Versed (midazolam) dosing, indications, interactions, adverse effects, a...

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http://reference.medscape.com/drug/versed-midazolam-342907

midazolam (Rx)Brand and Other Names:Versed

Classes: Antianxiety Agents;
Anxiolytics, Benzodiazepines

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

Preoperative Sedation/Anxiolysis With Anterograde Amnesia
IM
70-80 mcg/kg (dose range ~5 mg) 30-60 minutes before surgery (reduce 50% for chronically ill or geriatric
patients)
IV
Initial: Usually 0.5-1 mg given over 2 minutes (not to exceed 2.5 mg/dose); wait 2-3 minutes to evaluate
sedative effect after each dose adjustment; total dose >5 mg usually not necessary to reach desired sedation;
use 30% less midazolam if patient premedicated with narcotics or other CNS depressants
Debilitated or chronically ill patients: 1.5 mg IV initially; may repeat with 1 mg/dose IV q2-3 min PRN; not to
exceed cumulative dose of 3.5 mg; peak effect may be delayed in elderly, so increments should be smaller
and rate of injection slower
Maintenance: 25% of initial effective dose PRN by slow titration; reduce 30% if premedicated with opiate
(50% in elderly/chronically ill)

Anesthesia
Induction
<55 years without premedication: 300-350 mcg/kg IV injection over 20-30 seconds; wait 2-3 minutes to
evaluate sedative effect after each dose adjustment; may use increments of 25% of initial dose PRN to
complete induction; may use up to 0.6 mg/kg total dose in resistant cases, but such dosing may prolong
recovery
>55 years without premedication and with no systemic disease, in a patient who is not weak: 300 mcg/kg over
20-30 seconds initially; wait 2-3 minutes to evaluate sedative effect after each dose adjustment
>55 years without premedication but presence of systemic disease or weak patient: 200-250 mcg/kg over
20-30 seconds usually enough; 0.15 mg/kg enough in some cases; wait 2-3 minutes to evaluate sedative
effect after each dose adjustment
>55 years with premedication: 150-350 mcg/kg IV injection over 20-30 seconds; wait 2-3 minutes to evaluate
sedative effect after each dose adjustment; a dose of 250 mcg/kg usually enough to achieve desired effect
Maintenance
May administer increments of 25% of induction dose PRN when there are signs that anesthetic effects are
lightening

Sedation of Intubated/Ventilated Patients

Load: 10-50 mcg/kg (dose range 0.5-4 mg) slow IV injection or infusion over several minutes; repeat q10-15min
PRN
Maintenance: Initial, 20-100 mcg/kg/hr infusion; titrate up or down 25-50% PRN

Refractory Status Epilepticus (Off-label)

150-300 mcg/kg IV; may repeat q10-15min PRN
Alternatively, 0.2 mg/kg bolus followed by continuous infusion of 50-600 mcg/kg/hr

Seizure Clusters (Orphan)

Rescue treatment of seizures in patients on stable AED regimens who require control of intermittent bouts of
increased seizure activity (eg, acute repetitive seizures, seizure clusters)
Administered by intranasal route
Orphan indication sponsors
Upsher-Smith Laboratories, Inc. 6701 Evenstad Drive Maple Grove, MN 55369-6026
Schwarz Biosciences, Inc. 8010 Arco Corporate Drive Raleigh, NC 27617

Dosing Considerations
Because it is water soluble, takes approximately 3 times longer than diazepam to peak EEG effects; thus, clinician
must wait 2-3 minutes to fully evaluate sedative effects before initiating procedure or repeating dose
Has twice the affinity for benzodiazepine receptors that diazepam has
May be administered IM if unable to obtain vascular access
Anesthesia: Typical adult induction and maintenance doses may need to be decreased in some elderly patients by
20-50%, because the elderly overall are more susceptible to CNS depressants than is the general population

10/12/2015 23:37

Versed (midazolam) dosing, indications, interactions, adverse effects, a...

2 of 2

http://reference.medscape.com/drug/versed-midazolam-342907

Geriatric Dosing
Preoperative sedation/anxiolysis with anterograde amnesia
IM: 1-3 mg (~35-40 mcg/kg) 30-60 minutes before surgery; some elderly patients may respond to as little as 1
mg; onset is 15 minutes (peaking at 30-60 min)
IV (>60 years): 1.5 mg initially; may repeat with 1 mg/dose q2-3min PRN; not to exceed cumulative dose of
3.5 mg; peak effect may be delayed in elderly, so increments should be smaller and rate of injection slower
IV maintenance: 10-15% of initial effective dose PRN by slow titration
Dosing considerations
Anesthesia: Typical adult induction and maintenance doses may need to be decreased in some elderly
patients by 20-50%, because the elderly overall are more susceptible to CNS depressants than is the general
population

Dosage Forms & Strengths

Sedation
500-750 mcg/kg PO once diluted by juice 20-30 minutes prior to procedure; not to exceed 20 mg
100-150 mcg/kg IM; up to 500 mcg/kg used; not to exceed 10 mg
IV
<6 months: Initial, 50 mcg/kg IV over 2-3 minutes; titrate with small increments to clinical effect; monitor
closely
6 months-6 years: Initial, 50-100 mcg/kg IV over 2-3 minutes; repeat q2-3min PRN; may require up to 600
mcg/kg total dose; not to exceed 6 mg total dose
6-12 years: Initial, 25-50 mcg/kg IV over 2-3 minutes; repeat q2-3min PRN; may require up to 400 mcg/kg;
not to exceed 10 mg total dose

Anesthesia (Non-neonatal)
Loading dose: 50-150 mcg/kg IV over 2-3 minutes PRN to achieve desired effect
Continuous infusion: 1-2 mcg/kg/min IV infusion

Anesthesia (Neonatal)
IV loading dose should not be used in neonates
Continuous infusion: 0.5 mcg/kg/min IV infusion

10/12/2015 23:37