From the Guidelines
The initial intravenous dose of midazolam in healthy adults younger than 60 years of age is 1 to 2 mg (or no more than 0.03 mg/kg) injected over 1 to 2 minutes, with additional doses of 1 mg (or 0.2-0.3 mg) administered at 2-minute intervals until adequate sedation is achieved 1.
Key Considerations
- The dose of midazolam may need to be reduced in patients older than 60 and those with ASA physical status 3 or above by 20% or more 1.
- When midazolam is used with an opioid, a synergistic interaction occurs, and a reduction in the dose of midazolam may be indicated 1.
- A total intravenous dose greater than 6 mg is usually not required for routine endoscopic procedures 1.
Patient-Specific Factors
- Elderly patients and those with liver or kidney dysfunction require lower doses, typically starting at half the standard dose.
- Patients with a benzodiazepine tolerance may require larger doses.
Administration and Monitoring
- Midazolam should be administered over 1 to 2 minutes to minimize the risk of respiratory depression.
- Patients should be closely monitored for signs of respiratory depression, which can occur up to 30 minutes after administration of the last dose of midazolam 1.
From the FDA Drug Label
USUAL PEDIATRIC DOSE (NON-NEONATAL) Pediatric patients 6 months to 5 years of age: Initial dose 0. 05 to 0.1 mg/kg. A total dose up to 0.6 mg/kg may be necessary to reach the desired endpoint but usually does not exceed 6 mg. Pediatric patients 6 to 12 years of age: Initial dose 0.025 to 0.05 mg/kg; total dose up to 0. 4 mg/kg may be needed to reach the desired endpoint but usually does not exceed 10 mg. Pediatric patients 12 to 16 years of age: Should be dosed as adults Prolonged sedation may be associated with higher doses; some patients in this age range will require higher than recommended adult doses but the total dose usually does not exceed 10 mg.
The dose of midazolam varies by age:
- For pediatric patients 6 months to 5 years of age, the initial dose is 0.05 to 0.1 mg/kg, with a total dose up to 0.6 mg/kg.
- For pediatric patients 6 to 12 years of age, the initial dose is 0.025 to 0.05 mg/kg, with a total dose up to 0.4 mg/kg.
- For pediatric patients 12 to 16 years of age, the dose is the same as for adults, with a total dose usually not exceeding 10 mg 2.
From the Research
Dose of Midazolam
- The dose of midazolam is not explicitly stated in the provided studies, but it can be inferred from the contexts in which it is used.
- In the study 3, the mean dose of midazolam in the real-world midazolam group was 6.2 ± 3.1 mg, compared with 3.5 ± 1.5 mg in the on-label midazolam group.
- The studies do not provide a specific dose of midazolam for sedation, but they discuss its efficacy and safety in various clinical settings 4, 5, 6, 7.
- It is worth noting that the dose of midazolam may vary depending on the specific clinical context, the patient's age and health status, and other factors.
Administration Routes
- Midazolam can be administered through various routes, including intravenous, intramuscular, oral, nasal, and rectal 4.
- The choice of administration route may depend on the specific clinical context and the patient's needs.