Can midazolam be administered intravenously?

From the Guidelines

Yes, midazolam can be administered intravenously, with a typical adult IV dose ranging from 1-2.5 mg initially, titrated slowly to effect, with a maximum total dose of 5-7.5 mg, as recommended by the most recent and highest quality study 1. When administering IV midazolam, it's essential to have resuscitation equipment immediately available as respiratory depression and hypotension can occur, especially with rapid administration or when combined with other central nervous system depressants. The onset of action is rapid (1-5 minutes) with IV administration, and the duration of effect is typically 30-60 minutes, as noted in the clinical pharmacology of sedative medications 1. Midazolam works by enhancing the inhibitory effect of GABA, the main inhibitory neurotransmitter in the brain, producing anxiolysis, sedation, amnesia, and anticonvulsant effects. Some key points to consider when administering midazolam intravenously include:

• The initial dose for 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, as recommended by 1.
• Patients older than 60 and those with ASA physical status 3 or above require a dose reduction of 20% or more, as noted in 1.
• Continuous monitoring of vital signs, especially respiratory status, is mandatory during and after IV midazolam administration, due to the risk of respiratory depression and hypotension, as highlighted in 1. It is also important to be aware of the potential side effects of midazolam, including respiratory depression, hypotension, and disinhibition reactions, as reported in 1. Overall, midazolam can be a safe and effective option for procedural sedation, anesthesia induction, and management of status epilepticus when administered intravenously, as long as proper precautions and monitoring are in place, as recommended by the most recent and highest quality study 1.

From the FDA Drug Label

Midazolam Injection is indicated: intramuscularly or intravenously for preoperative sedation/anxiolysis/amnesia; intravenously as an agent for sedation/anxiolysis/amnesia prior to or during diagnostic, therapeutic or endoscopic procedures, such as bronchoscopy, gastroscopy, cystoscopy, coronary angiography, cardiac catheterization, oncology procedures, radiologic procedures, suture of lacerations and other procedures either alone or in combination with other CNS depressants; intravenously for induction of general anesthesia, before administration of other anesthetic agents. Midazolam should only be administered intramuscularly or intravenously.

Yes, midazolam can be given intravenously, as indicated for various procedures and conditions, including preoperative sedation, diagnostic procedures, and induction of general anesthesia 2.

From the Research

Administration of Midazolam

• Midazolam can be administered intravenously, as stated in the study 3, where it is used for anesthesia induction, and in the study 4, which discusses its pharmacology and uses.
• The study 3 mentions that for anesthesia induction, midazolam should be used together with barbiturate or propofol to take advantage of synergistic effects.
• The study 4 highlights that midazolam is preferable to diazepam in many clinical situations because of its rapid, nonpainful induction and lack of venous irritation.
• Midazolam can also be used intravenously for sedation in local anesthesia, as mentioned in the study 3, where it is used in a dose of 0.05 mg.kg-1 during spinal or epidural anesthesia.

Dosage and Precautions

• The dosage of midazolam varies depending on the patient's age and medical condition, as stated in the study 3, where it is recommended to use a dose of 0.04 mg.kg-1 to 0.08 mg.kg-1 as a premedication.
• The study 3 also mentions that in aged, hepatic damaged, or renal damaged patients, the effects of midazolam are slightly increased, and therefore, lower doses may be required in such patients.
• The study 5 used midazolam in a dose of 2.5-15 mg to rapidly terminate seizures in patients suffering from seizures or status epilepticus.

Comparison with Other Agents

• The study 6 compares the efficacy and safety of propofol and midazolam in patients with acute respiratory distress syndrome requiring neuromuscular blocking agents, and found that propofol may be an effective and safe alternative to midazolam.
• The study 4 compares midazolam with thiopental, and mentions that midazolam is not as rapid acting nor predictable in hypnotic effect, but has advantages over thiopental due to its more versatile pharmacologic properties.