From the Guidelines
For seizure control, the recommended dosage of Versed (midazolam) is 0.2 mg/kg (maximum: 6 mg per dose) administered intramuscularly (IM), which may be repeated every 10–15 min. This dosage is based on the study published in Pediatrics in 2008 1. The study suggests that other benzodiazepines, such as lorazepam, are typically used for initial IV treatment of status epilepticus, but midazolam can be used for refractory status epilepticus.
- Key points to consider when administering midazolam for seizure control include:
- Monitoring oxygen saturation due to the increased incidence of apnea when combined with other sedative agents
- Being prepared to provide respiratory support regardless of the route of administration
- Having flumazenil available to reverse life-threatening respiratory depression caused by benzodiazepines such as midazolam, although it will also reverse the anticonvulsant effects and may precipitate seizures 1.
- It is essential to note that the dosage and administration route may vary depending on the specific clinical scenario, such as refractory status epilepticus, which may require a loading dose followed by a continuous infusion 1.
From the Research
Dosage for Seizure Control with Versed (Midazolam)
The recommended dosage of Versed (midazolam) for seizure control varies depending on the route of administration, age, and severity of the seizure.
- For adults with status epilepticus, an initial dose of 15 mg IM of midazolam is suggested, with the option for additional doses every 8 hours for 24 hours if necessary 2.
- For intravenous administration in patients suffering seizures, doses of 2.5-15 mg have been used effectively 3.
- In children, a dose of 0.3 mg/kg of buccal midazolam has been shown to be effective in stopping prolonged seizures 4.
- For children with status epilepticus, a bolus of 0.15 mg/kg IV midazolam followed by a continuous infusion at 1 microgram/kg/min, increasing as needed, has been used successfully 5.
- In the prehospital setting, paramedics have administered IV and IM midazolam to pediatric patients with seizures, with IV administration showing greater success (96% vs 80%) 6.
Administration Routes and Efficacy
Different routes of administration have been studied for midazolam in seizure control, including:
- Intramuscular (IM) 2, 6
- Intravenous (IV) 3, 5, 6
- Buccal 4 Each route has its own efficacy and safety profile, with IV administration often showing rapid and effective seizure control.
Safety and Side Effects
The studies reviewed indicate that midazolam is generally safe and well-tolerated for seizure control, with side effects such as drowsiness and respiratory compromise being rare or minimal 2, 3, 4, 5, 6.