What is the recommended intravenous (IV) dosage of Midazolam (Versed) per weight for seizure management?

From the Guidelines

For the management of seizures, the recommended intravenous (IV) dosage of midazolam (Versed) is 0.2 mg/kg, with a maximum dose of 6 mg per dose, which can be repeated every 10-15 minutes as needed 1. This dosage is based on the most recent and relevant evidence from the field of pediatrics, which prioritizes the safety and efficacy of midazolam in seizure management.

Key Considerations

• The dosage of 0.2 mg/kg is specifically recommended for the treatment of seizures, with a maximum dose of 6 mg per dose 1.
• Repeated doses can be administered every 10-15 minutes as needed, depending on the patient's response to treatment.
• It is essential to monitor the patient's respiratory status and blood pressure during administration, as midazolam can cause respiratory depression and hypotension.
• Flumazenil should be available as a reversal agent for severe respiratory depression, although it is rarely needed and can potentially trigger seizures.

Administration Guidelines

• Administration should be slow and controlled to minimize the risk of respiratory depression.
• The patient should be closely monitored for signs of respiratory depression, including decreased oxygen saturation and respiratory rate.
• Resuscitation equipment should be readily available in case of emergency.

Special Considerations

• In cases of refractory status epilepticus, a loading dose of 0.15-0.20 mg/kg can be followed by a continuous infusion of 1 mg/kg per minute, with increments of 1 mg/kg per minute every 15 minutes until seizures stop 1.
• Patients with hepatic or renal impairment may require dose adjustments due to reduced midazolam clearance.

From the FDA Drug Label

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.

The initial dose of midazolam for seizure in pediatric patients is:

• 0.05 to 0.1 mg/kg for patients 6 months to 5 years of age
• 0.025 to 0.05 mg/kg for patients 6 to 12 years of age The total dose may be up to 0.6 mg/kg for patients 6 months to 5 years of age and up to 0.4 mg/kg for patients 6 to 12 years of age, but usually does not exceed 6 mg and 10 mg, respectively 2.

From the Research

Versed IV Dosage per Weight for Seizure

• The dosage of Versed (midazolam) for seizure treatment varies based on the patient's age, weight, and the severity of the seizure 3.
• For adults, intramuscular midazolam dosages range from 2 to 10 mg per single dose, and 0.1 to 0.2 mg/kg as a weight-based dose 3.
• For pediatric patients, intramuscular midazolam dosages range from 2 to 8 mg per single dose, and 0.1 to 0.2 mg/kg as a weight-based dose 3.
• Intravenous/intrasosseous midazolam dosages range from 1 to 6 mg per single adult dose, 1 to 5 mg per single pediatric dose, and 0.05 to 0.1 mg/kg as a weight-based dose 3.
• A study on prehospital seizure management in children found that paramedics frequently administered an incorrect weight-based dose of midazolam, with 36% of patients receiving an incorrect dose 4.

Weight-Based Dosage Recommendations

• The American Academy of Pediatrics recommends a dose of 0.1 to 0.2 mg/kg for intramuscular midazolam in pediatric patients 3.
• Another study suggests a dose of 0.05 to 0.1 mg/kg for intravenous/intrasosseous midazolam in pediatric patients 3.
• However, it is essential to note that the optimal dosage of midazolam for seizure treatment may vary depending on the individual patient's response and the severity of the seizure 5.

Administration Routes and Efficacy

• Midazolam can be administered via intramuscular, intranasal, or intravenous routes 3, 5.
• A study comparing the efficacy of continuous intravenous infusion of sodium valproate and midazolam in children with status epilepticus found that both treatments were effective, but sodium valproate had a shorter seizure duration and fewer side effects 6.
• Another study found that intramuscular midazolam was effective in controlling status epilepticus in adults, with a high success rate and minimal side effects 7.