midazolam
Indication
- Treatment of refractory seizures after other therapies such as PHENobarbital, levETIRAcetam or phenytoin have failed
- Sedation
Dosage Guidelines
Seizures: 0.15 mg/kg IV direct followed by 2 micrograms/kg/minute IV continuous infusion. If seizures continue, give 0.15 mg/kg bolus and increase infusion rate by 2 microgram/kg/min q5 minutes as needed to a maximum of 24 microgram/kg/min.
If no seizures for 48 hours, taper by 1 microgram/kg/min q15 minutes. If seizure recurs during taper, give 0.15 mg/kg IV direct and resume prior infusion rate for 48 hours
Sedation:
- Loading dose: 0.05-0.1 mg/kg/dose IV direct over 5 minutes
- Maintenace dose: 0.16-1 microgram/kg/min IV via continuous infusion
- Procedural sedation: 0.05-1 mg/kg/dose IV direct/IM or 0.1-0.2 mg/kg/dose intranasal (administer approximately half total volume in each nostril)
Administration
- IM
- IV direct over 5 minutes
- Intranasal
- IV continuous infusion
- For patients 2 kg or less:
Use midazolam 0.2 mg/mL
To make 50 mL of midazolam [0.2 mg/mL] [10 mg/50mL]:
Add 10 mL (10 mg) of midazolam [1 mg/mL] to 40 mL of solution
- For patients over 2 kg to 4 kg:
Use midazolam 0.6 mg/mL
To make 50 mL of midazolam [0.6 mg/mL] [30 mg/50mL]:
Add 30 mL (30 mg) of midazolam [1 mg/mL] to 20 mL of solution
- For patients over 4 kg to 10 kg:
Use midazolam 1 mg/mL
To make 50 mL of midazolam [1 mg/mL] [50 mg/50mL]:
50 mL (50 mg) of midazolam [1 mg/mL] (straight drug)
Adverse Effects
- Hypotension, bradycardia, respiratory depression, oxygen desaturation, apnea
- Rhythmic myoclonic jerk
Comments
- Use with caution in preterm infants
- Doses should be tapered gradually with prolonged use. Benzodiazepine withdrawal may occur with abrupt discontinuation.
- Monitor blood pressure, ECG
Remember that midazolam provides sedation, NOT analgesia.
Supplied As
- 1 mg/mL (2 mL and 5 mL vials)
- Supplied by Pharmacy as standard concentrations:
- 2 kg or less: 0.2 mg/mL, supplied as 10 mg in 50 mL solution
- Over 2 kg to 4 kg: 0.6 mg/mL, supplied as 30 mg in 50 mL solution
- Over 4 kg to 10 kg: 1 mg/mL, supplied as 50 mg/mL (straight drug)
- At LHSC, standard concentration reference charts are available on the NICU Intranet site
References
LexiComp Sick Kids and LexiComp Pediatric and Neonatal