Can Midazolam (Versed) be administered intramuscularly?

From the Guidelines

Midazolam (Versed) can be administered intramuscularly (IM) and is an approved route of administration. The typical adult IM dose ranges from 0.07 to 0.08 mg/kg (approximately 5 mg for most adults), with onset of action within 15 minutes and peak effect at 30-60 minutes. When administering Versed IM, inject it deep into a large muscle mass like the gluteal muscle or lateral thigh. Always have resuscitation equipment readily available as midazolam can cause respiratory depression. The IM route is particularly useful in situations where IV access is difficult or unavailable, such as for pre-procedural sedation, acute agitation, or seizure management when other routes aren't feasible. However, the IM route has more variable absorption compared to IV administration, making precise titration more challenging. The medication works by enhancing the effect of GABA, an inhibitory neurotransmitter in the brain, producing anxiolysis, sedation, and amnesia.

Key Considerations

• The IM route of administration is useful when IV access is not available or feasible.
• Resuscitation equipment should always be readily available due to the risk of respiratory depression.
• The typical adult IM dose is approximately 5 mg, with onset of action within 15 minutes and peak effect at 30-60 minutes.
• Midazolam enhances the effect of GABA, producing anxiolysis, sedation, and amnesia.

Evidence-Based Recommendations

The most recent and highest quality study supporting the use of midazolam IM is from 1, which provides guidance on the administration of midazolam for seizures, including the use of the IM route. Additionally, 1 and 1 provide information on the pharmacology and clinical applications of midazolam, including its use for procedural sedation and induction of general anesthesia. However, it is essential to prioritize the most recent and highest quality study, which in this case is 1, when making definitive recommendations.

Administration Guidelines

When administering midazolam IM, it is crucial to follow proper guidelines to minimize the risk of adverse effects. This includes:

• Injecting the medication deep into a large muscle mass.
• Using the recommended dose and titrating as needed.
• Having resuscitation equipment readily available.
• Monitoring the patient closely for signs of respiratory depression or other adverse effects.

From the FDA Drug Label

For preoperative sedation/anxiolysis/amnesia (induction of sleepiness or drowsiness and relief of apprehension and to impair memory of perioperative events). For intramuscular use, midazolam hydrochloride should be injected deep in a large muscle mass Midazolam injection, USP is indicated: intramuscularly or intravenously for preoperative sedation/anxiolysis/amnesia; Midazolam hydrochloride should only be administered intramuscularly or intravenously.

Yes, Midazolam (Versed) can be administered intramuscularly 2, 2, 2.

From the Research

Administration of Midazolam

• Midazolam can be administered through various routes, including intravenous, intramuscular, oral, nasal, and rectal 3.
• The drug has a rapid onset of action following administration through these routes, making it suitable for sedation prior to procedures and for the treatment of generalized seizures and status epilepticus 3, 4.

Intramuscular Administration

• Studies have shown that midazolam can be effectively administered intramuscularly, with rapid absorption and a mean terminal half-life of 2.8 +/- 1.7 hours 4.
• Intramuscular midazolam has been used as a preanesthetic medication, producing rapid onset of sedation, anxiolysis, and anterograde amnesia 5.
• However, caution is advised when using intramuscular midazolam in patients aged 70 years and older, as excessive drowsiness may occur 5.

Comparison with Other Routes

• The pharmacokinetics of intramuscular midazolam have been compared to those of intravenous midazolam, with the intramuscular route showing a slower onset of action but a longer duration of sedation 4.
• Intramuscular midazolam has also been compared to other sedatives, such as diazepam and lorazepam, with midazolam showing a faster onset of action and a shorter duration of sedation 6, 7.