransmitter of the brain. This acts to calm the patient, relaxes skeletal muscles, blocks memory, prevents feeling pain, but enables them to follow commands.
Indications: Sedation before general anesthesia, to impair memory of perioperative events, for conscious sedation prior to short diagnostic or endoscopic procedures, and as a supplement for short surgical procedure
Onset: IV 1 to 5 minutes; IM-5-15 minutes, PO/Rectal-less than 10 minutes, Intranasal-less than 5 minutes.
Peak Plasma Concentrations: IV-3-5 minutes, IM-15-30 minutes, PO-30 minutes, Intranasal-10 minutes, Rectal-20-30 minutes. In the body Midazolam becomes highly lipid soluble and readily passes the blood-brain barrier and the placenta.
Steady State: This drug does not reach steady state as it is not given on an on-going basis, but a peak concentration is achieved.
Duration of Action: IV-less than 2 hours; IM-1-4 hours; PO/Rectal-2-6 hours
Metabolism: Metabolized in the liver and excreted in the urine.
Half-life: 1-4 hours
Contraindications: Patients with intolerance to benzodiazepines, acute narrow-angle glaucoma, shock, coma, acute alcohol intoxication, and intraarterial injection. Safe use of this medication in pregnancy, labor and delivery, or by nursing mothers has not been established.
Should be used with caution in patients with COPD, chronic renal failure, CFH, and the elderly.
Warning: Intravenous midazolam has been associated with severe respiratory depression and arrest, especially when given with an opioid analgesic or when administered too rapidly. It should be administered only in a hospital or ambulatory care setting that has continuous respiratory and cardiac monitoring and resuscitative drugs and equipment available.
Drug interactions:
Alcohol and Narcotics: CNS and circulatory depressant effects will be potentiated.
Cimetidine: increases midazolam plasma levels, increasing it's toxicity
Levodopa: will decrease the antiparkinsonism effects
Phenytonin: may increase levels of this drug
Smoking: decreases sedative and antianxiety effects
Method of Administration: Midazolam is given primarily by IV injection by a Registered Nurse or Physician prior to a procedure or surgery in an ambulatory care (clinic) or hospital setting. It is not intended for home use. It is a scheduled IV controlled substance.
Dosing: PO-20-40mg (0.5-0.75mg/Kg) Give 5mg/m1 solution diluted in 3-5ml of apple juice or carbonated cola; atropine 0.03mg/Kg po may be added to reduce secretions.
Intranasal-0.2-0.3mg/Kg; use a high potency injectate solution of 5mg/ml.
IV-0.5-5mg (0,025-0.lmg/Kg); titrate slowly to the desired effect. Continuous monitoring of respiratory and cardiac functioning should occur.
IM-3.5-10mg (0.05-0.2mg/Kg)
Rectal-15-20mg (0.3-0.35mg/Kg); dilute in 5ml NS
Anticonvulsant: IV/IM 2-5mg (0.025-0.lmg/Kg) every 10-15 minutes as needed
The range between therapeutic dosage and unconsciousness and disorientation is narrow, necessitating close monitoring of the patient.
Toxicity: Not routinely monitored
Overdose symptoms: Somnolence, confusion, sedation, coma, increased pulse, and low blood pressure
Antidote: Flumazenil IV, 0.2-2mg
Management of overdosage: Discontinue or reduce the medication; support ventilation and circulation (maintain a patent airway, give oxygen IV fluids, and vasopressors), administer the antidote.
Routes: Midazolam is available intranasal, PO, rectal, IM, and IV. The most common method of administration by far is IV.
Side effects:
CNS-amnesia, headache, lightheadedness, euphoria, confusion, agitation, anxiety, delirium, prolonged dreaming with emergence from anesthesia, insomnia, muscle tremor, ataxia, dizziness, dysphoria, slurred speech, and paresthesia.
Cardiovascular-hypotension, PVC's, tachycardia, vasovagal episode
Eye-blurred vision, diplopia, nystagmus, pinpoint pupils
Gastrointestinal-(low incidence) nausea, vomiting, acid taste, retching, excessive salivation
Respiratory-coughing, bronchospasm, laryngospasm, apnea, hypoventilation, respiratory arrest, wheezing, airway obstruction, tachypnea
Skin-swelling, burning, pain, and induration at the site of injection
Patient education: Provide written instructions along with verbal teaching to ensure understanding and compliance during the amnesiac period.
Caution: Use of this medication with alcohol or CNS depressing drugs may result in hypotension, respiratory depression, and possible respiratory and cardiac arrest. Debilitated patients and those 55 years and older require a smaller dose than normal and administered at a slower rate.
How do you know if it works: The patient will be calm, pain free, but able to follow directions. Speech will be slurred, patient will be drowsy, motor movements will be sluggish. Memory of the procedure will be blocked.
References:
McKenry, L. & Salerno, E. (1998). Mosby's Pharmacology in Nursing 20th Edition. -St. Louis: C.V. Mosby. p. 283 and 309.
Omoigui, Sota. (1995). The Pain Drugs Handbook.
Shannon, M.T., Wilsom, B.A., & Stana, C.L. (1995) Eighth Edition Govoni & Hgyes Drugs and Nursing implications. Norwalk, Connecticut: Appleton and Lange. p. 780-78 1.
Fonz
